Thank you for your article revealing the gross discrepancy between Medicare ratings and actual conditions in America’s nursing homes. It is literally the tip of a very dirty iceberg. Yes, ANY quantitative approach to quality—going back to the revered W. Edwards Deming—can be gamed. Period!
Given time, money and smart people, any law, any prescription, any formula, any code can be broken. And given the REITs consolidating interests and making so much money in this industry, given the lax and sometimes crooked regulators in some if not many states and given how stacked the deck is in favor of the homes in terms of how MUCH information they have and how LITTLE information consumers have, until and unless this issue is fathomed and plumbed by those with the courage and stamina to do so, needless deaths, injuries, and atrocities will continue to be experienced by a consuming elderly public that deserves better!
Please do not let up. Even if information could not be gamed, because of the ridiculous turnover numbers with Administrators/Executive Directors and caregivers in facilities across America (100,200, even 400% or more at too many facilities), what WAS true last year (even if properly measured and graded), all too often bears absolutely NO relationship to what is occurring at the same facilities just a year later. Add in profit motives, too much lousy and often “gamed” state regulation and the information imbalance between homes and consumers and the system is exactly what someone knowledgeable would expect--broken.
We often say that weather forecasters and economists should sometimes get out of the numbers and take a look outside at reality. There is only one company doing that in healthcare, with a focus on long-term care—4OurElders (4ourelders.com), a small non-profit headquartered in AR. Forget IHI, Press Ganey surveys, even the Joint Commission and others doing the best they can in acute care settings. Only when you put knowledgeable experts in the facilities real time, with their eyes, ears, and noses open and not mired in data, with only one purpose of evaluating safety, care and service with NO conflicts of interest (like being paid by the very homes they are recommending) will the system have a chance to become what our seniors and their families need and deserve.