Nursing home quality star ratings don't match survey results

Quality scores and survey results should correlate, yet sometimes do not. The story below in the 3/14/21 Hospice News Today highlights nursing home inconsistency. It would be interesting to replicate the methodology with hospices. Yes - quality measures and surveys use different tools for different purposes - but generally one would expect to find similar results.

Maggots, Rape and Yet Five Stars—How U.S. Ratings of Nursing Homes Mislead the Public
New York Times, March 13, 2021
Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating—one being the worst, five the best—the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics. The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable. But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken. Despite years of warnings, the system provided a badly distorted picture of the quality of care at the nation’s nursing homes. Many relied on sleight-of-hand maneuvers to improve their ratings and hide shortcomings that contributed to the damage when the pandemic struck. ... To evaluate the ratings’ reliability, The Times built a database to analyze millions of payroll records to determine how much hands-on care nursing homes provide residents, combed through 373,000 reports by state inspectors and examined financial statements submitted to the government by more than 10,000 nursing homes. ... Among The Times’s findings:

• Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are.
• Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported.
• In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.
• Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings. ...

The rating system allowed facilities to score high grades without upgrading the care they provided. “They were working to improve their ratings, but not their quality,” said Charlene Harrington, who sits on a board that advises C.M.S. on the ratings system.