Deregulation makes shopping for nursing homes more difficult in Trump era

Finding a safe, high-quality nursing home for a loved one is never an easy task. Complicated decisions often are made at a moment of emotional crisis and reliable guidance can be difficult to come by.

And it is going to get more difficult. The Trump administration is moving quickly to deregulate nursing homes, complying with a wish list submitted by industry lobbying groups. Consumer advocates worry that the changes will lead to deterioration in safety and the quality of care delivered to some of the most vulnerable Americans.

Just before the holidays, news broke that the Trump administration is curtailing the use of penalties against nursing homes that harm their residents or put them at risk of injury.

The story by Kaiser Health News, first reported in the New York Times, is just the latest in a series of rapid-fire moves by the Centers for Medicare & Medicaid Services (CMS) to loosen, delay or strip away regulation of nursing homes.

In November, CMS exempted nursing homes that violate new patient safety rules from financial penalties for 18 months. In June, it proposed to reverse an Obama administration rule prohibiting clauses in residents’ contracts requiring them to use arbitration to settle disputes rather than go to court.

CMS has broad authority to regulate nursing homes that accept patients covered by Medicare and Medicaid – virtually all nursing homes in the United States. Its recent moves will take an industry where enforcement of rules has been weak, and make it weaker still.

Unfortunately, information rating the quality of nursing homes is spotty. A good starting point is Medicare’s system for rating nursing homes for quality of care and staffing levels, called Nursing Home Compare. The system rates nursing homes on a scale of 1 to 5 and is considered the industry authority.

But much of the data that determines ratings is self-reported by nursing homes, and the ratings do not take into account negative information such as fines and enforcement actions by states. And reviews of this system have found numerous cases of facilities attempting to game the system.

Nursing home shoppers also should consult Nursing Home Inspect, an online database created and maintained by ProPublica, the nonprofit investigative news service. The database contains state-by-state breakdowns displaying fines and deficiencies turned up by inspections, and it flags nursing homes with histories of serious quality issues.

Also consider checking on any facility you are considering with your state’s long-term care ombudsman, a program administered by the Administration on Aging. Consumer Voice, an advocacy group, offers a directory of state ombudsmen on its website.

A trusted physician also can be a good resource. Geriatric care managers – human service professionals who help coordinate care for the elderly and their families – also can help navigate the nursing home maze.

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