Recently, CMS announced a significant change to the Nursing Home Compare website. They included a consumer alert icon - in the form of a stop sign - next to nursing homes which have been cited during survey for incidents of abuse, neglect, or exploitation. The alert icon will be associated with facilities that have inspection reports that include in CMS's words, "abuse that led to harm of a resident within the past year; and abuse that could have potentially led to harm of a resident in each of the last two years."
This action taken by CMS will ultimately determine which nursing homes patients go to for skilled nursing services.
No one can deny that abuse and neglect occurs in skilled nursing facilities. But, abuse and neglect is the exception not the rule. In addition, no one would argue that CMS has a responsibility to protect older adults from abuse and neglect. However, associating a consumer alert icon - as strong as a stop sign - with facilities that have committed or "could have potentially" cause harm to a resident will have unforeseen consequences that CMS did not consider in its decision.
Why do some believe the abuse icon goes too far?
The leadership from both AHCA and Leading Age National have argued that CMS has not clearly defined abuse and neglect. Katie Smith Sloan, CEO of Leading Age, remarked in an article in McKnights LTC News that the abuse icon "is built on the back of a flawed survey system in which interpretations of regulations are notoriously inconsistent. We need to fix the survey system before we start adding this warning sign." Both AHCA and Leading Age are essentially concerned with the innocent being lumped together with the guilty. If the survey system is flawed, then the placement of the consumer alert icon will likely be as well.
What will be the real impact of the abuse icon?
The meaning of a red stop sign has been ingrained in our minds since childhood. As far back as preschool we learn that green means go, yellow means caution and red means stop. We have been taught to stop at a stop sign. Not investigate things further to see what is around the bend. Not ask questions in order to gain further clarity. And certainly not to disregard the stop sign altogether. Our reaction to a red stop sign is the same as our reaction to a wild animal in the woods. One false move, and we know their will be consequences. This symbol will undoubtedly direct and determine where patients go for skilled nursing services. Is that the purpose of the Nursing Home Compare website? Is that the purpose of the five star system? According to CMS they "created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions." Notice the phrase, "ask questions". People don't ask questions at a stop sign. Certainly, there are some bad apples in every bushel and one could argue that they earned their stop sign. However, there will be many facilities who are innocent of any wrong doing, but because of the flawed survey system and the inability to clearly define "abuse that could have potentially led to the harm of a resident", they will be severely impacted by this simple icon.
Most everyone I talk to in our profession supports the idea of ensuring the consumer has enough information to make an informed decision about which facility to go to. However, I wonder does the addition of the consumer alert icon put CMS in the position of directing patients to facilities versus empowering them to make an informed decision?