On November 30, 2015, the Government Accountability Office (GAO) released a report on nursing home quality.  The Report examines (1) the extent to which reported nursing home quality has changed in recent years and the factors that may have affected any observed changes, and (2) how CMS oversight activities have changed.  The GAO found that, while consumer complaints suggest that consumers’ concerns over quality have increased, data on deficiencies, staffing levels, and clinical quality measures indicate potential improvement in nursing home quality.  According to the GAO, issues with reliability and consistency of the various data sources make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both. 

The Report found that recent trends in the four key data sets analyzed showed mixed results on the quality trends of nursing homes, and data issues complicated the ability to assess quality trends.  Four key sets of quality data were analyzed in the Report—(1) deficiencies cited during standard on-site nursing home surveys, (2) consumer complaints, (3) staffing levels, and (4) a subset of clinical quality measures.  Consumer complaints suggest that consumers’ concerns over quality have increased, but the other three data sets analyzed (deficiencies, staffing levels, and clinical quality measures) indicate potential improvement in nursing home quality.  The GAO noted that CMS made several modifications to its nursing home oversight activities, but has not monitored the potential effect of these modifications on nursing home quality oversight. 

Given the findings, the GAO recommended that CMS:

  • Establish specific timeframes and milestones for developing and implementing a standardized methodology for state surveys of nursing home deficiencies; and
  • Implement a clear plan for ongoing auditing of self-reported nursing home quality data, including payroll-based staffing data and data used to calculate clinical quality measures.

The GAO also recommended that CMS establish a process for monitoring changes in oversight activities to better assess their effects. 

A copy of the Report is available here