In November 2014, The Center for Public Integrity published a three-part series on nursing home staffing, HUD financing of substandard nursing homes and inferior care provided to minorities.

Part 1 of the series reveals that the staffing information available to the public on CMS’s Nursing Home Compare is widely inflated and misleading. Comparing 2012 staffing data from Medicare cost reports to the staffing data reported on Nursing Home Compare, the Center found that over 80 percent of nursing homes reported higher levels of registered nurse (RN) care to Nursing Home Compare than were reflected in their cost reports. In more than 25 percent of nursing homes nationwide, the amount of RN staffing reported on Nursing Home Compare was at least double the level in the cost reports.

There were also widespread discrepancies for total hours of nursing care provided to residents.

The Center’s report explains that these discrepancies may be caused by nursing homes staffing up before surveys, resulting in misleading staffing data being collected during surveys that is presented on Nursing Home Compare and used in CMS’s Five Star rating system.

More reliable staffing data may be on the horizon. On October 7, 2014, President Obama signed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, which includes $11 million to fund a system for collecting data on nursing home staffing levels through verifiable payroll data. Under the Affordable Care Act, CMS was to have established and implemented such a system by March 2012. With the funding from the IMPACT Act, CMS now says the electronic payroll data system will be in place by 2016. Whether the data it collects will be clear, complete and reliable remains to be seen.

Part 2 of the series examines HUD financing of lowly rated nursing homes. The Center reports that HUD gave mortgage guarantees to hundreds of poorly rated nursing homes since 2009. According to its report, the number and volume of one-star facilities that got HUD insurance rose each year from 2009 to 2012 despite two decades of critical reports on this practice from the GAO and HUD’s Office of the Inspector General. 

Since 2009, 240 nursing homes in 38 states and Washington, D.C. reportedly received HUD-backed mortgages worth nearly $2 billion the month after receiving a one-star rating from CMS. 

California had the third highest number of such facilities. The Center’s analysis listed the following 19 facilities: Apple Valley Christian Care Center, West Hills Health & Rehab Center, Capistrano Beach Care Center, Valley Healthcare Center, Mirada Hills Rehab and Convalescent Hospital, Country Villa Laguna Hills, Lake Forest Nursing Center, Antelope Valley Care Center, Antelope Valley Health Care, Windsor Gardens Convalescent Center of Long Beach, Vernon Convalescent Hospital, Monterey Care Center of Monterey, Valley Palms Care Center, Mission De La Casa, Carehouse Healthcare Center, Hampton Care Center, Foothill Health and Rehabilitation, Windsor Vallejo Care Center, and Country Villa Nursing West.

Part 3 of the series reports that nursing homes serving minorities offer less care than those housing whites. The Center found that majority-white nursing homes – where a majority of residents were Non-Latino whites – had average registered nurse care levels 60 percent higher than Latino-majority homes and 34 percent higher than facilities where a majority of residents were African-American.