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Secretive Appeals Process Hides Cases of Nursing Home Abuse

The Centers for Medicare & Medicaid Services (CMS) rates nursing homes across the country on its Care Compare website. However, the New York Times reported in December 2021 that thousands of complaints filed against nursing homes were secretly appealed by facilities — and didn’t affect their ratings despite glaring problems. Learn how you can take action to protect your loved ones.

Thousands of Nursing Home Abuse Cases Hidden Through Appeals

Thanks to an under-the-radar appeals system, elder care facilities throughout the United States are able to maintain high ratings on the CMS Care Compare website despite severe cases of nursing home abuse and neglect.

Notably, the New York Times found that nursing homes are able to appeal citations from investigators through a process that’s hidden from the public. If the appeal is successful, the nursing home retains its high rating even if abuse or neglect occurred.

The New York Times also found that:

  • Inspectors have been encouraged to give guidelines but not act as enforcers when reviewing nursing homes
  • Nearly 3,000 reports of nursing home neglect and abuse didn’t affect ratings of facilities across the country — and weren’t made easily available to the public
  • Nursing homes used the appeals system to delay reports of abuse or neglect for years
  • Sometimes citations weren’t publicly posted even after a nursing home’s appeal failed

All cases of nursing home abuse and neglect deserve to be taken seriously. Further, nursing homes must be held accountable for their actions. Thankfully, our team can help.

Get a free case review if you or a loved one has suffered from nursing home abuse or neglect. You can pursue justice and compensation right now.

What Is the CMS Rating System?

The CMS Care Compare website is a tool that, on paper, can help families make key care choices. It audits nursing homes that are certified through Medicare and Medicaid and rates different aspects of care they provide.

That said, the New York Times reported a wide range of problems with this ratings system in a series of articles in 2021.

The CMS ratings are partly based on inspections from state (and sometimes federal) investigators. Yet the New York Times found that inspectors may not be aggressive enough when giving citations — and even if they are, the appeals process can prevent the issues from affecting the facility’s rating.

The New York Times also noted that the data that funnels the Medicare ratings system is often flawed. Due to this, nursing homes are often less clean or safe than they appear on the site.

The Flaws of the Nursing Home Appeals Process

Nursing facilities can appeal citations from state investigators due to federal regulations. Appealing follows the “informal dispute resolution process” and allows facilities to explain why they believe the citation is incorrect.

Some appeals can take over a year even though the normal appeals process window is 60 days, according to the New York Times. But until the appeal has concluded, the citation in question won’t appear online or affect the nursing home’s CMS rating.

Nursing homes can win or lose the informal dispute process. If they win, the citation is thrown out or reduced. If they lose, they can appeal again to judges working with the Department of Health and Human Services (HHS).

However, citations sometimes don’t appear on the CMS website during the HHS appeals phase despite mandates. Even worse, regulators told the New York Times that some citations never reached the CMS Care Compare site due to glitches in the system.

The Times notes that appeals occur out of the public eye. Nursing home residents and families cannot participate in the process.

“These cases [HHS appeals] play out in courtrooms. But unlike most legal cases, there are no public dockets, where members of the public can look up the status of cases, the next court date or the latest legal filings.”

— The New York Times

Impact of a Flawed Nursing Home Appeals System

Because the current appeals process makes it very easy for nursing homes to sweep incidents under the rug, facilities with high ratings can afford to let dangerous issues go unresolved.

  • In Texas, a wheelchair-bound woman with dementia was found lying face-down in a pool of blood due to a lack of staff supervision. The facility lost the appeals process after a lengthy four-year battle but no citation is listed online, according to the Times.
  • An Indiana nursing home was cited after allegedly failing to isolate nursing home residents who might’ve had COVID-19. There are no public deficiencies on the CMS Care Compare site for this facility, though the citation is being appealed and thus needs to be listed.
  • A West Virginia resident suffered a serious nursing home fall that took his life after staff failed to keep guard rails on his bed. The incident was never made public before the New York Times report in December 2021 — even though the nursing home was cited and its appeal was denied.

Since all of these facilities basically went unpunished, the nursing home residents and families who suffered got no justice. Worse, other families may have been deceived into thinking these facilities were safe since their CMS Care Compare ratings remained high.

How to Choose a Safe Nursing Home for Your Loved Ones

Choosing a safe assisted living facility is very important to keep your loved one healthy and happy. While there’s no way to guarantee someone will be safe at all times, there are steps you can take to reduce the risks.

  • Don’t just rely on CMS: As noted, a nursing home’s rating on the CMS Care Compare website may not really indicate the quality of care. When looking at nursing homes, see if there are other reviews or ratings for a facility that you’re considering. These can give you a better idea about the quality of care a facility provides.
  • Talk to current residents and their families: Speaking with people who already live in the nursing home you’re looking at can give you a more realistic perspective. Family members of other residents can also give their insights about the level of care the staff provides.
  • Regularly check in with your loved one: If possible, try to visit loved ones who live in nursing homes often. Make sure to closely monitor the overall care they’re receiving and note any possible signs of nursing home abuse or neglect.

Help for Residents and Families Affected by Nursing Home Abuse

The issues with the nursing home appeals process and the CMS Care Compare website underscore the fact that nursing home abuse can still occur even if a facility seems safe.

Thankfully, there are ways you can take action to reduce the risks of nursing home abuse or neglect.

If you think a problem is happening in a nursing home:

Remember: nobody deserves to suffer from elder abuse or neglect. Even if a nursing home has a great rating on the CMS Care Compare website, older people can still get hurt. Thankfully, you can hold nursing homes accountable with legal help. Get started today with a free case review.

Author:Nursing Home Abuse Justice Team
Nursing Home Abuse Justice Team

Nursing Home Abuse Justice was founded to shine a light on nursing home and elder abuse. Every day, thousands of people in nursing homes and assisted living facilities are abused. Our team helps educate seniors and their loved ones on the common causes, signs and preventions of nursing home abuse. We report on real-world studies and current events from respected news outlets to expose this national problem.

Last modified: January 20, 2022

View 2 References
  1. Centers for Medicare & Medicaid Services. (n.d.). More information about health care providers. Retrieved January 11, 2022, from https://www.medicare.gov/care-compare/resources/information-about-provider-types

  2. Gebeloff, R., Thomas, K., & Silver-Greenberg, J. (2021, December 09). How nursing homes’ worst offenses are hidden from the public. Retrieved January 11, 2022, from https://www.nytimes.com/2021/12/09/business/nursing-home-abuse-inspection.html