KANSAS CITY, Mo. — It's hard to know where to turn when a loved one needs care in a nursing home. Navigating that process in a pandemic might feel like going in circles.
Families could use a compass to find that care — but can they trust it's pointing them in the right direction?
The Centers for Medicare and Medicaid services (CMS) unveiled a new tool in September that allows the public to easily check how many nursing home residents and staff have received the COVID-19 vaccine.
A KSHB 41 I-Team investigation raised questions about the accuracy of those vaccination rates, and who's accountable.
Having peace of mind
Tracey Hawkins made the difficult decision to move her two elderly aunts, Lola and Cordia Mae, into a Kansas City nursing home in 2020. It was up to her to make sure they received proper care, especially once the COVID-19 virus emerged.
"One had lung cancer and the other had Alzheimer's disease. Both of them needed to be protected," Hawkins said.
But making sure they were protected was a struggle.
"It was a fight every step of the way," Hawkins said. "From the time both my aunts were in a nursing home, there was always a fight."
Hawkins' aunts passed away before the vaccines came out, something she said could have helped in that fight.
They also died before CMS started posting COVID-19 vaccination rates on the Medicare.gov website.
For the past five months, CMS has made this information readily available. By using the Nursing Home Compare tool, people can search for a nursing home by zip code or city, browse through the homes in any area, and pull up the vaccination rates for staff and residents. There, one can compare the rates to the state average.
The KSHB 41 I-Team tracked the vaccination rates for staff and residents from a sampling of 160 nursing homes in Missouri and Kansas for six weeks, starting in late October.
But, in the middle of tracking these numbers, our investigation took a turn when we asked CMS who verifies the data. CMS relies on the nursing homes to self-report. We discovered CMS does not verify the data and a spokesperson told us it's "generally accurate".
"Unacceptable," Hawkins said.
Hawkins was shocked to hear our findings.
"How can anyone with a loved one in a nursing home or care facility have peace of mind?" she said. "It's inexcusable. It cannot be allowed, and I don't know why it's okay."
Advocates not surprised
We also shared our findings with Mitzi McFatrich with Kansas Advocates for Better Care, a non-profit that advocates for long-term care residents.
"Vulnerable older adults who basically are captive in a building are at tremendous risk," McFatrich said.
She said she's not surprised the data is "generally accurate" and that CMS doesn't verify it, referring to a 2015 U.S. Government Accountability Office report that found CMS didn't regularly audit quality data, including nurse staffing.
McFatrich said for years, CMS relied on facilities to self-report its staffing data, which is a key indicator of quality care. Audits found that the self-reported data was not accurate, leading to a payroll-based staffing data requirement in 2018.
"Why wouldn't we be doing the same thing about any of the quality measures and about COVID vaccination rates?" McFatrich said.
So, is it possible to verify vaccination data?
"Of course it is," McFatrich said.
She said to look no further than background checks.
Kansas and Missouri require people who work at nursing homes to have a criminal background check and a check to see if they're on any abuse registry. This is a federal and state background check.
"That's been in place for a number of years. Validating whether or not somebody has a vaccination should be a fairly simple thing," McFatrich said.
The I-Team is not suggesting that any nursing home or facility is falsifying the data they report, but McFatrich worries the opportunity is there.
"There are some things about self-reported data that KABC and other consumer advocates have, for years, challenged CMS about," McFatrich said. "When you have self-reported data that is not audited by the government, either federal or state or not validated during the survey inspection process, what you do is leave a giant door open for facilities that want to game the system."
CMS can fine nursing homes for not complying with infection control policies and failing to report COVID-19 data. Nursing homes can appeal. If the facilities don't pay, CMS reduces future Medicare payments to the facilities until the full amount of the fine is paid.
In 2021, CMS issued the following fines to Kansas and Missouri for failure to report vaccination rates:
- Kansas: $593,106.43
- Missouri:$1,099,548.24
As of December 2021, CMS collected about 25% of the fines from Kansas and about 38% of the fines from Missouri.
Who to trust?
"It's so hard to right now to know who to trust — if to trust," Linda MowBray, president of the Kansas Health Care Association/Kansas Center for Assisted Living, said.
KHCA and KCAL represent more than 250 long-term care providers.
MowBray agreed the data is generally accurate and said it reflects the industry's current state of distress.
"Not only are we just hemorrhaging for help, we have had staff turnovers in very key positions," MowBray said. "There is a possibility of a lag time before someone else is up to speed and can get the data entered."
If someone leaves their position, it takes time to get a new staffer up and running. Data can get stuck in CMS's system as well, she said.
MowBray said nursing homes are depending on temporary employment agencies more and more, which have "been a lifeline but come at extreme cost."
Reputable temp agencies will do training, background checks and check employee vaccination records and are willing to turn that over to the nursing home.
MowBray said that unfortunately, not everyone is a reputable player.
"Homes that did use staffing agencies but had one or two they worked with are having to contract with six to 15 different staffing agencies to try to fill the gaps," MowBray said. "Within that, there is a wide variance."
This is compounded with the fact that state surveyors have not completed yearly inspections in two years due to the pandemic.
It could be months before inspectors can verify employee records and vaccination data.
MowBray said the data is as accurate as it can be for any given point in time.
"I don't know if we'll ever get to the point where we can say any data source is a 100% accurate. There's human error, technical glitches," MowBray said.
MowBray advised consumers not to assume the worst, but to call the facility and find out more.
"Having a clear and fair picture of what's going on in our homes not only should bring consumer confidence but should also help validate that our providers are good providers," MowBray said.
CMS's website does not have a disclaimer that says the vaccination data is "generally accurate" and unverified. After the I-Team started asking questions, CMS added a line to its website suggesting that consumers can ask a nursing home about any recent COVID-19 information, any recent outbreaks and what percentage of residents and staff have received a booster shot.
Hawkins hopes the CMS vaccination data will have added accountability, so families can feel good navigating through their decisions.
"It's lifesaving information," Hawkins said. "If that information is not accurate and the family members don't have the details, their loved ones are being put in danger."
Local lawmakers response
The KSHB 41 I-Team reached out to Kansas Senators Jerry Moran and Dr. Roger Marshall, as they serve on the health committee that has oversees CMS, to find out if they were aware of "generally accurate" data.
Moran’s office sent a statement about his opposition to the vaccine mandate, though he's vaccinated and encourages other Kansans to do so.
"The CMS vaccination mandate will exacerbate staffing shortages and burnout in the medical field. This threatens Americans’ access to care due to staff resignations and increases the risk of health care facility closures, especially in rural communities," the statement read.
Marshall’s office said that all COVID-19 vaccination data is self-reported, and when surveyors start reviewing records during inspections, “this information will add a greater level of accuracy.”
Hawkins has a message for lawmakers and CMS:
"If you had a loved one in a care facility or nursing home, would it be okay if the data is not up-to-date? Not just any data, but lifesaving data. Would that be okay with you?"
CMS declined the KSHB I-Team's request for an on-camera interview.
Experts say it's up to the family to get involved
Families have several options to give them peace of mind with their loved one in a nursing home:
- Visit the nursing home in person. Make sure the staff knows your name and you know theirs.
- Talk to the people who live there, and their families. They will tell you what's going on.
- Ask to see inspection reports, staffing reports and vaccination reports. Find out who enforces these protocols.
- Look at survey inspection reports to see how compliant the facility has been over the last three inspection cycles.
- Call Kansas Advocates for Better Care for resources. In Missouri, you can call VOYCE.
- Call your local long-term care ombudsman office. They are the federally and state authorized advocate for nursing home residents.
- Contact your lawmakers and tell them you want the vaccination data audited and current.
- Call your area agency on aging center.
- Your local Alzheimer’s Association may be able to point you to facilities they've worked with and approve.
The Inspector General's office will release an audit later this year about the accuracy of staffing levels, health, and quality care measures on CMS's Nursing Home Compare website.
In the meantime, a vaccine mandate for CMS healthcare workers in Kansas and Missouri just went into effect. These workers were required to have at least one dose of the vaccine by Feb. 14 and to be fully vaccinated by March 15.
Facilities must implement policies and procedures to get 100% of its workers fully vaccinated, except those with valid exemptions. They must also document and track the information properly.
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We want to hear from you on what resources Kansas City families might benefit from to help us all through the pandemic. If you have five minutes, feel free to fill out this survey to help guide our coverage: KSHB COVID Survey.
