Nursing homes aren’t reporting residents’ serious falls, inspector general says

Nursing homes didn’t report 43% of serious falls suffered by their residents to a federal agency, according to an inspector general’s report that said the homes may be cooking their numbers to try to win business.

Men, younger residents and those with government-sponsored health care were least likely to have their serious falls reported.

Large, for-profit and chain nursing homes were the worst at reporting, the Health and Human Services Department’s inspector general said.

Investigators looked at falls where there was an injury or hospitalization for a Medicare-enrolled resident. Medicare requires those incidents to be reported. It found that during a one-year period, there were 42,236 falls that should have been reported, but 18,369 of them weren’t.

The audit called that “poor overall compliance.”

Homes are supposed to report fall data for Care Compare, a Medicare website that allows people to look for the best experience. But the bad reporting data suggests that the tool is not able to capture the reality for many homes.

“Nursing homes with the lowest fall rates on Care Compare were the least likely to report the falls we examined. This suggests that low fall rates for nursing homes on Care Compare are likely driven by nursing homes’ failure to report falls, rather than an actual low incidence of falls,” the inspector general said.

Residents who only had Medicare coverage and lacked supplemental health insurance were less likely to have their falls reported. So were short-stay residents.

Investigators said they came across one large nursing home, with more than 200 beds, that had 13 falls with major injuries requiring hospitalization during the study period. It only reported three of them.

That home, which had a 5-star rating, claimed a 1.3% fall rate on Care Compare, which was lower than the national average of 3.4%.

The inspector general had urged the Centers for Medicare and Medicaid Services to try to fund supplemental data beyond self-reporting, but said that could take years. In the meantime, the inspector general urged CMS to provide better training for employees and use data analysis to spot homes that aren’t reporting what they should.

CMS agreed with the recommendations.

In 2023, the inspector general reported that home-health agencies failed to report more than half of falls with major injury and hospitalization among Medicare patients.