Long-Term Care Is Not Happy with the Abuse Icon on Nursing Home Compare

April 1, 2021
April 1, 2021

The long-term care industry is struggling to deal with a variety of issues. Some such as preventing falls and ensuring emergency preparedness have been concerns for these facilities for quite some time; others such as new regulatory oversight and handling the COVID-19 pandemic are new to the mix. The result is that industry leaders are faced with a multitude of new challenges to manage simultaneously. Needless to say, grappling with the pandemic by itself would be more than all-consuming. When we overlay all of these other elements on top of COVID-19, we find many in this industry overwhelmed by the scope and variety of the issues at hand. This article is Part 2 of our attempt to look more closely at some of the serious concerns of organizations across the continuum of care.

The Abuse Icon on the Nursing Home Compare Website is Problematic for Many Long-Term Care Organizations

In October 2019, Medicare announced a new feature that was being added to the website Nursing Home Compare (https://www.medicare.gov/nursinghomecompare/search.html) that would allow anyone investigating a nursing home to tell if the facility has been cited for issues related to nursing home abuse or neglect. From the time of a citation, a red stop alert will appear “if a facility has been cited for nursing home abuse that led to harm within the last year, or potential harm of a resident within the last two years” (CMS, 2019), based on monthly nursing home inspection reports.

According to an editorial article in McKnight’s Long-Term Care News, the open-palmed stop icon in a red circle was launched quickly, and “the provider community complained loudly about both the propriety and the mixed message of the icon itself” (Berklan, 2019). The same article adds that “There is also a prominent explanation on the Nursing Home Compare website search page, which does a credible job of explaining what consumers should do if they’re interested in a facility that bears this icon” (Berklan, 2019). Predictions at the time of launch were that approximately 5% of the nation’s nursing facilities would receive the abuse warning, with data affected by “significant regional variations that could have an impact on valuations and bottom lines moving forward” (Spanko, 2019). The same article cautions that we need to remain aware that the “vast differences in abuse citations, and the resulting distribution of warning icons, highlights the inherent flaws in the current survey process” (Spanko, 2019).

A proposal to improve this warning system suggests “the Centers for Medicare & Medicaid Services (CMS) utilize a more cautionary symbol as the icon and not the ‘red stop sign’ portrayed by the agency. One area of concern is the potential decreased “access to care if residents avoid a particular SNF not experiencing ‘current significant problems’ but which also continues to have an icon suggesting consumers avoid the facility“ (Connole, 2019). The symbol appears to tell people to stop rather than the intended message for consumers to learn more. The goal of this new alert is to prevent abuse and neglect of residents who are often victims. It may go too far, however, and its application may well discourage care for people who need it badly.


Berklan, J., “The ‘abuse’ icon debuts on Nursing Home Compare,” McKnight’s Long-Term Care News: October 23, 2019, Retrieved at https://www.mcknights.com/daily-editors-notes/the-abuse-icon-debuts-on-nursing-home-compare/.
CMS, “New feature helps you compare nursing home safety,” Medicare.gov: October 23, 2019, Retrieved at https://www. medicare.gov/blog/nursing-home-abuse.
Connole, P., “AHCA Urges CMS to Change Planned Consumer Alert Icon on Nursing Home Compare,” Provider: 10/11/2019, Retrieved at http://www.providermagazine.com/news/Pages/2019/1019/AHCA-Urges-CMS-to-Change-Planned-Consumer- Alert-Icon-on-Nursing-Home-Compare-.aspx.
Spanko, A., “Less Than 5% of Nursing Homes Receive Abuse Icon — But Financial Impacts Could Be Coming,” Skilled Nursing News: October 24, 2019, Retrieved at https://skillednursingnews.com/2019/10/less-than-5-of-nursing-homes-receive-warning-icon-but-financial-impacts-could-be-coming/.


This blog post continues a series based on our article, Top Issues Across the Care Continuum - Part Two, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. An earlier blog post series was based on our article Top Issues Across the Care Continuum – Part One. Subsequent challenges to be examined during this blog post series include:

  • Falls with Injury Are a Serious Concern for Long- Term Care Facilities and the People Who Reside in Them.
  • Emergency Preparedness, While Necessary, Is a Burden for Long-Term Care Facilities.
  • Nursing Homes Struggle with the Demands of Required Compliance Surveys and Regulatory Oversight.
  • Long-Term Care Faces Even More Requirements with QAPI Phase 2 and Phase 3 Regulations.
  • Changes Related to COVID-19 Will Impact Surveys and Visitation Policies in the Future

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.

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