A recent New York Times investigation of the nation’s popular five-star nursing home rating system found that the system is “broken,” offering at best a “distorted” picture of nursing home quality.

Meticulous research revealed that nursing homes routinely game the star system in order to boost their ratings and hide their deficiencies. Nursing homes submit incorrect information that makes them look better, such as artificially increasing staff hours by including vacationers and underreporting patients with severe bed sores or taking controversial medications.

Nearly 70% of five-star nursing homes were cited for problems with patient abuse or infection control. Residents at five-star nursing homes were nearly as likely to die from COVID-19 as residents of one-star nursing homes. Quality levels at five-star nursing homes don’t necessarily hold up to on-site inspections, with such highly rated homes about as likely to “ace” as to “flunk” when assessed in real time.

Times staffers analyzed three types of publicly available data from more than 10,000 nursing homes: hands-on care hours derived from payroll records, state inspection reports, and financial statements submitted to the government. Additional data came from researchers who have agreements with the Centers for Medicare & Medicaid Services, which runs the Five-Star Quality Rating System and Nursing Home Compare website.

The five-star rating system was started in 2008 and hailed as a consumer-friendly improvement over the previous ratings system that was heavy on statistics and much more inaccessible. The current system bases ratings on three core areas: recent health inspections and investigations, staffing hours relative to intensity of patient needs, and a 15-point quality measure of patient physical and clinical care.

Trouble spots include relying on self-reported data rarely audited by the government and the likelihood, suggested by the data, that at least some nursing homes are aware of upcoming inspections that are supposed to be a surprise.

The program is intended “to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions” according to the CMS website.

Nursing home ratings have become especially important during the pandemic as social distancing requirements often prevent in-person nursing home selection visits.