Inspections and Illusions: How Some Nursing Homes Game the System

In this episode, Yiqun Chen and Marcus Dillender join us to discuss their revealing study on how nursing homes respond to government inspections. They explain how facilities often make short-term changes—like boosting staff and discharging patients—just to look better during inspections, only to revert immediately afterward. Despite this gaming, inspection ratings still offer meaningful insights into resident outcomes. The conversation covers why some citations lead to real improvements while others don’t; how inspection ratings relate to mortality risk; and what policymakers can do to make oversight more effective and less predictable. This episode offers a candid look at the strengths and blind spots of government monitoring, and what it means for the future of elder care. Guests: Yiqun Chen & Marcus Dillender, economists and authors of the National Bureau of Economic Research (NBER) paper “Government Monitoring of Health Care Quality: Evidence from the Nursing Home Sector”