NURSING HOMES:
Nursing Homes Receive Poor Marks For Quality And Safety
Published on Fri Jan 13, 2006
Weak oversight, recurring understatements and poor compliance continue to plague nursing homes.
Nursing home oversight standards have increased, but not enough to eradicate many important quality and safety issues.
A recent report from the Government Accountability Office outlines several critical flaws in nursing home standards and care that have been recurring since 1998. Senate Finance Committee Chairman Sen. Charles E. Grassley (R-IA) and Sen. Herb Kohl (D-WI), Special Committee on Aging ranking member, requested the report.
Nursing homes fail to meet the grade in five key areas related to annual Centers for Medicare & Medicaid Services' state agency surveys and investigations, the GAO finds:
• A "small but unacceptable portion" of nursing homes repeatedly harm their residents. Such harm includes worsening pressure sores, failure to treat avoidable weight loss and putting residents at risk of death or serious injury. Many states cited confusion about the definition of "actual harm" in response to the report, notes the GAO.
• State inspections (surveys) frequently understate serious quality-of-care problems and fire safety issues. These recurring understatements reflect weaknesses in survey methodology and an inconsistent application of federal standards, the GAO suggests.
• Many states repeatedly fail to report allegations and investigate residents' and family members' serious complaints for weeks or even months, the report charges. Such delays not only hinder investigations but also compromise the quality of available evidence, says the GAO.
• Federal and state enforcement policies fail to ensure that homes adequately address and correct deficiencies that surveyors identify successfully.
• Federal mechanisms that oversee state monitoring of nursing home quality and safety have limited scope and effectiveness. CMS oversees homes' compliance with federal nursing home standards and has set many improvement and evaluation initiatives into motion since 1998, when the GAO previously reported quality and safety weaknesses among nursing homes. The GAO evaluates the progress CMS has made since 1998 in addressing those quality and safety weaknesses in the report. The new report reviews trends in nursing home survey results, evaluates the success of CMS' improvement initiatives, and identifies challenges that threaten continuing progress in ensuring residents' quality and safety. Declining Trends And Oversight Failures Aren't The Only Challenges Serious surveyor oversights continue to undercut CMS' efforts to improve nursing home quality and safety. Trends from 1999 through January 2005 show that the number of nursing homes with serious quality problems has declined from roughly 29 percent to 16 percent. But inconsistencies in the way states conduct surveys, coupled with understated quality problems, undermine this success--as well as CMS' improvement initiatives, the report points out.
For example, the proportion of nursing homes with serious deficiencies varies widely--as much as 6 percent to 54 percent--from state to state. In addition, discrepancies between federal and state surveys of the same [...]
