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 How
tough are nursing home inspectors?
By Kathleen Murphy,
Stateline.org Staff Writer
A third of U.S. nursing homes have food sanitation problems, and
nursing homes in California, Nevada, Delaware, West Virginia and
Hawaii scored more bad marks on state inspections than in other
states in 2004.
The most serious problems failures that cause actual harm to
residents were reported in Connecticut, Idaho, Kansas, South
Carolina and Washington.
These are the latest findings based on the U.S. government's system
for checking up on nursing homes. But experts say its still hard to
know whether trends seen in the federal database of state inspection
reports are changes in the quality of care or differences in how
states inspect.
For example, the number of U.S. facilities cited for infractions
that could put residents in harm's way declined sharply, from 30
percent in 1998 to 15.5 percent in 2004, according to an August
report by Charlene Harrington, a University of California San
Francisco researcher and a national expert on nursing home
deficiencies. While the numbers might suggest that the quality of
care has improved, Harrington concludes instead that states are
becoming less likely to cite homes for serious deficiencies. She
points to increases in the number of residents with pressure sores
or who are bedridden.
"There is some evidence that some state agencies may be downgrading
the severity ratings for deficiencies," Harrington's report said.
Thirty states saw severity ratings for deficiencies decline in 2004
from the previous year, the report said, even as more total
deficiencies were found in 2004 in all states except Mississippi,
Oregon and Wyoming.
The average number of violations per facility increased from 5.2 in
1998 to 9.2 in 2004, indicating compliance with federal regulations
is deteriorating, Harrington said. The report found that the
District of Columbia ranked No. 1 in the average number of nursing
home deficiencies, and that Wisconsin had the lowest percentage of
violations.
Evvie Munley, senior health policy analyst for the American
Association of Homes and Services to the Aging, a group of
not-for-profit nursing homes, said there's widespread agreement that
inconsistency tarnishes the inspection process and that improvements
are needed.
"The survey process is one tool. How do we know there is quality for
people looking for a nursing home? You have to go visit," Munley
said.
Congress authorized the first set of nursing home regulations in
1967, and nursing homes that use Medicaid and Medicare must follow
the guidelines or lose funding. State inspectors check nursing homes
on behalf of federal regulators annually, making observations about
how residents behave, whether they have bruises or scrapes and
whether the facility smells of ammonia. They inspect the kitchen,
observe how drugs are distributed and interview staff members about
abuse prevention.
Until last year, federal funding paid for an analysis of the
inspection reports. This year, Harrington's report was paid for by
the Service Employees International Union..
Mary Kahn, spokeswoman for the federal Centers for Medicare and
Medicaid Services, which oversees state nursing home inspections,
said, "States are the first line of defense" against nursing home
deficiencies. She said CMS is reviewing Harrington's report.
Each state can decide how to punish a nursing home for violations
but most defer to the federal government, which can fine a facility
as much as $10,000 a day. A Washington Post analysis of a
federal database this year showed that since 1995, Medicare has
charged more than $100 million in fines against the country's 17,000
nursing homes based on violations found in state inspections. Most
fines go to homes in the Midwest and Southeast, the Post
said.
Instead of deferring to federal fines, Louisiana is one among a few
states that by law imposes its own fines with a $5,000 per month
maximum. After statistics showed the state's nursing homes were far
less likely to be fined than homes in other Southern states, Health
and Hospitals Secretary Fred Cerise decided this month to compare
Louisiana's regulatory system to other states and consider adopting
stronger penalties.
New York's inspections of nursing homes were found to be lax in a
study released this year by the Long Term Care Community Coalition,
a nonprofit consumer advocacy group. The group said state health
inspectors failed to identify violations at nursing homes
that surfaced in followup visits by federal inspectors. Their study
found New York's number of reported deficiencies was fewer than in
38 states between 1997 and 2003.
Cynthia Rudder, the group's director of special projects, said study
was done "to embarrass government (officials) into doing their job.
A big concern is what message is being sent from the governor's
office. Too often, the message is, 'Let's not burden big
business.'"
Send your comments on this story to
letters@stateline.org. Selected reader feedback
will be posted in the Letters to the editor section.
Contact Kathleen Murphy at
kmurphy@stateline.org
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