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Elder Care News
Some Nursing Homes that Repeatedly Provide
Low-Quality Care Subject to Minimal Penalties
GAO report: nursing homes often avoid penalties
by temporarily improving care quality and then resume noncompliant
practices
April 23, 2007 - Nursing homes with repeated safety
compliance problems usually face only minimal penalties from the federal
government, according to a
Government
Accountability Office report, the
New York Times
reports.
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Congress established "stringent" standards for
nursing homes in 1987, but a 1998 GAO report found that nursing homes
that repeatedly harmed residents were insufficiently penalized. Former
President Bill Clinton, President Bush and the nursing home industry
have since announced a number of initiatives to improve care.
However, according to the new GAO report - which is
scheduled for release next week -
HHS
still "fails to hold homes with a long history of harming residents
accountable for the poor care provided," and "[s]ome of these homes
repeatedly harmed residents over a six-year period and yet remain in the
Medicare and Medicaid programs."
The report, which focuses on nursing homes with a
history of compliance problems, uses as an example a California nursing
home where a patient choked to death in part because machinery needed to
save his life was broken. The facility has been cited for more than 170
serious deficiencies but still was open in late 2006, according to the
report.
The report also looks at a Michigan nursing home
that remained open despite repeated citations for poor care quality,
poor nutrition services, medication errors and employing people who had
been convicted of abusing patients.
Additional Findings
The report found that the Bush administration
rarely denies federal payments to nursing homes with compliance problems
and usually imposes fines that are much smaller than the maximum of
$10,000 per day.
Federal officials generally impose fines no greater
than $200 per day in part because of concern that larger penalties
"could bankrupt some homes," according to the report.
Nursing homes facing exclusion from Medicare and
Medicaid often avoid penalties by temporarily improving care quality and
then resume noncompliant practices, the report found.
The report also states that immediate sanctions the
federal government is supposed to take against nursing homes that
repeatedly cause "actual harm" to residents "are often not immediate"
because the Bush administration provides homes a grace period.
Grace periods are provided even to "some homes with
the worst compliance histories," the report states. GAO recommends more
frequent inspections and closer scrutiny of nursing homes with a history
of compliance problems, in addition to making information about
compliance problems at specific nursing homes available to the public.
Reaction
Federal officials said that higher fines were a
good idea in some circumstances and that they would ask Congress for
more power to collect fines without first having to wait for the
resolution of appeals.
Acting
CMS
Commissioner Leslie Norwalk said that her agency was taking steps to
improve enforcement but added that larger fines "may simply not be very
effective."
Norwalk said that nursing homes denied Medicare and
Medicaid payments are likely to close, thereby reducing some patients'
access to care.
In addition, Norwalk said that CMS' budget is too
small to increase inspections of nursing homes with histories of
compliance problems.
Federal officials said that they plan to post
information about the quality of nursing homes' care on the Internet.
Senate Finance
Committee ranking member Chuck Grassley (R-Iowa), who
requested the study, said that the findings are "very discouraging."
Grassley said, "After the tremendous reform effort
of the last 10 years, the federal agency that's supposed to coordinate
regulatory affairs is taking an approach that is undermining the
sanctions that are available to try to improve care in the most
questionable nursing homes."
Members of Congress "are likely to use the report
as a map for legislation requiring stiffer penalties for the most
serious violations," the Times reports.
Bruce Yarwood, president of the
American Health
Care Association, a trade group, said that the quality of
care at the average nursing home -- which was not the focus of the GAO
report -- has improved during the past decade (Pear, New York Times,
4/22).
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