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Nursing Home Problems Missed in Inspections, GAO Says

May 15, 2008 | Parker Waichman LLP

In a report scheduled for release today, the Congressional Government Accountability Office (GAO) reveals a widespread “understatement of deficiencies,” that include malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports.  The report states that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats.

Facilities are generally inspected once yearly by state employees who work under contract with the federal government.  Federal officials attempt to validate state inspector work by joining them on visits or conducting follow-ups.  It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections.  Worse, in nine states—Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee, and Wyoming—inspectors missed serious problems in over 25 percent from 2002 to 2007.

There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year.  “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.  Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which cover over two-thirds of their residents, at a cost of more than $75 billion a year.

Senators Charles E. Grassley (Republican—Iowa) and Herb Kohl (Democrat—Wisconsin and Senate Special Committee on Aging Chairman), requested the study and introduced a bill to upgrade nursing home care and increase penalties for federal standards violations. The maximum fine, now about $10,000, would be increased to $25,000 for a serious deficiency and $100,000 for deficiency resulting in patient death.  The senators are pushing their bill for inclusion in a package of Medicare changes Congress is expected to pass in June.

The American Health Care Association, a nursing home trade group, opposes the bill.  “We should not be increasing fines, adding auditors, and encouraging a ‘gotcha’ mentality.  We should be testing new, less punitive ways to measure and improve the quality of care,” said Bruce A. Yarwood, association’s president.  But, David P. Sloane, senior vice president of AARP, the lobby for older Americans, said it was “one of the most significant nursing home reform initiatives” in two decades.  Under the bill, nursing homes must provide consumers and the government with more information about their owners and “affiliated or related parties,” including any individual or company with a role in managing operations.  Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he has been frustrated in identifying nursing home owners for facilities providing substandard care.  “We have found nursing home residents who were grossly dehydrated or malnourished.  We’ve found patients with maggot infestations in wounds and dead flesh.  We’ve found residents with broken bones that went unmended,” he said.  After discovering such problems, the federal government now requires some companies to sign compliance agreements, which are monitored by outside experts.

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