More Than 90% Of Nursing Homes Were Cited For Health, Safety Violations In 2007, According To Report
Main Category: Seniors / AgingAlso Included In: Caregivers / Homecare; Public Health
Article Date: 01 Oct 2008 - 12:00 PDT
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More than 90% of U.S. nursing homes were cited for federal health and safety violations in 2007, according to an HHS Office of Inspector General report released on Monday, the New York Times reports. The report found that deficiencies were cited for 94% of for-profit nursing homes, 88% of not-for-profit homes and 91% of government-run homes. HHS Inspector General Daniel Levinson said, "In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively." For-profit homes account for approximately 66% of U.S. nursing homes, not-for-profit homes account for 27% and government-run homes account for 6% (Pear, New York Times, 9/30).
According to the report, the most common deficiencies centered on quality of care measures, including treatment and prevention of bedsores and urinary tract infections. The most common quality of life issues involved housekeeping, maintenance and nutrition, with 43% of homes cited for problems with dietary services (Freking, AP/Boston Globe, 9/29). The report found that about 17% of nursing homes had deficiencies that caused "actual harm or immediate jeopardy" to residents. Of the 37,150 complaints inspectors received in 2007 about the condition of nursing homes, 39% were substantiated and about 20% of those verified complaints involved patient abuse or neglect.
The proportion of nursing homes cited varied among states, ranging from 76% of homes in Rhode Island to 100% of homes in Alaska, Idaho, Wyoming and Washington, D.C. The average number of deficiencies per home ranged from 2.5 in Rhode Island to 13.3 in Delaware (New York Times, 9/30).
The report's findings were included in a memorandum sent to CMS acting Administrator Kerry Weems (AP/Boston Globe, 9/29). Levinson issued a compliance guide for nursing homes on Monday stating that some facilities "have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents." He also said that he found cases in which nursing homes billed Medicare and Medicaid for services that "were not provided, or were so wholly deficient that they amounted to no care at all." In December, President Bush plans to institute a five-star system to be published on a federal Web site that will rank the overall quality of care at all U.S. nursing homes (New York Times, 9/30).
The report is available online (.pdf).
Response
CMS spokesperson Jeff Nelligan said, "The addition of stronger inspections and enforcement of quality-of-life requirements means that more of the serious deficiencies are being identified, even though many nursing homes also made improvements in their care" (Marcus, Bloomberg/Pittsburgh-Post Gazette, 9/30).
Bruce Yarwood, president of nursing home trade group American Health Care Association, said, "We know we have to do a better job" but the inspection system "does not reliably measure quality" and "does not create any positive incentives." He added, "Inspectors are subjective and inconsistent. They interpret federal standards in different ways" (New York Times, 9/30).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Legislate Federal Mandatory Nursing Staff Levels
posted by Gregory D. Pawelski on 2 Oct 2008 at 11:20 pmOn Friday, September 26, 2008, Reps. Pete Stark and Jan Schakowsky introduced the "Nursing Home Transparency and Quality of Care Improvement Act of 2008."
The bill increases the transparency of nursing home ownership, ensures that residents and their families have information about the quality of care at these facilities, and strengthens enforcement of nursing home compliance with quality of care standards. It is a companion to S. 2641, introduced by Senators Charles Grassley and Herb Kohl.
The Nursing Home Transparency and Quality of Care Improvement Act enables nursing home residents and government regulators to better know who actually owns the nursing home and who controls the decision-making that impacts the quality of care provided. In addition, the bill improves the reporting of information on staffing levels and direct patient care expenditures.
In addition to increasing transparency, the bill takes additional steps to improve the quality of care. The bill puts patients first, by requiring advance notice of home closures, standardizing the nursing home complaint process, and establishing specific processes and consumer protections for complaint resolution.
The bill also improves staff training to include dementia management and abuse training as part of pre-employment training. The bill improves accountability and enforcement by mandating that homes establish compulsory ethics and compliance programs, making civil monetary penalties more meaningful, and studying the feasibility of new independent monitoring requirements.
While the bill proposes collecting accurate information about nurse staffing by comparing it with payroll records, mandatory staffing levels is not in the nursing home bill.
Many states fought twenty world-wars to get mandatory staffing levels, even then, it was constantly being attacked. In one state, when there was a possibility of cutting Medicaid funding, the industry jumped at the chance to use that funding cut as an excuse to abandon the staffing level requirements.
Federal law only requires nursing homes to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident, and we know this is insufficient.
There have been numerous federal bills requiring various mandatory staffing levels, only to be defeated or die on the vine. Now is the time for those mandatory staffing levels!
Write or call your federal congressional delegation to be on the ground floor at getting this much needed legislation passed.
Nursing Home Legislation And Mandatory Staffing Levels
posted by Gregory D. Pawelski on 20 Oct 2008 at 3:24 pmWhile the Nursing Home Transparency and Quality of Care Improvement Act of 2008 proposes collecting accurate information about nurse staffing by comparing it with payroll records, mandatory staffing levels is not in the nursing home bill.
Federal law only requires nursing homes to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident, and we know this is insufficient. Minimum standards need to be raised because nursing homes operate at just that level - minimum.
There have been numerous federal bills requiring various mandatory staffing levels, only to be defeated or die on the vine. Now is the time for those mandatory staffing levels. The biggest problem with staffing is that the industry will not allow it to happen unless it's tied to additional taxpayer funding (and the current economy will be the biggest weapon as to why taxpayers can't afford it).
Most importantly, the only way additional funding should ever be allowed is if every red cent of it goes directly to hands-on caregivers, no one else. There have been instances where taxpayer funding for nursing homes has been raised, but it did not translate into those dollars going solely to the hiring/training of more hands-on staff.
The lack of staffing can be explained in simplified terms, right down to the basic facts that, without it, patients don't receive even basic humane care; i.e., fed, hydrated, changed, bathed, turned, given their meds on time and/or given correctly. Lack of staffing, in turn, creates a constant high turnover among even the most highly-trained, dedicated workers.
Patients lose weight and some starve to death because no one helps them eat or leaves the tray at bedside, out of reach; same thing with drinking fluids; subjected to the humuliation of soiling themselves, often just because no one assists them to the bathroom, and such lack of hygiene also creates physical problems as well, from skin breakdown all the way to deadly, septic pressure sores.
This lack of care also translates into even more taxpayer dollars down the drain because the health problems that result from the lack of staff means costly hospitalizations, surgeries, and/or other medical treatments and/or medications that wouldn't have been necessary.
The problem with nursing home inspections is they depend on paperwork to verify residents are getting good care. However, surveyors look at self-reported and unaudited data (data reported by the facilities themselves and no over sight agency verifies audits to ensure it is even true. This leads nursing staff to do charting by rote, they are not charting care that they're actually giving.
Repeated findings by the Government Accountability Office have shown that self-reported data makes nursing home quality appear to be better than it actually is. It focuses on structure and process measures, not on whether residents actually get appropriate care.
In addition, the nursing home has nurses on staff to make sure the paperwork is perfect, thereby ensuring a good inspection. Because of a lack of nursing staff, nurses are ignoring signs that a resident's condition is deteriorating until the resident is in a medical crisis. Licensed staff is not doing the critical thinking to keep these things in check.
State regulatory agencies should be stopped from notifying nursing homes when annual inspection dates are impending, giving them time to clean up their act before the surveyors come, like "filling in the blanks" on medication administration records, wound care documentation, doctors' orders, and monthly care summaries. Filling in the blanks is represents extreme negligence of care that's happening in those facilities.
Neglect is the silent killer in nursing homes. By some estimates, malnutrition, dehydration, bedsores and infection - caused by neglect - account for half of nursing home deaths and injuries.
This nation needs to write or call their federal congressional delegation to be on the ground floor at getting this much needed legislation passed.
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