Number of Penalties Assessed to Nursing Homes Has Decreased Since 2000, Government Data Indicate

New data from the federal government indicate a "significant decline" in the number of penalties assessed to nursing homes for violations of federal health and safety standards over the past four years, the New York Times reports. According to data obtained by the Times and confirmed by the Bush administration:

• The number of nursing homes penalized for violations of federal standards decreased by 18% to 2,146 in 2003 from 2,622 in 2000.
  


• The number of civil monetary fines assessed to nursing homes decreased by 12% to 1,979 in 2003 from 2,242 in 2000.
  


• The number of nursing homes denied Medicare or Medicaid reimbursement for a new admission decreased by 47% to 698 in 2003 from 1,312 in 2000. The penalty is optional in some cases and mandatory in others, such as when serious problems continue for more than three months after an inspection.

Bush administration officials said that the decrease in penalties assessed to nursing homes in part has resulted from improvements in care at some facilities, the Times reports. In November 2002, HHS Secretary Tommy Thompson launched a "nursing home quality initiative" that included a Web site to help consumers compare the quality of more than 16,000 nursing homes nationwide. The initiative also called for not-for-profit organizations to advise nursing homes on how to improve care. Thompson said that consumers would benefit from "new levels of collaboration" between nursing homes and the federal government. According to the Times, nursing home officials "have long advocated a more collaborative, less punitive approach to regulation." Toby Edelman, an attorney for the Center for Medicare Advocacy, which represents Medicare beneficiaries, said, "The administration is placing less emphasis on direct enforcement of standards of care. Its basic approach is to collaborate with the industry and give information to consumers, in the hope that market forces will produce improvements in quality."

According to the Times, some analysts attributed the decrease in penalties assessed to nursing homes to "less vigorous enforcement of standards and growing workloads for inspectors," rather than improvements in care. The Times obtained the data from a paper titled "Barriers to Effective Enforcement" that was written by CMS official Jerry Sandlin and Georgia Department of Human Resources official David Dunbar.

According to the paper, many nursing homes display a "yo-yo pattern," in which they correct violations of federal standards to avoid penalties but later allow the violations to occur. The paper said, "The enforcement process has become increasingly complex, inefficient, inconsistently applied and demonstrably ineffective in ending yo-yo compliance and ridding the industry of chronically poor-performing providers." In addition, Sandlin said that states do not have an adequate number of nursing home inspectors, which forces inspectors to "rush through a survey or a survey task." Charlene Harrington, a professor at the University of California-San Francisco School of Nursing, said that Bush administration officials "have not been vigorous in enforcing" federal standards, adding, "I'm not sure if it's a deliberate reduction in enforcement or just a reduction in attention and commitment."

However, Dennis Smith, a senior CMS official, said that the decrease penalties assessed to nursing homes is "a positive thing, showing an improvement in the performance of nursing homes." Mary Kahn, a spokesperson for CMS, added that the decreases resulted because of "improved quality of care in nursing homes and the effectiveness of earlier enforcement actions" (Pear, New York Times, 8/6).