Nursing Home Violations Often Underreported, GAO Report Finds
State nursing home inspectors often fail to report or underreport "serious deficiencies that cause actual harm or immediate jeopardy to patients," according to a new report released by the Government Accountability Office, the New York Times reports. Nursing homes must meet federal standards to participate in Medicare and Medicaid, and state employees under contract with the federal government inspect the facilities.
According to the report, requested by Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.), most of recent "significant improvements" in the quality of nursing homes cited by the Bush administration have resulted from inadequate inspections, rather than improved conditions. The report finds that state investigations into complaints of injuries to nursing home residents -- such as severe weight loss, multiple falls and preventable bed sores -- often take weeks or months to begin and that the adequacy of inspections varies from state to state.
In addition, the report finds that the predictability of nursing home inspections "allows homes to conceal problems if they so desire." The report also finds that more than 20% of nursing homes lack sprinkler systems in the event of fires.
Grassley said, "If state surveyors are missing serious deficiencies in the quality of care, then the federal government has not yet achieved the necessary level of improvement in oversight of the inspection process."
Kohl said, "There are too many inconsistencies in what is deemed a deficiency from state to state."
CMS Administrator Mark McClellan said that he is "concerned about possible understatement or omission of serious deficiencies" in nursing home inspections and that the federal and state governments should spend more to address the issue. However, McClellan said that the quality of nursing homes has improved under the Bush administration.
According to the Bush administration, nursing home inspectors investigated 47,124 complaints in 2004, a 45% increase from 1999, and the percentage of facilities cited for serious violations decreased to 16% in 2005 from 29% in 1999.
According to McClellan, the Bush administration hopes to link nursing home reimbursements with "pay-for-performance" standards (Pear, New York Times, 1/16).