NURSING HOMES: Senate Hearings Conclude Feds Too Lenient On California Facilities

      In response to evidence that federal and state regulators have been too lax in regulating nursing homes, officials are "targeting the nation's worst nursing homes for repeat inspections and tough sanctions for violations," the Los Angeles Times reports. Michael Hash, deputy administrator of the Health Care Financing Administration, yesterday outlined his agency's plan for correcting nursing home abuses that Senators had been reviewing for the last two days (Rosenblatt, 7/29). The New York Times reports that yesterday in the last of the Senate Special Committee on Aging hearings, General Accounting Office investigators "said federal officials had been extremely reluctant to take action, even against nursing homes repeatedly cited for serious violations of federal health and safety standards." William Scanlon, GAO director of health care studies, said, "Homes can repeatedly harm residents without facing sanctions." The New York Times reports that committee Chair Chuck Grassley (R-IA), after hearing eight hours of testimony over two days, concluded that the Health Care Financing Administration "has been comatose for too long" in regulating nursing homes. He called the situation in California "horrifying -- the equivalent of a national scandal."

Who Ya Gonna Call?
      Scanlon said HCFA "has authority to terminate a home from participation in Medicare and Medicaid. But termination rarely occurs and is not as final as the term implies." Of the nearly 1,400 nursing homes that the GAO audited for its report, Scanlon said "16 have been terminated at some time since 1995, but 14 of the 16 were reinstated." And six of these reinstated 14 "have been cited for new violations that harmed patients." The New York Times notes that experts told the Senate panel yesterday "that the administration had done nothing to address one of the biggest problems: a shortage of nursing assistants and other personnel at many homes" (Pear, 7/29). According to the Los Angeles Times, the GAO reported that "122 troubled homes" in California "were cited again and again," but in 75% of these cases, "no sanctions were imposed."

Time For A Fix
      To correct these problems, Hash told senators that HCFA could possibly ban errant nursing homes from admitting new patients under Medicare and Medicaid. He said the agency "will start with a list of more than 100 of the worst homes," but enforcement efforts "will be expanded in the next fiscal year to cover a broader category of 'poor performers'" -- up to 15% of the nation's 17,000 nursing homes. In addition, "[n]ursing homes with repeated serious violations will no longer be given a grace period to correct the problem," but will be hit immediately with sanctions that could include fines "or the appointment of an outside temporary manager with the power to hire and fire personnel" (7/28).

More Reform
      An editorial in today's Los Angeles Times says the state could have been stricter with nursing homes "if the Wilson administration had not helped gut a state bill meant to toughen sanctions against nursing homes." The piece urges passage of this bill -- AB 2559, sponsored by state Assemblyman Martin Gallegos (D-Baldwin Park) -- which would "increas[e] the top fine the state could levy from the current $25,000 to $100,000." But the editorial adds that "more fundamental reform is needed." California lawmakers should change "an outrageous state law that allows nursing homes to greatly inflate representations of the amount of care provided by registered nurses" and nursing homes should set "clear, minimum staffing levels so one nursing assistant isn't hand-feeding two dozen patients." The piece concludes: "The abuses documented this week in Congress are inhumane and unconscionable. State and federal regulators need to confront them with specific reforms, not bureaucratic excuses and finger-pointing" (7/29).