Report Finds Federal Penalties for Nursing Homes Inadequate
Nursing homes with repeated safety compliance problems usually face only minimal penalties from the federal government, according to a Government Accountability Office report, the New York Times reports.
Congress established "stringent" standards for nursing homes in 1987, but a 1998 GAO report found that nursing homes that repeatedly harmed residents were insufficiently penalized.
Former President Bill Clinton, President Bush and the nursing home industry since have announced a number of initiatives to improve care. However, according to the new GAO report -- which is scheduled for release next week -- HHS still "fails to hold homes with a long history of harming residents accountable for the poor care provided," and "[s]ome of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs."
The report, which focuses on nursing homes with a history of compliance problems, uses as an example a California nursing home where a patient choked to death in part because machinery needed to save his life was broken. The facility has been cited for more than 170 serious deficiencies but still was open in late 2006, according to the report.
The report also looks at a Michigan nursing home that remained open despite repeated citations for poor care quality, poor nutrition services, medication errors and employing people who had been convicted of abusing patients.
The report found that the Bush administration rarely denies federal payments to nursing homes with compliance problems and usually imposes fines that are much smaller than the maximum of $10,000 per day. Federal officials generally impose fines no greater than $200 per day in part because of concern that larger penalties "could bankrupt some homes," according to the report.
Nursing homes facing exclusion from Medicare and Medicaid often avoid penalties by temporarily improving care quality and then resume noncompliant practices, the report found. The report also states that immediate sanctions the federal government is supposed to take against nursing homes that repeatedly cause "actual harm" to residents "are often not immediate" because the Bush administration provides homes a grace period. Grace periods are provided even to "some homes with the worst compliance histories," the report states.
GAO recommends more frequent inspections and closer scrutiny of nursing homes with a history of compliance problems, in addition to making information about compliance problems at specific nursing homes available to the public.
Federal officials said that higher fines were a good idea in some circumstances and that they would ask Congress for more power to collect fines without first having to wait for the resolution of appeals.
Acting CMS Commissioner Leslie Norwalk said that her agency was taking steps to improve enforcement but added that larger fines "may simply not be very effective." Norwalk said that nursing homes denied Medicare and Medicaid payments are likely to close, thereby reducing some patients' access to care. In addition, Norwalk said that CMS' budget is too small to increase inspections of nursing homes with histories of compliance problems.
Federal officials said that they plan to post information about the quality of nursing homes' care on the Internet.
Senate Finance Committee ranking member Chuck Grassley (R-Iowa), who requested the study, said that the findings are "very discouraging." Grassley said, "After the tremendous reform effort of the last 10 years, the federal agency that's supposed to coordinate regulatory affairs is taking an approach that is undermining the sanctions that are available to try to improve care in the most questionable nursing homes."
Members of Congress "are likely to use the report as a map for legislation requiring stiffer penalties for the most serious violations," the Times reports.
Bruce Yarwood, president of the American Health Care Association, a trade group, said that the quality of care at the average nursing home -- which was not the focus of the GAO report -- has improved during the past decade (Pear, New York Times, 4/22).