GAO Report Criticizes Lax Oversight of Nursing Homes

APRIL 23, 2007  VOLUME 14, NUMBER 43

Individuals with disabilities, confused and vulnerable seniors and patients recovering from medical procedures often end up staying in nursing homes for weeks, months or years. Quality of care in those facilities is obviously important, and yet difficult to monitor. The good news: since most nursing homes accept Medicare and/or Medicaid dollars, they are subject to close scrutiny and, when they fall below basic levels of care, to penalties that can force them to improve. The bad news: the government agency charged with conducting that scrutiny does an inadequate job.

You won’t have to take our word for it. The Government Accountability Office (formerly the General Accounting Office, but better known as the GAO) is Congress’ investigative arm, and is famous for its non-partisan reviews of government programs. In a report finalized last month and issued to the public today, the GAO takes the government to task for its failure to impose meaningful sanctions on nursing homes that repeatedly harm residents.

The federal agency charged with monitoring nursing home compliance has a spotty track record of enforcement. The GAO report found that sanctions were too often delayed, and often voided altogether when the offending home submitted a plan for compliance. That practice did not change, notes the GAO, even for homes with multiple offenses.

The 63 homes (in four states) surveyed by the GAO, for example, had a total of 444 citations for deficiencies that actually harmed residents. It is important to note that those citations were not complaints—presumably there were many more complaints filed—but actual findings of deficiencies, and that those deficiencies resulted in actual harm to patients. So how many of those resulted in immediate sanctions? Just 69, or a little more than 15%.

Although given authority to impose fines as high as $3,000 per day against offending nursing homes, CMS (The Centers for Medicare and Medicaid Services) imposed fines of $350 to $500 per day, and those fines were not collected until the expiration of an appeal process that might take years in a given case. More than half the time CMS chose sanctions that gave the nursing homes another three months to correct deficiencies rather than the fifteen-day option available to the agency. In almost a quarter of cases meriting immediate sanctions, there was no evidence of any action being taken at all.

What did CMS say in response to the criticism? The agency “is taking additional steps to improve nursing home enforcement … but it is not clear whether or when these initiatives will address the enforcement weaknesses GAO found.”

The entire report, “Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents,” is available online. An abstract highlights the report’s major findings.

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