[4alabama] Nursing Home Deficiencies

[Judy R. Roy]

May 15, 2008

NY Times - Serious Deficiencies in Nursing Homes Are Often Missed, Report
Says
By ROBERT PEAR
WASHINGTON - Nursing home inspectors routinely overlook or minimize problems
that pose a serious, immediate threat to patients, Congressional
investigators say in a new report.

In the report, to be issued on Thursday, the investigators, from the
Government Accountability Office, say they have found widespread
"understatement of deficiencies," including malnutrition, severe bedsores,
overuse of prescription medications and abuse of nursing home residents.

Nursing homes are typically inspected once a year by state employees working
under contract with the federal government, which sets stringent standards.
Federal officials try to validate the work of state inspectors by
accompanying them or doing follow-up surveys within a few weeks.

The accountability office found that state employees had missed at least one
serious deficiency in 15 percent of the inspections checked by federal
officials. In nine states, inspectors missed serious problems in more than
25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama,
Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota,
Tennessee and Wyoming, the report said.

More than 1.5 million people live in nursing homes. Nationwide, about
one-fifth of the homes were cited for serious deficiencies last year.

"Poor quality of care - worsening pressure sores or untreated weight loss -
in a small but unacceptably high number of nursing homes continues to harm
residents or place them in immediate jeopardy, that is, at risk of death or
serious injury," the report said.

Nursing homes must meet federal standards as a condition of participating in
Medicaid and Medicare, which cover more than two-thirds of their residents,
at a cost of more than $75 billion a year.

The study was done at the request of Senators Charles E. Grassley,
Republican of Iowa, and Herb Kohl, Democrat of Wisconsin, who is chairman of
the Senate Special Committee on Aging.

Mr. Grassley and Mr. Kohl have introduced a bill to upgrade nursing home
care and increase the penalties for violations of federal standards. The
maximum fine, now generally $10,000, would be increased to $25,000 for a
serious deficiency and $100,000 for one that resulted in a patient's death.

The senators are pushing to have their bill included in a package of
Medicare changes that Congress is expected to pass next month.

But the American Health Care Association, a trade group for nursing homes,
opposes the Grassley-Kohl bill in its current form.

Bruce A. Yarwood, president of the association, said: "We should not be
increasing fines, adding auditors and encouraging a 'gotcha' mentality. We
should be testing new, less punitive ways to measure and improve the quality
of care."

Influential consumer groups support the bill. David P. Sloane, senior vice
president of AARP, the lobby for older Americans, said it was "one of the
most significant nursing home reform initiatives" in two decades.

Under the bill, nursing homes would have to provide consumers and the
government with more information about their owners and "affiliated or
related parties," including any individual or company that had a role in
managing their operations.

Lewis Morris, chief counsel to the inspector general of the Department of
Health and Human Services, said he had often been frustrated in trying to
identify the owners of nursing homes that provided substandard care.

"We have found nursing home residents who were grossly dehydrated or
malnourished," Mr. Morris said. "We've found patients with maggot
infestations in wounds and dead flesh. We've found residents with broken
bones that went unmended."

After discovering such problems, the federal government has required some
companies to sign compliance agreements, monitored by outside experts. "Our
experience shows that such compliance programs do improve the quality of
care," Mr. Morris said.

The Bush administration said it agreed with the findings of the
accountability office and would supervise state inspectors more closely.

"We fully endorse and will implement all the G.A.O. recommendations,"
Vincent J. Ventimiglia Jr., an assistant secretary of health and human
services, said in written comments on the report.

Judy R. Roy
Independent Living Resources of Greater Birmingham
206  13th Street S.
Birmingham, AL  35233-1317
Phone  205.251.2223  ext 102
Email  bhamilc1 at bellsouth.net
There are only four kinds of people in the world: those who have been
caregivers; those who are currently caregivers; those who will be
caregivers; those who will need caregivers. - Rosalynn Carter