Bush proposal to reduce nursing home inspections

[Hellllllo Nurse, BSN, RN]

Bush proposal to reduce nursing home inspections

http://www.auditorgen.state.pa.us/Department/Press/LTCBushPlan.html

Auditor General Robert P. Casey, Jr. - An Independent Fiscal Watchdog for Taxpayers

Casey blasts Bush proposal to reduce nursing home inspections

Calls it a callous, dangerous plan that will threaten quality of care to Pennsylvania's 85,000 nursing home residents

September 7, 2001

CONTACT:

Karen Walsh

717-787-1381

Pager: [phone]

[email protected]

AG-256-01

Auditor General Robert P. Casey, Jr. today blasted a Bush administration proposal to ease regulatory requirements on nursing homes. According to today's New York Times, the Bush administration wants to reduce the frequency of nursing home inspections and lessen or eliminate some penalties against deficient facilities.

Currently, nursing homes that participate in the Medicaid or Medicare program are inspected every 12-15 months. Under Bush's new plan, the average time between inspections would increase to three years. In place of more frequent inspections, the federal government would rely on nursing homes to "self-report" such critical quality-of-care issues as the number of patients with severe bedsores, dehydration and significant weight loss.

"The vast majority of Pennsylvania's 776 nursing homes provide good, quality care," Casey said. "In fact, 60% of our nursing homes have fewer deficiencies than the national average. However, the Bush administration's plan to extend the time between inspections and allow the industry to regulate itself is a callous, dangerous plan that will threaten the quality of care provided to Pennsylvania's 85,000 nursing home residents and mask serious health and safety violations."

According to the Times, the Bush administration wants to make the inspection process "less burdensome" and more focused on "bad" nursing homes. However, a performance audit released by Casey last October found that the Ridge administration was lax in sanctioning "bad" homes.

In fact, the Pennsylvania Department of Health failed to impose aggressive or consistent penalties against long-term care facilities with egregious deficiencies -- even those with health and safety violations that caused actual harm to residents.

Casey's audit found that in at least eight sampled cases where Health investigators substantiated the complaints and the violations appeared egregious, Health failed to impose any sanctions - no provisional licenses, no bans on admissions and no monetary penalties.

Casey's auditors also looked at another sample of 10 nursing homes that had been cited for a total of at least 1,526 federal and state deficiencies during a 23-month period. They found that Health imposed sanctions on only half of those 10 facilities during that period. In other words, Health permitted five nursing homes with a total of 549 federal and state deficiencies to continue operating with no sanctions - even though residents at these facilities suffered actual harm at least 32 times.

"If the federal government is going to shirk its responsibility to ensure quality of care, Pennsylvania must be more aggressive in imposing sanctions against poor performing nursing homes for serious deficiencies that impact residents' quality of life, quality of care, and overall health, safety and welfare," Casey said.

Casey's October 2000 audit also found that Health repeatedly cited three of these five nursing homes for violations, but allowed the homes to correct or partially correct the deficiencies, then accrue new deficiencies and correct or partially correct them before Health finally imposed sanctions.

"In fact, over the entire course of our audit - both before and after sanctions - these three facilities combined had a total of at least 670 federal and state violations, including 34 instances resulting in actual harm to residents," Casey said. "We found no instances in which Health issued sanctions that were either too harsh or addressed insignificant issues. On the contrary, our sample found that Health's approach to sanctioning was more lenient than reasonable standards would dictate. In one case, a nursing home that had an avoidable death received only a fine."

Casey recommends that Health determine if deficiencies are caused by systemic problems such as staffing shortages and insufficient training.

"Any plan to 'focus enforcement' at poor performing nursing homes -- which I am not opposed to -- must be combined with a commitment to address the root of the problem: the staffing crisis facing Pennsylvania's long-term care system," Casey said. "Until we get serious about staffing, it's not going to matter how many penalties we hand out."

Casey first sounded the alarm about Pennsylvania's staffing crisis nearly three years ago. Since then, he and his staff have been working with nursing home administrators, long-term care advocates, nurses' aides, union representatives, and provider associations to reduce the high turnover rates of direct care workers that threaten the quality of long-term care.

Casey also has repeatedly called on the Ridge administration to develop a comprehensive, easy-to-access, family-friendly nursing home report card for use by consumers.

"Although the Health Department has initiated some important steps toward providing information that might comprise a report card, not enough has been done," Casey said. "At least five other states - Florida, Massachusetts, New Jersey, Maryland and Iowa - have developed nursing home performance reports and made them available to families. It is inexplicable that Pennsylvania has not moved more quickly to produce a report card of its own."

As of April 30, 2001, Pennsylvania had 776 long-term care facilities. The fastest growing segment of Pennsylvania's population is 85 years of age and older. This segment of Pennsylvania's population increased at a rate of 38.25 percent between 1990-2000, while Pennsylvania's overall population increased by only 3.36 percent during the same time period.

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[Hellllllo Nurse, BSN, RN]

BUSH ADMINISTRATION IGNORES

OWN FINDINGS ON NURSING HOME CRISIS

CMS Study Says Nine out of Ten Facilities Lack Staff to Provide Quality Care

WASHINGTON-Nine in ten nursing homes nationwide lack enough staff to provide proper care for their residents, according to a study released by the U.S. Centers for Medicare & Medicaid Services (CMS). Despite clear evidence of nearly universal inadequate staffing, the Bush administration ignores the study's findings and offers little to end the crisis of substandard care, according to the American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO.

The government study found that 91 percent of all nursing homes do not have enough certified nursing assistants (CNAs) on duty to provide the minimum hours of daily direct care per resident needed. In concluding that quality problems occur below this minimum threshold, the report echoes previous studies and recommendations from geriatric experts, resident advocates, and AFSCME, which represents 40,000 nursing home employees in 22 states.

"This study backs up what our members who work on the front lines caring for nursing home residents have been saying for years -- quality care cannot be provided if there are not enough properly trained nursing staff," said AFSCME President Gerald W. McEntee.

The administration's response is inadequate to addressing the widespread quality problems that this report confirms. Rather than proposals to address the startling fact that nine in ten nursing homes have insufficient staff to provide proper care, the administration reiterates plans for a pilot project to improve the availability to consumers of quality information about nursing homes. Such a project falls short. We doubt whether consumers will find great comfort knowing that they have no choice but to place a loved one in a nursing home that is unable to provide good care.

The letter accompanying the report from Secretary Tommy Thompson to the Congress notes that the study did not fully address how other factors affect quality of care. The Administration suggests that better management techniques may improve quality. Yet with regard to inadequate minimum staffing levels the report states that, "there appears to be little facilities can do to mitigate quality problems." Clearly, the establishment of federal standards is a necessary component to protecting nursing home residents from substandard care.

Other important findings in the CMS report include:

Ninety-seven percent of nursing homes had insufficient staff in at least two out of these three categories: CNAs, licensed practical nurses and registered nurses.

Forty percent of all nursing homes would need to increase nurse assistant staffing by 50 percent or more to meet the minimum threshold.

Establishing minimum staffing ratios would increase costs by $7 billion or 8 percent, a level the study called "substantial but not so high to preclude feasibility."

A bipartisan study released last month by Rep. Henry Waxman (D-CA) and Sen. Charles Grassley (R-IA) for the period October 2000 through 2001 alone, showed that more than 25,000 violations were found but not even reported on the government's "Nursing Home Compare" web site.

AFSCME has endorsed congressional legislation that would promote minimum staffing standards and improve training, including the "Nursing Home Quality Protection Act," introduced by Rep. Waxman and the "Quality Care for Nursing Home Patients Act," introduced by Rep. Janice Schakowsky (D-IL).

# # #

American Federation of State, County

and Municipal Employees, AFL-CIO

1625 L Street, N.W., Washington, D.C. 20036-5687

Telephone [phone]

Fax [phone]

[nekhismom]

Well, I see Bushie is at it again. UGH! He makes me sick! How would he feel if it was his dear old dad in a nursing home and his dad was harmed? I bet he would want more inspections then! Just another reason why I will NOT be voting for Bushie.

[Katnip, RN]

Dear old Dad won't end up in a nursing home. The family has plenty of money to provide private home care for the rest of their lives. They have no concept what it's like for the majority of people out there.

[SmilingBluEyes]

$(&_%*&^#(_+

I cannot say it and not get banned..

VOTE VOTE VOTE

[VivaLasViejas, ASN, RN]

Ditto to what Deb said!! OUT THE DOOR IN 2004!!!!!!!

[unknown99, BSN, RN]

:eek:

Although I no longer work in a nursing home, I did for 15 years. I cannot believe that he would even think of reducing nursing home inspections!!! That is 100% certifiably insane!!! What can we do to prevent this from happening?

[Dixen81]

Bush is such an idiot.

[warrior woman]

My Lord!! I can't stand that man!!! He make my BP ABSOLUTELY SKYROCKET!!