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Can
care facilities ensure welfare of elderly?
Gannett News Service, June 16, 2003
WASHINGTON - Where a nursing home is and who owns it can be critical in
determining the care given to America’s most frail and vulnerable, a
Gannett News Service investigation has found.
Nearly three-fourths of the most severe and repeated nursing home patient
care violations found in the past four years were concentrated in a dozen
states. Additionally, patients at homes owned by for-profit companies
fared worse in some ways than residents in government and nonprofit
nursing homes.
"There are many flaws in the long-term care system," said Thomas
Scully, administrator of the Centers for Medicare and Medicaid Services,
which directs federal nursing home programs. "We’re trying to look
at them and fix them."
The findings are the result of a four-month Gannett News Service
investigation. GNS interviewed dozens of people and analyzed four years’
worth of federal data on inspections and patient well-being at the
nation’s 16,000 nursing homes.
The analysis revealed significant weaknesses in the safety net designed to
protect the nation’s 1.5 million nursing home residents, weaknesses not
apparent on a nursing home quality Web site the federal government
created. Star ratings for each Medicare- and Medicaid-certified nursing
home, the vast majority of nursing homes nationwide, can be found in a GNS
searchable database on the Internet. The analysis also ranks each home’s
inspection results against peers in its home state.
Some findings:
· For-profit
nursing homes accounted for 83 percent of the more than 500 nursing homes
with repeated, serious violations, yet are only 65 percent of all
Medicare- and Medicaid-certified nursing homes.
· Patients at
for-profit homes had, on average, higher rates of infections and pressure
sores than those the government and nonprofits own.
·
Homes monitored by councils of residents’ family members tended
to have a higher use of physical restraints and a lower rate of patients
in pain.
Information about nursing homes and the care they provide is crucial to
thousands of Americans who each year must confront the difficult decision
of placing a loved one in a long-term care center.
As a nurse, Anne Smith of Salt Lake City is well aware of the troubled
past and present of nursing homes. When she needed care for her
88-year-old mother who was recovering from a heart ailment, she asked the
hospital discharge planner for help. The planner handed her a list of 31
nursing homes in the area.
"I said, ‘Can you help me find a good one?’ and she said she
wasn’t allowed. And to tell you the truth, she probably didn’t know
which ones were good or bad," said Smith, 65.
Smith turned to a new consumer-oriented tool on the Internet, the federal
government’s Nursing Home Compare Web site, which lists residents’
health status and inspection results for all Medicare- and
Medicaid-certified nursing homes.
The site is part of the federal government’s major new nursing home
initiative, which spent about $30 million to draw attention to the Web
project. It features inspection and patient health results for every
nursing home in the country.
Another $1 billion was pledged over three years to expand the role of
quality improvement organizations, staffed by health care professionals,
that work with nursing homes to lift the level of care delivered to
nursing home patients nationwide. With a list from the Web site, Smith
narrowed her choices, using proximity to her home and other factors.
"It helped me go into the nursing home with this information and ask
them, ‘What is your strategy for caring for my mother because you
don’t look very good on paper,’ " Smith said.
Legislation
ineffective
Consumer
advocates who reviewed the GNS findings said they were not surprised the
investigation found a substantial number of repeat violations and links
between poorer care and for-profit ownership.
They say nursing home residents continue to suffer from neglect and abuse
despite new quality and information efforts and years of legislation and
regulation intended to protect patients.
The National Citizens’ Coalition for Nursing Home Reform recently
published a book depicting in graphic, detail the neglect and pain 82
Texas nursing home residents suffered. The coalition is the nation’s
largest consumer advocacy group focused solely on nursing homes.
Incidents of neglect continue to occur despite government officials’
claims that care in nursing homes is improving, said Donna Lenhoff, the
coalition’s executive director.
"These are severe breakdowns in the provision of health care services
and in the provision of basic human decency," she said. "There
are a lot of nursing homes that are giving a lot of bad care."
Federal officials, nursing home administrators and others representing the
industry said recent reforms, especially the Nursing Home Compare Web
site, have helped improve patient care.
"Getting people talking about quality, measuring poor quality, making
people aware of quality is a big first step," the Medicare agency’s
Scully said.
"Long after we’re all gone, this is going to have a huge impact on
the health care system -- if we can manage to slowly turn around quality
measures and public accountability," he said.
Few states
had most problems
Nearly
three-fourths of severe and repeated violations of federal patient care
standards from 1999 to 2003 were at nursing homes in 12 states. They are,
in descending order: Texas, Illinois, Arkansas, Washington, New Jersey,
Kansas, Missouri, Indiana, Oklahoma, North Carolina, Mississippi and
Tennessee.
The violations included failing to protect patients from mistreatment,
hiring staff without conducting criminal background checks, and allowing
patients to be abused and physically punished.
In some cases, problems were isolated. But in others, dangerous conditions
were widespread.
Government regulators, the nursing home industry and consumer advocates
disagree on whether nursing home quality has improved or slipped in recent
years. The theory behind the Bush administration’s $1 billion quality
improvement effort, barely seven months old, is to encourage nursing homes
to improve care for patients by offering them guidance from teams of
experts and by holding their violations records up to public scrutiny. The
program has not yet produced measurable results.
Some states such as Florida and Washington have gone beyond federal
requirements by enacting their own reforms, but those, too, are so recent
that results are not conclusive.
Terry Watters, a Maryland ophthalmologist who compiles nursing home
information, said it is important to know which homes are cited repeatedly
for severe violations.
"This means somebody is not doing their job," said Watters, who
founded the nursing home watchdog group Member of the Family.
Scully -- whose agency sets nursing home care standards, payment and
enforcement policies -- said concentrations of repeat offenders in certain
states do not necessarily mean those states have more problem nursing
homes.
"Obviously in some states, due to different secretaries of health,
different state legislatures, different funding, and different cultures,
you may have more aggressive or less aggressive inspections," he
said.
Federal health quality measures can be similarly misleading.
The New Underwood Good Samaritan nursing home in New Underwood, S.D.,
recently reported 71 percent of its patients in pain. That’s seven times
the average for all nursing homes nationwide.
Administrator Ron Kortemeyer said his nursing staff records and treats
pain precisely as the Centers for Medicare and Medicaid Services recommend
it be done, and the high number for his nursing home indicates strong
oversight, not poor care.
"It is our understanding we’re doing it correctly," Kortemeyer
said. "Which suggests others are not."
Officials with the trade association representing for-profit nursing homes
argue that the inspection process is so inconsistent -- from state to
state and even within the same state -- that any attempt to make
comparisons or draw conclusions is misleading.
"The statistics are easily subject to misinterpretation," said
Alan DeFend, vice president for public affairs of the American Health Care
Association. "Drawing sweeping conclusions could present readers with
an incorrect picture of reality."
DeFend said providing consumers with the information is helpful but
focusing on violations and attempting to rate nursing homes give consumers
false information.
DeFend’s group represents 12,000 for-profit and nonprofit nursing homes
and other long-term care centers. It spent $305,000 lobbying Congress last
year, and its political action committee made more than $800,000 in
campaign contributions in the 2001-2002 election cycle, according to
watchdog group Political MoneyLine.
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