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Nursing homes in state short of federal mark
By Traci Shurley and Nell Smith,
Arkansas Democrat-Gazette
November 11, 2003
More than 90 percent of Arkansas’ 245 nursing homes violated federal health guidelines, and one-third of the homes harmed residents or placed them at risk, according to a federal review of recent inspections.
Further, 83 percent of the homes failed to meet federal recommendations for staffing.
The findings were culled from state inspections and nursing home reports submitted between May 2002 and August. The U.S. House Committee on Government Reform began circulating the results late last week.
The report follows recent occurrences that have raised concern about long-term care in Arkansas, including the brassknuckles beating death of an 81-year-old nursing home resident and five patient deaths in a state-run nursing home that were linked to staff mistakes or failed policies.
Representatives of the state’s nursing homes cautioned Monday that the report didn’t represent a complete picture of nursing home care. Industry critics, however, said the results strengthen their arguments for higher standards. "These violations are violations of minimum standards. They’re not violations of... the perfect situation for your grandmother or your great-grandmother," said Mark Johnson, a spokesman for the Arkansas chapter of AARP. "We ought to be doing a lot better for our elderly than just the minimum standards."
The study, requested earlier this year by U.S. Rep. Vic Snyder, D-Ark., is one of about 30 the House committee’s special investigations division has done on nursing home conditions around the nation. About 18,000 Arkansas residents live in nursing home facilities.
Randy Wyatt, executive director of the Arkansas Health Care Association, said Monday that the violations tallied in the Arkansas study are subjective and only reflect a state inspector’s impression at a given moment. The association represents more than 200 Arkansas nursing homes. Arkansas nursing homes typically meet mandated state standards for personnel and have added hundreds of staff members since 2002, according to the Arkansas Health Care Association. "We feel like our regulatory process is somewhat skewed to reflect a greater number of violations in Arkansas than they do in other states," Wyatt said.
Some of the most common violations noted in the Arkansas report include: 510 violations for failing to provide medical care. 173 violations for failing to prevent abuse, mistreatment and neglect of residents or theft of residents’ property. 134 violations for failing to store, cook or serve food "in a safe and clean way." 248 violations for failing to ensure residents received proper hydration and nutrition.
Authors of the congressional report stated that the findings were only "a snapshot" of Arkansas nursing homes, noting that conditions at a given home could be better or worse than the last inspections. "Snapshot inspections do not tell the whole story of quality care over the long term," said Peggy Moody, president of the Arkansas Health Care Association. "In fact... Arkansas nursing homes are in compliance with required staffing levels most of the time."
Arkansas law requires nursing homes to provide 2.8 hours of direct care per resident each day. The federal recommendation is for 4.1 hours. In February 2003, the state’s nursing homes averaged 3.1 hours, according to the state Office of Long Term Care, which regulates nursing homes.
For years, the nursing home industry has said qualified caregivers are difficult to find and even harder to keep. "The federal recommendations of 4.1 hours of direct patient care per day is a laudable goal," said Wyatt. "However, Medicare and Medicaid will not reimburse Arkansas nursing homes for those recommended number of hours."
Administrators say they are already using a quality-assurance fee passed by the 2001 state Legislature to improve staffing. The fee is paid by nursing homes and matched by a ratio of 3-to-1 by the federal government.
Some advocates for the elderly say they have yet to see promised results from the quality-assurance fee, also known as the bed tax. They also say staffing levels aren’t the only personnel problem. "They’ve got to be not only better trained, but better screened," said Johnson, the AARP spokesman.
A joint meeting of the Legislature’s judiciary committees and the state House Public Health, Welfare and Labor Committee earlier this month examined the death of Willie Mae Ryan, an 81-year-old resident at Dallas County Nursing Home in Fordyce. Ryan was beaten with a pair of brass knuckles by a certified nursing assistant who thought Ryan was "disrespectful," according to police.
The nurse and an accomplice suspect had clean background checks. The two have been charged with capital murder.
Rep. Stephen Bright, RMaumelle, said Ryan’s death has "put a face on" problems of neglect and abuse that those with family in nursing homes have long alleged. The report from the U.S. House of Representatives makes the challenges even more clear, he said. "A lot of the things we’ve been saying are definitely true," Bright said. "These are things that we have to do something about, but more importantly, we have to do it quickly."
Snyder, who was in Little Rock on Monday, said he expects the report to be a source of much discussion. "There are some very concerning statements in there that are made, but I want to hear from people who are in the [nursing home] business."
Though the report cautions against comparing one state to another, the Committee on Government Reforms has completed 30 such reports and made similar findings elsewhere. In October 2002, for example, the office found that 86 percent of nursing homes in Texas had at least one violation of federal guidelines between March 2001 and August 2002. Similar results were found in a 2001 study of Oklahoma’s nursing homes.
The report on Arkansas also refers to a July 2003 study by the U.S. General Accounting Office that found nationwide "the proportion of nursing homes with serious quality problems remains unacceptably high."
Carol Shockley, head of the state’s Office of Long Term Care, said her office is continually looking for trends where enforcement is concerned and the office gears the training it requires to those trends.
Meanwhile, nursing home industry officials are calling for relief from rising liability insurance premiums, which they say are fueled by numerous abuse and neglect lawsuits.
During the state’s legislative session earlier this year, lawmakers argued over the legal remedies that should be available in cases of abuse. One bill imposing some limits on damages passed in 2003. Another that would create a liability insurance pool for nursing homes and limit punitive damages died at the close of the session. Some have speculated the issue could be brought up if Gov. Mike Huckabee calls a special session in December.
Bright hopes the new report will help quash support for focusing on tort reform during a special session.
Nancy Allison, president of Arkansas Advocates for Nursing Home Residents, said the report demonstrates that care in the state’s nursing homes is more deficient than nursing home administrators have led legislators to believe. "I would hope in a perfect world the health-care industry would take a look at this and stop worrying so much about money and start thinking about residents," she said.
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