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New York Said to Be Lax Inspecting Nursing Homes
New York Times
May 16, 2005
State health inspectors routinely failed to identify problems at New York nursing homes over the last three years, and those problems only came to light during follow-up visits by federal inspectors, according to a study by a consumer advocacy group.
Federal inspectors were also more rigorous than their state counterparts in rating the problems they uncovered as either endangering people or being widespread, said the study by the Long Term Care Community Coalition, a nonprofit group that has long been critical of the state's Department of Health for being lenient on long-term care providers.
The study drew its main conclusions from a comparison of the findings in 12 cases in which federal inspectors double-checked the work of state inspectors within weeks of their visits. But it also compared national data and found three significant problem areas in New York: that nursing staff levels fall below the national average; that inspectors verify fewer complaints about poor conditions; and that the numbers of deficiencies identified per nursing home are fewer than in 38 states.
A State Health Department spokesman said the study was still being reviewed. An official in the regional office of the federal Centers for Medicare and Medicaid Services, which contracts with states to provide inspections, said the study's conclusions were overstated. But analysts for the advocacy group argued that state inspectors needed more training and they highlighted data showing that inspectors rarely interview residents or their relatives while trying to identify and solve problems.
''We feel all these findings fit together to demonstrate the failure of the Department of Health's nursing home survey and complaint system and its failure to protect nursing home residents,'' said Cynthia S. Rudder, the executive director of the advocacy group, an umbrella organization for two dozen consumer, civic and professional groups that are a watchdog of the state's nursing home industry.
The State Assembly has planned a May 19 hearing on the state's role in regulating the more than 600 nursing homes in New York. There are 120,000 beds in the state's nursing home system, a $10 billion annual industry that gets 78 percent of its revenue from Medicaid and is subject to annual state and federal inspections.
While several states have come under criticism for understating problems in nursing homes, New York is notorious for its lapses, said Charlene Harrington, a professor at the University of California at San Francisco, whose work was cited in the study.
''New York comes out badly on most of the measures that I look at,'' she said. ''They don't do well and it is a low-enforcement state.''
But Steven T. Blaum, the manager of the certification and enforcement branch in the New York office of the Centers for Medicare and Medicaid Services, defended the state's work. He said the federal government was vigorous in reviewing the state's annual inspections and in working to correct deficiencies with an aim of always improving its monitoring.
''You could say the feds do a better job than the state but just because we find more deficiencies does not necessarily mean that the residents are in jeopardy,'' Mr. Blaum said. Of the study, Mr. Blaum said, ''All of the findings are stretches.''
In addition to comparing the data from the 12 nursing homes visited by state and federal inspectors between 2002 and 2004, the advocacy group's analysts re-examined a portion of the cases that were included in the latest surveys done by state inspectors in each region of New York.
The group noted one case in which a patient who should have been sitting up to eat was seen lying in bed with her knees to the side and coughing while being fed. Though a nurse explained that low staff levels meant ''that some days everything could not be done as it should,'' the home was not cited for having too few workers, the study said. In another case, state inspectors found that it took 10 months to deliver a hearing aid to a resident, but said the wait caused no harm to the woman. Ms. Rudder said the resulting mental health damage was immeasurable.
Federal officials said that by focusing on nurse counts, the study failed to account for the numbers of aides and other staff members who provide direct care to residents or how large many of New York's nursing homes are. Mr. Blaum said it was not surprising that federal inspectors found more deficiencies since they have an average of 7.5 years of experience compared with state inspectors, who average less than two years experience.
Robert Kenny, a spokesman for the State Health Department, said that while New York ''has one of the most comprehensive surveillance programs'' in the country, it is ''always looking for ways to further strengthen our efforts.''
Ms. Rudder said she hoped the state would consider its recommendations, especially one to make sure that Health Department supervisors monitor and review inspectors' work, ''on an ongoing basis.''
Carl S. Young, the president of the New York Association of Homes and Services for the Aging, said the inspectors were not perfect.
''Any time there is harm to a resident is of concern to all of us and I don't think anybody is going to make excuses for it,'' Mr. Young said. But over all, he said, ''The instances of poor care are a really, really small percentage.''
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