The 15,000 nursing homes in the United States are occupied by at least 1.5 million elderly and invalid Americans, about two-thirds of whom are covered in Medicaid or Medicare programs.  In addition to covering the cost of care to many, at a cost of more than $75 billion each year, the federal government requires an annual inspection of each and every nursing home.  The most recent round of inspections uncovered shocking statistics, according to Daniel R. Levinson, inspector general for the Department of Health and Human Services (HHS), the government agency charged with licensing and regulating these homes.

In a report issued on September 29, Levinson revealed a violation rate of 94% for homes operating on a for-profit basis.  Other homes fared better but only by a very small margin.

Nursing homes operating on a not-for-profit basis, which includes 27% of all nursing homes, were found to be in violation at a rate of 88% while 91% of the nation’s government-operated homes were in violation.  These government homes account for 6% of all nursing homes.  The private, or for-profit, homes account for the remaining 67%.  All in all, 17% of these violations were classified as causing "actual harm or immediate jeopardy" to the patients involved.

Many violations involve bed (pressure) sores, some of which were found to be infected.  Other common violations included mix-ups in medications, inadequate nutrition, neglect, and abuse of the patient.

In 2007, 37,150 complaints were filed with HHS and state authorities, 39% of which were substantiated upon further investigation.  Approximately 20% of those complaints focused on neglect or abuse.

On an individual nursing home basis, for-profit homes received the highest number of deficiency citations, averaging 7.6 violations per home.  Not-for-profit homes averaged 5.7 violations and government homes were found to average 6.3 violations each.

The rate of deficiency, or violation, varied throughout the nation, with a low of 76% in Rhode Island and 100% of all homes in the District of Columbia, Alaska, Idaho, and Wyoming.  On a per-home basis, Rhode Island again demonstrated better care, with an average of just 2.5 violations per home while Delaware topped the list at 13.3 violations on average.

In addition to violations of personal care, Levinson’s report highlights the systematic failure of many homes to hire enough staff members to provide sufficient care and many staff members are inadequately trained for the positions they hold.  Care is best at nursing homes that have a higher ratio of nursing staff to patients.

Other violations involve nursing home administrators who bill the federal government, as Medicare/Medicaid services, for procedures and services that were not actually provided or for services so inadequate as to be deemed no care at all.  Nursing homes receive a fixed, daily, rate of pay per resident, with higher payments made for more severely ill patients.  As a result, many nursing homes overstate the severity of illness for their patients or classify them improperly in order to receive higher daily care payments.

Speaking on behalf of the American Health Care Association, its president, Bruce A. Yarwood says a better job must be done.  He further says the industry has been doing better in recent years with regard to treating patient’s bed sores, managing their pain, and using physical restraints less often.

Describing the inspection system as broken, Yarwood further says the inspection system is an unreliable measure of quality that does not create positive incentives to the homes to provide better care.  He says inspectors are inconsistent, subjective, and they interpret federal law on an individual basis.

Beginning in December, a five-star rating system will be implemented in an effort to rank quality of services on a per-home basis, with a five-star rank designating the highest quality.  Rankings will be available to consumers via a federal web site.

Source: NYT