By John Reichard, CQ HealthBeat Editor
September 30, 2008 -- A new report by the HHS Office of the Inspector General says that percentage of nursing homes that violated federal requirements for quality of care and other standards crept up slightly from 91.1 percent in 2005 to 91.9 percent in 2007. The total number of such deficiencies reported rose from 95,624 in 2005 to 104,665 in 2007. In 2007, nearly 17 percent of nursing homes inspected by state regulators were cited for deficiencies stemming from actual harm to residents or placing them in immediate jeopardy of actual harm.
Although the number of deficiencies rose over the three years studied, the report by HHS Inspector General Daniel R. Levinson said the increase was not significant. The reported also cautioned that factors other than quality of care affect deficiency rates. Under the federal–state nursing home inspection system, there are 190 possible deficiencies, in areas ranging from quality of care to resident rights to pharmacy and dietary services.
"We note that many factors in addition to quality of care may affect deficiency rates," the report said. "These factors may include an increase in enforcement, additional guidance or training from states and CMS, legislative changes, and state surveyor practices."
The IG's office also released a "voluntary guidance" document it said will help facilities develop programs to help improve compliance with quality of care and anti-fraud standards.
Nursing home quality is a continual concern on Capitol Hill, with the focus this year directed toward increasing ownership by private equity firms. The House Energy and Commerce Oversight Subcommittee spotlighted the increasingly veiled nature of nursing home ownership in a hearing earlier this year in which witnesses warned that debt-laden Wall Street firms were skirting quality of care standards in taking over facilities.
Pending bills in Congress aim to make public which companies actually own nursing homes and to provide more public information on management and staffing practices. House Democrats Pete Stark of California and Jan Schakowsky of Illinois introduced legislation (HR 7128) with those goals and Sens. Charles E. Grassley, R-Iowa, and Herb Kohl, D-Wis., have similar legislation (S 2641) pending in the Senate.
CMS spokesman Jeff Nelligan said his agency is working to improve the current inspection system.
"CMS has consistently worked to strengthen our identification of problems in nursing home care through the survey and certification process," he said. "For example, we strengthened fire-safety requirements, improved inspections for identifying medication problems, and inspected poorly performing nursing homes more frequently through CMS' 'special focus facility' initiative. The addition of stronger inspections and enforcement of quality of care requirements means that more of the serious deficiencies are being identified, even though many nursing homes also made improvements in their care."
The inspector general's report found that since 2005, "the percentages of for-profit nursing homes with deficiencies were between 3 and 6 points higher" than the percentages for nonprofit and government run homes. In 2007, for-profit homes averaged 7.6 deficiencies per home, while nonprofit and government-run homes average 5.7 and 6.3 deficiencies, respectively.
Susan Feeney, spokeswoman for the American Health Care Association, said the findings are based on "a broken survey and oversight system." The current system is too subjective in assessing what deficiencies are, Feeney said. She added that other systems such as a method called the Quality Indicator Survey used on a limited basis by CMS offers a more objective way of assessing quality. Acting CMS Administrator Kerry Weems said at the hearing in May that use of the method is limited because of budget constraints.
Feeney said the association is aiming to offer either a "roadmap" or a legislative proposal early next year for congressional action to improve the inspection system and possibly create financial or other incentives to reward improvements in quality of care.
