Enforce quality care for elders
THE UNITED States has more than 16,000 nursing homes, caring on an average day for about 1.5 million patients. More than two-thirds of them are Medicaid or Medicare recipients, which gives the federal government a heavy responsibility to ensure that the homes are providing quality care. Unfortunately, the Department of Health and Human Services is failing in its duty to make sure that nursing homes correct their shortcomings and then continue to meet quality standards.
That is the conclusion of a report Congress mandated from the Government Accountability Office. All too often, officials impose minimal penalties even on nursing homes that regularly mistreat patients, with the result that such homes move in and out of compliance with federal requirements. To ensure the level of care that patients deserve, Congress should insist that Health and Human Services be more willing to close down poorly managed homes or exact stiff fines that will be more than just a cost of doing business.
The picture is less discouraging in Massachusetts, where the state Department of Public Health inspects nursing homes on behalf of Health and Human Services. In 2003, the state's nursing homes were rated as having 27 percent fewer deficiencies than the national average. According to Paul Dreyer of the division of health care quality, DPH is less reluctant than inspectors in other states to close down nursing homes with substandard patient care. In the past year, the Department of Public Health closed three. In fiscal 2006, the agency imposed $6 million in fines on 22 homes. Information on inspections of individual homes is available on the DPH's website.
After horrific revelations of deficient care nationwide, the federal government set quality standards in 1987, but a GAO study in 1998 found that homes could still harm residents without facing meaningful punishment. This week's report indicates little progress in toughening the surveillance process. The law allows the federal government to withhold reimbursement from homes that are mistreating patients or to set fines as high as $10,000 a day, but the latest report found that federal inspectors are reluctant to apply these sanctions and hesitate to set fines greater than $200 a day. A home in Michigan continued to operate even though it fed patients poorly, made errors in dispensing medication, and employed workers who had been convicted of abusing patients.
Nursing homes will improve beyond the minimum levels of required care if more homes participate in HHS's Nursing Home Quality Initiative, which encourages voluntary compliance. But the agency must continue to insist on basic standards, and it must be prepared to shut down or heavily fine nursing homes that fail to meet them.
