Three reports that have been released just in the last month highlight very serious problems and concerns when it comes to America’s nursing homes. Specifically, a number of these homes are not only delivering poor but also outright dangerous, care that is largely hidden from the public and visitors.
In addition, unfortunately, there doesn’t appear to be a lot that the government or states can do about it. Not only is the industry demonstrably resistant to government regulation and enforcement, but budget cuts are making it harder and harder for state and federal governments to respond to these bad actors, and this includes the federal Centers for Medicare and Medicaid Services (CMS).
Hundreds of Facilities Are Causing Problems
Facilities that have been designated as special focus facilities by the CMS are supposed to be subject to additional inspections — i.e. reviewed every six months – and made public on the CMS’s website. However, according to these reports, due to budget issues, the CMS can only designate 88 nursing homes nationwide as special focus facilities, regardless of how many patients are at risk at a number of other facilities. In other words, only when one is removed can a new one be added, and that leaves hundreds of facilities that are providing persistently poor care simply listed as “candidates,” and therefore not publicly identified or subject to additional oversight.
Hospices Are a Serious Part of the Problem
Unfortunately, hospices are no exception: According to internal government reviews, about 20 percent of hospices have at least one serious issue that places patients at risk of being harmed. In fact, most had what has been described as “serious” problems in terms of placing patients at risk over a number of years, indicating a long history of very poor care. In addition, according to the Office of the Inspector General (OIG), surveyors often fail to identify and cite hospices for more serious violations. Indeed, many don’t even report the crimes to law enforcement at all.
Unfortunately, the CMS is also somewhat limited in terms of whether and how they can penalize hospices, which results in too much negligence. Specifically, the CMS reportedly does not have the power to impose intermediate penalties – they can only outright shut down facilities – which arguably discourages some surveyors from writing them up in the first place. In addition, while hospitals have to self-report any violations of rules, hospices do not, and while nursing homes and hospitals are often written up for paperwork problems, for example, it is not paperwork problems that are harming patients under their care.
Suggested Reforms
The Office of the Inspector General recommended a number of reforms for the CMS, including:
- Encouraging surveyors to report serious issues and crimes;
- Disclosing survey results on public websites;
- Making it easier for families and beneficiaries to file formal complaints;
- Requiring hospices to better educate and train staff to recognize abuse; and
- Strengthening requirements for hospices to report harm to patients.
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