The U.S. General Accountability Office recently filed a report where it reviewed federal oversight of a group of 63 nursing homes nationwide that have a history of repeatedly harming nursing home residents. In 1998 and 1999, GAO had issued reports reviewing the oversight exercised by the Centers for Medicare & Medicaid Services (CMS) over nursing homes. Those reports found that sanctions CMS imposed on bad nursing homes often did not take effect, because CMS had adopted a policy of giving nursing homes a “grace period” to correct deficiencies before sanctions would be imposed. The prior reports found a “yo-yo” pattern where the nursing homes would cycle into compliance just long enough to avoid the sanctions, and then revert to a pattern of serious violations - avoiding sanctions while continuing to harm residents.

In response to the GAO reports, CMS was supposed to adopt an “immediate sanctions” policy for nursing homes found to repeatedly harm residents. Did they? According to the current GAO report, the answer is “no.” The CMS “immediate sanctions” policy is in name only. More than half of the 63 homes that had serious violations that had harmed residents as of 1999 continued to have serious violations during 2000-2005.

GAO attributes the continuing yo-yo effect to CMS' lax enforcement policies, including failure to impose fines, delaying imposing fines, and levying fines in such small amounts that it is more profitable for the nursing homes to pay the fines (which averaged $350 to $500 per day) than it is for them to provide good care to nursing home residents. An example is:

“A significant medication error occurred when resident #8 was administered the wrong medication over a three day period. The resident experienced hypoglycemia and required hospitalization. Upon return from the hospital there was evidence of actual harm: a decline in the resident’s ability to perform activities of daily living.” The fine for this citation could have been anywhere from $1,000 to $10,000. CMS only fined the home $1,500.

GAO says that CMS terminated from Medicare or Medicaid reimbursement only 2 of the 63 bad homes. What incentive would a nursing home have to do things differently? These bad nursing homes are actually being paid by Medicare or Medicaid to provide the very care that CMS has determined merits a citation. The nursing homes can actually pay the fines with the money that they are receiving from Medicare for the resident’s care.

As long as the federal government makes it cheaper for nursing homes to violate the law than it is to comply, elderly residents will continue to be neglected by nursing homes. For the big corporations that own the nursing homes, it’s just more cost-effective to neglect the residents and pay the paltry fine if they get caught.

And, if you’d like to know the names of the 63 “repeat offender” “yo-yo" nursing homes studied in the GAO report, you’re out of luck: GAO won’t disclose their names. You or your parents could be living in one of these homes (which were in Texas, California, Michigan and Pennsylvania).

To read the GAO report, click here.

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Felicia Curran
www.ElderAdvocacyLaw.com