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State Inspections Minimize Serious Nursing Home Problems, GAO Report Says

WASHINGTON, DC — January 20, 2006 — State inspections often miss serious quality violations in nursing homes, according to a recent report by the Government Accountability Office (GAO). Overlooked problems include neglect that can lead to severe weight loss, multiple falls, pressure sores, and other health issues for residents.

Nursing homes must meet certain federal health and safety standards in order to participate in Medicaid and Medicare programs. The federal government contracts with state agencies to conduct annual inspections of nursing homes to make sure that these federal standards are met. The federal government also conducts periodic surveys to monitor the proficiency of the state inspections.

The GAO report found that the state inspections were inconsistent, showing wide variability among the states that was not due to genuine differences in each states’ nursing homes. For example, from 2003 through 2005, California cited only six percent of nursing homes for violations, while Connecticut cited 54 percent. The report suggested that this was due to differences in inspection procedures rather than to quality issues.

There was a large difference between federal and state inspections of the same nursing homes from 2002 through 2004. In five large states—California, Florida, New York, Ohio, and Texas—federal inspectors found serious deficiencies that the state inspectors had missed. The GAO report concluded that the differences were due in part to inexperienced state inspectors and inadequate quality assurance procedures at the state level. Also, the nursing homes could predict when the state inspections would be done, and therefore they could easily hide violations.

Report Makes Suggestions for Improving CMS Oversight of Nursing Homes

The GAO study belies reports by the Bush Administration and the federal Centers for Medicare & Medicaid Services (CMS) stating that there has been “significant improvement” in our nursing homes. Besides rooting out hidden violations in our nursing homes, the CMS faces other challenges, according to the GAO study:

Although the CMS web site, Nursing Home Compare, is supposed to be a consumer resource, it includes inadequate or inaccurate data.
About 21 percent of nursing homes do not have adequate sprinkler systems, which can save lives if a fire breaks out. CMS is in the process of updating its rules to require these systems, but the agency is undecided about the length of a phase–in period before it requires compliance.
Better standards should be established for hiring and retaining qualified inspectors.

Finding Out About Nursing Homes

The 81–page GAO study can be found on the GAO web site. You will need to obtain a copy of Adobe Acrobat Reader to open this file. If you do not already have this software, you may download a free copy at the Adobe Acrobat web site.

At Brayton Purcell, we are concerned with the level of care in nursing homes. We can help you with problems such as nursing home violations and inadequate pain management. If you have questions about a nursing home and your legal rights, or the rights of an elderly loved one, please feel free to contact us for more information.

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