Safety alert: The quality of nursing-home care In July 2003, an 81-year-old Arkansas woman was beaten at a nursing home by two of the facility’s employees, who police say used brass knuckles to inflict fatal injuries. While her death may have been more gruesome than most among the nation’s 1.6 million nursing-home residents, physical abuse and neglect at nursing facilities are not unheard of. Study after study by independent researchers and government agencies have documented problems with the quality of care in hundreds of the 17,000 nursing homes in the U.S. “Abuse and neglect are persistent problems,” says Charles D. Phillips, a gerontologist and professor at the School of Rural Public Health at Texas A&M University. To make consumers more aware of nursing-home problems, Consumers Union’s Center for Consumer Health Choices recently released a report, “How Good Are Your State’s Nursing Homes?” It identified 368 facilities across the country that either have appeared on all three of Consumers Union’s Nursing Home Watch Lists over the past three years or have exhibited a “yo-yo” pattern of compliance with health and safety regulations: They correct deficiencies one year but have recurring problems the next. CU’s Watch List identifies about 10 percent of nursing homes in each state whose inspection reports raise questions, in our judgment, about the quality of care given to residents. The Center also found an increase in the percentage of facilities cited for placing residents in immediate jeopardy: 6.8 percent of facilities were cited in 2002, compared with 5.6 percent in 2001. Why do the studies tell such a grim story? Much of the problem stems from a reimbursement system that many experts say does not adequately compensate facilities for providing good care. Poor care also results from a failure of the regulatory process--a joint effort by states, which conduct periodic inspections of nursing facilities, and the federal Centers for Medicare and Medicaid Services, which pays for a large portion of nursing-home care. Penalizing nursing homes is part of that process. The Center for Consumer Health Choices examined monetary penalties assessed by the states and found that although 39 could levy fines against bad nursing homes, only about half of them did so. In states that could levy fines, only about half of the facilities on our lists were penalized. The average fine was about $13,000. Three times, Connecticut fined one facility $1. The federal government also levies fines against nursing homes, but it is nearly impossible for the public to learn about them. The Center for Consumer Health Choices made a Freedom of Information request last December for a list of federal fines levied against nursing facilities across the country. To date, we have not received it. If the states are serious about improving care, they should use penalties more frequently and tell the public when they do.
Most states do not issue press releases or post information about penalties on their Web sites. The same goes for the federal
government. A list of penalties should be readily available to anyone who asks for it. Until fundamental changes are made,
publicizing homes that deliver questionable care is the only way consumers can know which facilities to avoid.
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