WHEN the worst of the worst in nursing homes repeatedly fail to comply with federal health and safety standards, it should follow that penalties be swift and severe. But they are neither, according to a report by congressional investigators, which perhaps speaks to the high-powered influence of the nursing home industry in Washington.
The Government Accountability Office reviewed industry progress over the last decade, purposely focusing on nursing homes with a history of compliance problems. Sen. Charles Grassley of Iowa was alarmed by the outcome.
The senior Republican on the Finance Committee, which oversees Medicaid and Medicare, said after all the struggle to reform substandard nursing homes, "the federal agency that's supposed to coordinate regulatory efforts is taking an approach that is undermining the sanctions that are available to try to improve care in the most questionable nursing homes."
The GAO found federal officials reluctant to levy stiff penalties on even the worst-performing homes lest the setbacks in fines or denied Medicaid and Medicare business bankrupt the facilities. It appeared the overriding concern of the Department of Health and Human Services was to keep even notorious nursing homes operating regardless of the potential risk to patients.
The accountability office, an investigative arm of Congress, discovered that many of the worst violators of federal nursing home standards figured out how to beat the system and keep collecting their Medicaid and Medicare payments.
Federal investigators said some homes, repeatedly cited for mistreatment of patients, would easily "cycle in and out of compliance" with lax government scrutiny and oversight.
In Michigan, investigators found a nursing home still open after repeatedly being cited for "poor quality care," poor nutrition services, medication errors, and even hiring staff previously convicted of abusing patients. Apparently, violators avoided serious federal penalties by making temporary improvements and then lapsed back into noncompliance.
The government is supposed to take prompt enforcement action against nursing homes that repeatedly threaten patients with poor care, but immediate sanctions are not so immediate. The Bush Administration gives offending homes a grace period to come up to code.
Leslie Norwalk, who's in charge of Medicare and Medicaid services, offered the warped logic that harsher penalties against the worst nursing homes could ultimately backfire on their patients. Financial hardships caused by steep fines or denied Medicare and Medicaid payments could force some repeat violators to close, she said, leaving patients without access to nursing home care.
If the government can be so cavalier about the worst of the worst, who's protecting the roughly 1.5 million people living in nursing homes on any given day, or the more than 3 million requiring nursing home care during the year?