GAO EXAMINES USE OF ENFORCEMENT STRATEGY FOR HANDLING NURSING HOMES PROVIDING EXTREMELY POOR CARE
WASHINGTON, D.C. - Today Senators Herb Kohl (D-WI) and Chuck Grassley (R-IA), along with Reps. Henry A. Waxman (D-CA), Pete Stark (D-CA), and Jan Schakowsky (D-IL), released a report by the U.S. Government Accountability Office (GAO) examining the federal government's use of sanctions on nursing homes whose negligent practices are found to be harming residents. The report specifically looked at the use of the federal government's temporary management sanction, under which the administration of a troubled nursing home is replaced for a period of time in order to rapidly correct severe safety and quality deficiencies that are jeopardizing residents' health.
"It is not enough to make enforcement tools available to nursing home regulators - we need to make sure they are being used effectively," said
Senator Kohl, chairman of the Senate Special Committee on Aging. "GAO lays out some really helpful recommendations here, including the creation of a list of best practices on how states can implement temporary management sanctions. I commend CMS for being receptive to these suggestions and for exploring taking further steps to ensure both short and long-term compliance."
"The GAO report highlights the effectiveness of temporary management sanctions in ensuring that nursing homes meet CMS quality requirements," said
Rep. Waxman, chairman of the House Energy and Commerce Committee. "I will work with CMS to see that the Agency makes this approach to improving nursing home quality easier to use and more effective. We must ensure that the most vulnerable of our population - the elderly and the disabled - are safe and receive the quality of care they deserve."
"When nursing homes are neglecting seniors, it's the job of the government to step in," said
Rep. Stark, chairman of the House Ways and Means Health Subcommittee. "The recommendations in this study will help CMS more effectively sanction shoddy nursing homes, and I am reassured that CMS agrees that more can be done. I look forward to seeing steps by the Agency to improve the quality of nursing home care."
GAO gathered information from every state in which the federal temporary management sanction had been put into action between 2003 through 2008, finding that use of the sanction is very rare. During this time period, the temporary management sanction was applied only 14 times to nursing homes in ten states. Through analyses of facility compliance histories and interviews with state officials, GAO identifies the most common instances in which the sanction was used and whether it is effective in those instances. The report also found obstacles to the use of the sanction. For example, state inspectors reported that in some cases they were unable to locate a temporary management company that could step in immediately and seamlessly take over the operations of a home in crisis.
In comments made about the report, the Centers for Medicare and Medicaid Services (CMS), which has jurisdiction over the nation's more than 16,000 nursing homes, agreed with GAO's assessment that the federal government can do more to provide guidance and best practices to states and regional offices that would help them implement the temporary management sanction more effectively when a situation calls for it. GAO also suggested that CMS work with states to develop a list of temporary managers who are qualified to step in on short notice and mitigate crises of care at nursing homes.
The report also announces CMS' intention to form a state-federal workgroup that will examine a range of strategies to incentivize nursing homes to maintain long-term compliance after they have been disciplined for poor care. Currently, many facilities "yo-yo" in and out of compliance, doing just enough to address a sanction in the short-term before falling below quality standards again.
All of the requestors are cosponsors of the
Nursing Home Transparency and Improvement Act, a bill that would give consumers more information about individual nursing homes and their track record of care, give the government better tools for enforcing high quality standards, and encourage homes to improve on their own. AARP has called the bill, which would significantly raise the bar for standards of care in nursing homes for the first time since 1987, "one of the most significant nursing home reform initiatives" in two decades. The bill has been included in both Senate and House health reform legislation.
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The GAO report can be found here:
http://www.aging.senate.gov/letters/gaonhtempmgmt.pdf
