HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, September 30, 2008

Violations Reported at 94% of Nursing Homes

The New York Times reports that federal investigators said, in a report issued on September 29, that more than 90% of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes.  Robert Pear writes,

Bed_with_flowersAbout 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.

Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.

The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”

On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.”

Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.

The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”

Bruce A. Yarwood, president of the American Health Care Association, a trade group, said: “We know we have to do a better job. We have been doing a better job, in treating pressure sores, managing pain and reducing the use of physical restraints.”

Mr. Yarwood said that the inspection system was broken. “It does not reliably measure quality,” he said. “It does not create any positive incentives.”

More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are typically inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Deficiency rates varied widely among states. The proportion of nursing homes cited for deficiencies ranged from 76 percent in Rhode Island to 100 percent in Alaska, Idaho, Wyoming and the District of Columbia.

The average number of deficiencies also varied, from 2.5 deficiencies per nursing home in Rhode Island to 13.3 per home in Delaware.

Mr. Yarwood said: “Inspectors are subjective and inconsistent. They interpret federal standards in different ways.”

In December, the Bush administration plans to begin using a five-star system to describe the overall quality of care. The best homes will get five stars. The rankings will be published on a federal Web site.

Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.

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There must have been some forbearance. I am surprised the rate was not 100%. The number of regulations is infinite, and everyone will violate them. The height of the stack of nursing home regulations exceeds that of a horse.

The surfeit of regulation is lawyer bad faith, since almost all regulations have no scientific validity. They are garbage, but effective tools of imposing lawyer power on all productive elements of the economy.

In this case, the violations were paperwork gotcha, another form of lawyer bad faith. All victims of lawyer oppression have an affirmative duty to not just resist their oppression by resisting every demand, but also by insisting on total e-discovery of the lawyer oppressor and of the judge, for improper motive and anti-clinical care bias by the biased hater on the bench. The lawyer oppressor must peer at personal destruction whenever contemplating attacking clinical care. Counter sue. Seek the removal of the judge from the bench. Send patients to express their anger in their offices and at their homes.

Recently, the Supreme Court declared that carbon dioxide was a pollutant, subject to EPA oversight and regulation. That means that Prof. Malloy and all beings using aerobic respiration are polluters whenever they exhale. I am sure an EPA consent decree can be arranged in exchange for agreeing that Prof. Malloy will stop all future exhaling. If she must exhale, she must self-report herself, and maintain detailed records of the violation.

Posted by: Supremacy Claus | Oct 2, 2008 6:12:31 PM

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