Government Oversight: Are Nursing Homes Being Held Accountable?
The safety and well-being of loved ones in nursing homes are paramount. When we entrust their care to these facilities, we expect a certain standard of quality and attention. However, the question remains: Are nursing homes truly being held accountable for maintaining these standards, and what role does government oversight play in ensuring resident safety and quality of care?
The State of Nursing Home Oversight
Nursing homes are regulated by both federal and state laws. The Centers for Medicare & Medicaid Services (CMS) is the federal agency primarily responsible for ensuring that nursing homes meet specific quality standards. CMS contracts with state agencies to conduct surveys of nursing homes, investigate complaints, and ensure compliance with federal regulations.
Federal regulations require nursing homes participating in Medicare and Medicaid to comply with quality of care rules. The Nursing Home Reform Act, enacted in 1987, mandates that nursing homes “must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care.” To participate in Medicare and Medicaid, nursing homes must comply with federal requirements for long term care facilities.
These regulations cover a wide range of areas, including:
- Staffing: Facilities must have sufficient nursing staff to meet residents’ needs.
- Resident Assessment: Conducting comprehensive and accurate assessments of each resident’s functional capacity.
- Care Planning: Developing comprehensive care plans for each resident.
- Quality of Life: Promoting each resident’s quality of life, maintaining their dignity and respect, and ensuring their right to choose activities, schedules, and healthcare.
- Quality of Care: Preventing the deterioration of a resident’s ability to perform daily activities, providing necessary services for nutrition, grooming, and hygiene, and ensuring residents are free from medication errors.
- Abuse Prevention: Protecting residents from abuse, neglect, and exploitation.
State oversight agencies also play a crucial role, regulating facilities and investigating complaints of abuse and neglect. These agencies ensure nursing homes comply with CMS regulations and uphold residents’ rights.
Challenges in Accountability
Despite these regulations and oversight mechanisms, challenges persist in holding nursing homes accountable.
- Underreporting of Abuse: Abuse in nursing homes is often underreported, making it difficult to identify and address.
- Data Limitations: CMS data may not readily identify the type of abuse or perpetrator, hindering effective analysis and response.
- Lack of Guidance: CMS has not always provided clear guidance to nursing homes on what information to include in self-reported incidents, leading to incomplete information and delays in investigations.
- Infection Control Deficiencies: Prior to the COVID-19 pandemic, a high percentage of nursing homes were cited for infection prevention and control deficiencies, with many having persistent problems across multiple years.
- Financial Transparency: There are concerns about the lack of transparency in how nursing homes spend taxpayer funds, particularly regarding “related party transactions” where profits may be diverted to businesses owned by the nursing home.
- Staffing Shortages: Many Michigan nursing homes struggle to provide adequate staffing and meet residents’ basic needs.
How Nursing Homes Are Held Accountable
When nursing homes fail to meet the required standards, several enforcement actions and remedies can be imposed:
- Termination of Provider Agreement: CMS can terminate the agreement, preventing the facility from receiving Medicare and Medicaid payments.
- Temporary Management: Appointing a temporary manager to oversee the facility’s operations and ensure compliance.
- Denial of Payment: CMS can deny payment for all Medicare and/or Medicaid residents or for new admissions.
- Civil Money Penalties: Imposing fines for non-compliance.
- State Monitoring: Implementing state monitoring to oversee the correction of deficiencies.
- Directed Plan of Correction: Requiring the facility to take specific actions within specified time frames to correct deficiencies.
- Directed In-Service Training: Mandating specific training for staff to improve their skills and knowledge.
- Criminal Prosecution: In cases of serious harm or death due to abuse, law enforcement agencies may investigate and press criminal charges against responsible parties.
What Can You Do?
If you suspect abuse or neglect in a nursing home, it’s crucial to take action:
- Report to the Nursing Home Administration: Report your concerns to the nursing home administration and request an internal investigation.
- Contact Government Agencies: File a formal complaint with Adult Protective Services (APS), the Centers for Medicare & Medicaid Services (CMS), or the state health department.
- Contact the Long-Term Care Ombudsman: Every state is required to have a Long-Term Care Ombudsman Program, which handles complaints and works to improve the quality of life for those living in nursing homes or other care facilities.
- Seek Legal Assistance: If the abuse has resulted in physical or emotional harm, consult with an attorney experienced in nursing home abuse cases.
- Report Suspicion of a Crime: Federal law requires that everyone who works in a nursing home (including administrative staff and contractors) must report any suspicion of a crime against a resident to both the Department of Health (DOH) and law enforcement.
Several resources are available to help you report abuse and neglect:
- Elder Abuse Hotline: 1-800-677-1116
- National Adult Protective Services Association (NAPSA): Directs you to your state’s APS.
- National Center on Elder Abuse (NCEA): 1-855-500-3537
- Eldercare Locator: 1-800-677-1116
The Five-Star Quality Rating System
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The Nursing Home Care Compare website features this rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. There is one Overall 5-star rating for each nursing home, and separate ratings for health inspections, staffing and quality measures.
Conclusion
While government oversight plays a vital role in ensuring nursing home accountability, challenges remain. By understanding the regulations, knowing how to report concerns, and utilizing available resources, you can advocate for the safety and well-being of your loved ones in long-term care facilities.
Disclaimer: This blog post provides general information and should not be considered legal advice. If you have specific concerns about nursing home abuse or neglect, consult with a qualified attorney.