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Gulf States Advocates For Nursing Home Reform, Inc.
Stop Nursing Home Abuse
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Press Releases
*_For Immediate Release_*
July 24th, 2007
*GRASSLEY WANTS PUBLIC TO KNOW MORE ABOUT NURSING HOMES THAT FALL SHORT
OF FEDERAL HEALTH AND SAFETY STANDARDS*
WASHINGTON — Sen. Chuck Grassley wants a watch list created to alert the
public about nursing homes nationwide that have repeatedly failed
federal health and safety standards.
"The public isn’t able to know as much as it ought to know about nursing
home quality. This is because sanctions are not publicly reported and
some sanctions are rescinded before their effective dates based on fixes
that turn out to be only patches that mask permanent problems," he said.
"A watch list could identify the nursing homes that repeatedly fall out
of compliance. That would be good for consumers and their families."
Grassley based his request on the findings of the Government
Accountability Office. Grassley had requested this independent review to
assess progress in making improvements to federal enforcement. He said
the report that was issued in April revealed shortcomings in the federal
effort to coordinate regulatory efforts and an enforcement approach that
undermined the sanctions available through the law."
Grassley has long worked to improve the quality of care provided in
nursing homes. As Chairman of the Senate Special Committee on Aging
during the late 1990s, he conducted an oversight effort that resulted in
the launch of the "Nursing Home Initiative" by the federal agency then
known as the Health Care Financing Administration. The goal of the
initiative was strong regulations and steadfast enforcement by federal
and state officials. Since the launch of the Nursing Home Initiative,
Grassley has frequently asked the GAO to provide status reports on the
progress made in holding homes accountable for the quality of care
provided to vulnerable residents.
Today, Grassley is Ranking Member of the Senate Committee on Finance,
which is responsible for Medicare and Medicaid oversight and
legislation. Nearly 1.7 million elderly and disabled Americans live in
17,000 nursing home facilities across the country. Combined Medicare and
Medicaid payments for nursing home services total an estimated $70
billion annually.
This week, Grassley made his request in a letter sent to the Center for
Medicare and Medicaid Services, the federal agency responsible for
overseeing enforcement of laws to protect nursing home residents from
abuse and neglect. He said the watch list should include nursing homes
that yo-yo in and out of compliance by using grace periods to correct
deficiencies temporarily.
The text of Grassley’s letter about the need for a new watch list
follows here.
July 23, 2007
Herb Kuhn
Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Acting Administrator Kuhn:
As Ranking Member of the United States Senate Committee on Finance
(Committee), I have a longstanding commitment to ensure that nursing
home residents receive the quality care they deserve. In America today,
there are nearly 1.7 million elderly and disabled individuals in
approximately 17,000 nursing home facilities. As the "Baby Boom"
generation increases in age, this number is going to rise dramatically.
It is therefore critical that the federal government does everything it
can to ensure that America's nursing homes deliver high quality care to
nursing home residents on a consistent basis.
As part of this effort, the Centers for Medicare and Medicaid (CMS) has
the duty to oversee health and safety standards in nursing homes, and
the responsibility to impose sanctions when appropriate if a facility
fails to meet these standards. Additionally, these congressionally
authorized sanctions are critical tools in ensuring that America's
nursing homes provide quality care and their residents are protected
from abuse and neglect. Yet too often, these sanctions are rescinded
prior to their effective dates as repeat offender homes "yo-yo" in and
out of compliance by using grace periods to correct deficiencies
temporarily. By doing so, they continue to harm their residents while
avoiding the sanctions. I know that you agree with me that this is
intolerable.
Concerned about this pattern, I asked the Government Accountability
Office (GAO) to assess CMS’s progress in improving the enforcement
process. Specifically, I asked GAO to: assess CMS’s sanctions against 63
nursing homes with a history of harming residents; determine which homes
cycled in and out of compliance; examine the sanctions placed upon them;
and to report on CMS's general management of sanctions. GAO's report,
"Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not
Deterred Some Homes from Repeatedly Harming Residents," is troubling, to
say the least.
GAO examined 63 nursing homes in California, Michigan, Pennsylvania, and
Texas, all of which had been identified in a prior report as having
serious quality problems. Of these, 31-nearly half-continued to cycle in
and out of compliance between fiscal years 2000 and 2005. While 27 of
the 63 homes were cited 69 times for deficiencies warranting immediate
sanctions, in 15 of these cases immediate sanctions were not imposed.
Eight of the homes reviewed cycled in and out of compliance seven or
more times each during this period. This does not make sense. These 31
homes - 2 of which are in California, 15 in Michigan, 5 in Pennsylvania,
and 9 in Texas - appear to be only part of a nation-wide problem.
Furthermore, GAO found that the sanctions CMS has imposed have had
little effect because they are often imposed at the lower end of the
available range.
In its report, GAO made several recommendations which would help solve
these problems, including the development of an administrative process
to collect monetary penalties before the exhaustion of appeals, a
strengthening of certain sanctions, and an expansion of enforcement
actions against homes with a history of noncompliance. I applaud these
recommendations and look forward to seeing them implemented, though I
think CMS should go further.
I am particularly interested in efforts to increase transparency and
give the public better access to information about nursing home
compliance. Currently, the public has access to nursing home information
through "Nursing Home Compare," hosted at www.Medicare.gov. While this
site is already an indispensable resource, it could be improved by
identifying the worst nursing homes that repeatedly fall out of
compliance, such as the 63 homes listed in the GAO report, though a
"watch list."
That "watch list" would identify the homes that are repeat offenders and
the sanctions that imposed upon them. By listing nursing homes and
implemented enforcement actions online, the public would have easy
access to this information and nursing homes should be incentives would
have an extra incentive to meet quality standards. This list 1) should
be easily accessible online, 2) ought to be searchable by location and
name, and 3) should clearly identify the nursing home, the date of the
sanction placed against it, and a detailed description of why the
sanction was put in place.
The process of choosing a nursing home is a very important and personal
one for thousands of American families every year. If CMS were to make
such a watch list easily available to the public, families could make
this important decision armed with complete information about a
prospective nursing home's quality of care. As I know you share my
commitment to ensuring that nursing home residents receive the quality
care they deserve, I look forward to seeing your efforts to create such
a watch list.
I would appreciate a briefing to my staff on this issue at your earliest
convenience.
Sincerely,
Charles E. Grassley
Ranking Member
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