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Nursing Homes, GAO Report and Your State

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From Steve Gold's Treasured Nuggets of Information

Information Bulletin 101, February 2006

Recently, a well-known national disability advocate, philosopher, and political wizard noted, "We have not changed the cultural mind set that nursing homes are where we [younger disabled persons] and old folks [older disabled persons] belong. Where has been the outrage about the institutional bias for the last 50 years?" When the Disability Odyssey Continues reporter asked him why he thought this has not occurred, the wise person responded "because people aren't aware of the options in the community." Obviously, this is correct to a large extent, but probably is not the full explanation.

Another reason is the fact that nursing homes are a $75 billion dollar a year industry ($65 billion is from our tax money via Medicaid and Medicare), and there's a LOT of profit. (See the Information Bulletin "Salaries, Profits and Nursing Homes," July 13,2005.) With financial profits comes political donations. Maybe someone needs to do a survey nationally and state by state regarding political contributions from the nursing home industry and lobby to our elected officials. Otherwise, what policy reason justifies your elected officials not welcoming a "Money Follows the Person" in your State to save money! (Mississippi and New Mexico are on the way of passing such legislation.)

After all, in the past twenty years, virtually every State has wisely reduced and/or eliminated its institutional State Centers for persons with developmental disabilities and provide community-based services. Most States have significantly reduced their institutions (euphemistically called "hospitals") for persons with mental disabilities and provide community-based services. So again, the question why have we not changed the cultural mind set regarding persons unnecessarily institutionalized in nursing homes?

Which leads to another reason. The DD state centers and MI "hospitals" were dangerous and caused significant physical harm and injury to persons in them. They could not be "fixed up." National press focused on this and helped change the cultural mind set.

Which leads to the January 17, 2006 Government Accountability Office Report regarding the failure of States to accurately report the injury and harm that nursing homes AFFIRMATIVELY CAUSE to persons with disabilities. Since 1998, the GAO has issued 14 reports on significant nursing home deficiencies, but there has been very little if any outrage from editorial pages, no national TV reporting, even very few news coverage of the GAO reports, and no press calls to give people a Real Choice where they want to live.

Now the most recent GAO report (GAOGAO-06-117, "Nursing Home Quality and Safety Initiatives") reports State by State (see below for your State) how your State inspectors "allows homes to conceal problems...". Here are some of its findings:

  1. "Nursing homes repeatedly caused ACTUAL HARM to residents, such as worsening pressure sores or untreated weight loss, or placed residents at RISK OF DEATH or SERIOUS INJURY." If a relative did that, there would be criminal charges filed. Shouldn't nursing homes have criminal charges against them for the same conduct?

  2. "The results of state inspections... UNDERSTATED the extent of SERIOUS quality-of-care problems, reflecting ... inconsistent application of federal standards." Why hasn't the federal agency, CMS, withheld federal Medicaid funds in those States for violating the federal standards, over and over again? Why hasn't your State agencies withdrawn the MA funding from these nursing homes? Why hasn't your State Attorney General or local District Attorney investigated and filed criminal charges? Why hasn't the U.S. Department of Justice taken action?

  3. "SERIOUS complaints by residents, family members, or staff alleging HARM to residents remained UNINVESTIGATED FOR WEEKS OR MONTHS...." Again, where are the criminal investigations of such derelictions? Where is your Medicaid office? Your State Attorney General? District Attorney? DOJ?

Let's review only the "understating BY STATE SURVEYS of SERIOUS DEFICIENCIES" in nursing homes that place residents at risk of "actual harm or immediate jeopardy." What is very important to keep in mind is that CMS ACKNOWLEDGES the following percentages of nursing homes in your State are UNDERSTATED BETWEEN 8 TO 33 PERCENT. That's correct, whatever your State survey found and reported is low by 8 to 33 percent. CMS also acknowledges that there is an "increase in such discrepancies [between what your State admits and what CMS found in the same nursing homes] from 22 to 28 percent." Also, it is also very important to remember that these are percentages of nursing homes and not people in them.

Percentage of nursing homes cited by State officials for CAUSING actual harm or immediate jeopardy, including "instances of severe weight loss, multiple falls resulting in broken bones and other injuries, and serious, avoidable pressure sores," as well as "numerous instances of serious, understated quality-of-care problems." Remember, the following are UNDERSTATED by 8 to 33%:

Percentage of nursing homes cited by your State agency for causing actual harm or placing residents in immediate jeopardy:

The national average was 15.5%.

What advocates should do:

  1. Hold a press conference with persons who have escaped the nursing home and who have either witnessed or been victims of the this harm. Bring copies of the GAO report. Change the cultural mind set. Nursing homes are institutions that like DD Centers and MI hospitals cannot be "fixed." The only option is community-based services, exactly what most people want!

  2. Ask your State Attorney General why he or she has not conducted criminal investigations into these homes?

  3. Ask your Governors why they are using precious Medicaid funds to keep these facilities in existence and causing serious injury to persons with disabilities? Unless your State offers Money Follows the Person, it is condemning persons with disabilities to be at significant risk in nursing facilities.

  4. Ask your Governor whether he or she will personally spend (incognito) the next four weekends as a resident in a nursing home? Would your Governor or State legislature place their relatives at such risk?

  5. Ask your State Medicaid officials why they have not withheld MA funds from these nursing homes and decertified them?

Steve Gold, The Disability Odyssey continues