How Effective Are Inspections of Nursing Homes' Deficiencies?

From Steve Gold:

How Effective Are Inspections of Nursing Homes' Deficiencies - Nursing Facility Residents' 2007 Clinical Characteristics. 
Information Bullet #240 (1/08).

CMS' 2007 Nursing Home Data Compendium was recently released.  In the previous two Information Bulletins # 238 and 239, we looked at the distribution of people in these institutions by ADLs and cognitive impairments and by medical care being provided. In this Information Bulletin, we look at how well States do monitoring nursing home deficiencies. Click here and scroll down to Nursing Home Data Compendium 2007 - Part 1 and 2 to see how your States compares.

CMS has defined "Substandard Quality of Care" (SSQC) to include Resident Behavior and Facility Practices, Quality of Life, and Quality of Care. 

As can be seen in the two previous Information Bulletins, deficiencies reflect what nursing facilities do that injure residents, both affirmatively and what they do not do which also may result in injury to nursing facility residents.

CMS ranks deficiencies. ALL of the following deficiencies in this Information Bulletin either are, at least, widespread in the nursing facility and cause greater than minimal harm, OR their severity put residents either in immediate jeopardy or actual harm.

The following percentages reflect the mean number of citations in a state, not the number of nursing homes.

The deficiency data presented here urgently demand the need for much stronger enforcement of nursing home standards. This data raises questions regarding why States are not, based on these and other on-going deficiencies, imposing severe penalties on violators.  Such penalties could include monetary fines, shut-down, refuse to pay Medical Assistance for residents in these nursing facilities.  What has your State done?

It is unconscionable that States permit nursing facilities to have repeated health deficiency citations and not either close them down or take other severe enforcement measures. It is beyond the pale that States permit nursing facilities to put people either in immediate jeopardy or actual harm. [See the news story at the end of this Information Bulletin.] Advocates should be livid that Older Americans and people with disabilities are being affirmatively harmed by these institutions.

Nursing Facility Deficiencies:
   
A.  Only 8.2% of the States' nursing home surveys had ZERO health deficiencies' citations. (Table 4.5.(e)).

The following states, in descending order, had the most nursing facility health deficiencies cited.

NH, 27.8%,
OR, 25.2%,
MA, 18.3%,
WI, 16%,
OH, 14.5%,
IA, 13.2%,
VA, 12.9%,
IL, 12.7%.

B.  18.2% of all States' nursing facilities had surveys resulting in a health deficiency of "actual harm or immediate jeopardy to residents."
(Table 4.8.(e)).

The following states, in descending order, had the most health deficiency citations of "actual harm or immediate jeopardy to residents." All had more than, or nearly, twice the national average.

CT, 43.3%,
CO, 43.0%,
DE, 38.6%,
ID, 35.7%,
IN, 33.7%,
KA, 32.9%.

We are still waiting to hear why nursing facilities that put residents in "actual harm or immediate jeopardy" are not investigated for criminal wrongdoing.

Advocates might want to contact your local U.S. Attorney offices and explore why they are not investigating actual abuses.  These nursing facilities are using federal funds to put residents in "actual harm or immediate jeopardy."

C.  9.8% of all States' nursing facilities were cited for a deficiency for using restraints on residents. (Table 4.17(e)).

The following states, in descending order, had the most citations for use of restraints.  All had more than, or nearly, twice the national average.

WY, 23.5%,
MN, 20.6%,
HI, 20%,
CA, 18.7%,
NV, 17.8%,
AK, 17.1%,
CN, 16.9%. 

Why are States' MA officials reimbursing nursing facilities that receive such deficiencies?  Why are they using Medicaid's federal and state funds to pay for nursing facilities using restraints?

D.  Nearly 18.3% of all states' nursing facilities had surveys resulting in a citation for failure to treat or prevent residents'
pressure ulcers.  (Table 4.18.(e)).  What follows is the percent of all nursing facilities by state that were cited for "Failure to Treat or Prevent Pressure Ulcers." As in the previous year, there is a very wide spread among the States.

Let's remember, these are "Failures to Treat or Prevent" pressure sores! 
Such failures can result in death of persons with disabilities. These deficiencies aren't the result of accidents or forgetfulness.  Obviously, behind these percentages are large number of nursing residents (all of whom are Older Americans and/or younger persons with disabilities), who are being unnecessarily injured and harmed, and many may not recover.
       
Alabama           18.7%   
Alaska             O%   
Arizona           12.8%   
Arkansas          28.6%
California        19.1%
Colorado          21.7%
Connecticut       32.7 %
Delaware          40.9%
D. C.             27.3%
Florida            9.5%
Georgia           19.3%
Hawaii             4.0%                  
Idaho             40.0%
Illinois          21.1% 
Indiana           23.1%    
Iowa              10.6%
Kansas            44.5%
Kentucky           6.6%
Louisiana         12.9%
Maine             30.4%
Maryland           8.5%               
Massachus          9.3%      
Michigan          21.6%
Minnesota         71.1%
Mississippi        4.1%
Missouri          24.8%
Montana            5.4%   
Nebraska          15.2% 
Nevada            17.8%
New Hamp          11.4%
New Jersey        15.4%
New Mexico        10.1%          
New York          18.3%
North Carolina     6.6%
North Dakota      19.0%
Ohio              17.9%   
Oklahoma          14.5%
Oregon            17.0%
Pennsylvania      12.7%
Rhode Island       9.6%
South Carolina    21.9%   
South Dakota      10.4%
Tennessee          9.1%
Texas             15.9%
Utah               2.1%
Vermont           23.1%   
Virginia          17.9%               
Washington        19.8%       
West Virginia      8.4%
Wisconsin         12.5% 
Wyoming           26.5%
National          18.3%

Following is a news story we just received.

Man Found With Maggots In Eye Dies. Cause Of Death Not Known

DELTONA, Fla. -- "A Volusia County nursing home resident who was found with maggots in one of his eyes, an infected breathing tube, a partially inserted catheter and bed sores has died, according to his family.

Anthony Digiannurio, of Deltona, was 82 years old when he was transported in November from the University Center West nursing home to Florida Hospital DeLand, where staff members discovered the ailments.

It is not known if the cause of death was related to the aforementioned conditions.

According to a DeLand police report released in November, a representative from University Center West said that the man had constant care from multiple hospice workers and two certified nursingaides at the nursing home.

Officials from the state Department of Children and Families were investigating the incident.

The U.S. Department of Health and Human Services has found 19 deficiencies at the facility since June 2006."

Hmm.  Is this enough to push the Older American and disability advocates into action?

    ~Steve Gold, The Disability Odyssey continues

Comments

[superbooks7@yahoo.com]

We need MORE people to visit inside of nursing homes. Care and attention is DIFFERENT while visitors are present. When visitors leave, care changes and things really look 70 percent different /and lack of care and non-care exists. We need more community organizations to come inside these places to VISIT various patients and residents. We need to begin an OUTREACH to all community organizations and have groves of individuals and groups visit all the nursing homes and REHABILITATION centers on a REGULAR basis. If you are a Priest or Rabbi or any other community leader, please organize your group and make a real effort to go inside these places.
At least for the time that you are there visiting, MANY residents will have better care, more care and will be treated better.

THIS is a serious request. Contact superbooks7@yahoo.com if you are willing to be organized or to enter into some community effort to help visit nursing homes.

There are residents who receive no visitors, and in some cases there are rehabilitation centers who make an effort to keep visitors OUT just so they can let the care down, put on less workers and do less work.

Please begin YOUR community efforts to visit MORE nursing homes and physical rehabilitation and care centers --not just at holiday time, but every single week throughout the year. These residents NEED your visits; they NEED your help, but they are afraid to speak out because they live there.