Monetary Sanctions for Nursing Home "Deficiencies" Too Low to Create Change
Valueless Lives of Elderly and Disabled in Nursing Homes
Information Bulletin # (5/08)
Federal monetary sanctions and fines against nursing facilities that fail to comply with federal minimal standards of care are abysmally low, reflecting how little value or worth elderly and disabled persons are to the Department of Health and Social Services' Centers for Medicare & Medicaid Services, the federal agency that is supposed to punish nursing facilities for the injuries they cause residents.
In a recent report, the Center for Medicare Advocacy reviewed 85 of the 2007 HHS enforcement decisions, and the monetary fines imposed against nursing facilities that had failed to comply with the federal standards that are supposed to ensure proper care and protection to people in nursing homes. Even though CMS could terminate the nursing facility's Medicaid payments, deny payment for new admissions or a combination of penalties, nearly all the deficiencies resulted in only small monetary
fines.
These administrative decisions/cases involved extremely serious failures/deficiencies: deaths, over medications, amputation of limbs, development of avoidable pressure sores, elopements, failures to give prescribed medications, and many other injuries. When HHS finds such violations, it gives the nursing facilities an "opportunity to correct" the deficiency. It's important to understand that money penalties are imposed NOT for the deficiency - the death, the amputation, etc.- but for a nursing facility's failure to correct the deficiency.
Fines, penalties and sanctions are imposed only if the nursing facility does not achieve substantial compliance with the standards within a given time period. That must be a great relief to the dead person, the person in pain with the avoidable pressure sure or the person who was over
medicated. Also, the dollar amount for serious deficiencies is only $3,050 -$10,000 per day. That surely must really frighten nursing facilities that receive Medicaid reimbursements, depending on your state, between $40,000 - $65,000 per year per person. If a nursing facility had 100 Medicaid recipients @ $50,000 per year, the following fines/penalties would not have much of an impact on the profits.
Here are a few of the deficiencies and the "penalties":
- Failure to provider CPR to resident who then died - $53,200 penalty [resident in cardiac distress, who was not transferred to the hospital or given emergency treatment, including CPR.]
- Strangulation death on bed rail - $4,050 penalty [88 year old resident who had fallen numerous times from her bed, found with her neck wedged between the side rail and the mattress.]
- Leg amputation following failure to follow doctors' treatment orders - $7,500 penalty [resident admitted for short-term rehabilitation following surgery for a fractured ankle. Nursing facility did not bring resident for follow-up visit and subsequently failed to monitor for infection and treatment, including antibiotics. Resident's leg had to be amputated.]
- Elopement death - $64,050 penalty [resident with history of elopement found dead a week later. Nursing facility failed to implement care plan that required monitoring every two hours. Nurse falsified report, counting resident present, even though she did not see resident.]
- No pain medication for three months - $7,500 penalty [ Resident, who cried out when she was given care and stopped crying when care was completed, was not given pain medications. Resident not given pain medication for three months, despite doctor's order that pain medication be administered
"as needed." ] - Sexual assault of resident by aide and staff failure to report sexual assault - $12,600 penalty [resident sexually abused, reported it, but next day the same aide was assigned to take care of resident.]
- Choking death of one resident and other residents' dehydration during heat wave - $80,000 [resident whose care plan required he be fed, fed himself, choked and died. Same nursing facility failed to provide residents with necessary care and services during heat wave, resulting in residents' suffering from dehydration.]
- Failure to monitor blood sugar levels, leading to re-hospitalization with hypoglycemia four days after admission to nursing facility - $38,700 penalty.
- Ten consecutive overdoses of morphine and other medication errors -$178,150 penalty.
The full report and many other case descriptions can be found at www.medicareadvocacy.org/SNF_08_05.13.DABNursingHomeDecisions.pdf
Elderly and Disability Advocates:
These incidents are not even the tip of the iceberg. Advocates who visit nursing facilities regularly hear and see regularly many, many other "deficiencies." Maybe it's time we publicly point out these violations in the press.
The Nursing Home Reform movement apparently believes that more money to nursing facilities will improve these institutions, despite the past 20 years of increased Medicaid reimbursements. Does not the continuation of these abuses demonstrate that institutions cannot and will not provide the care that elderly and disabled people deserve?
It's obviously beyond the CMS political will to shut down these nursing facilities that are literally killing some elderly and disabled persons.
CMS (and Congress) has known about these abuses for years, but continues to impose these paltry money penalties that do not amount to "chump" change. What about enlisting private lawyers to bring real damage actions against these nursing facilities? Although there have been some such litigation, the number of cases has been relatively minimal. Nursing homes are quite worried that such litigation will increase, and that's why the nursing home industry in a number of states have tried to prevent such
litigation.
~Steve Gold, The Disability Odyssey continues






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