According to a September 2006 report by Consumer Reports, "they wield considerable clout in state capitals, where their $500, $1,000, and $3,000 contributions count with gubernatorial, state legislative, and judicial candidates."
The Association also maintains an office near the Arkansas Capitol in Little Rock, Consumer says, where lawmakers can stop in and get a free lunch 3 times a week during legislative sessions.
In return, Consumer Report states, "messages from legislators, subtle and not so subtle, filter down to regulators, who have learned that nursing homes will challenge them if they press too hard."
Grachia Freeman, a former nursing home inspector in Arkansas, said supervisors "would not let me write deficiencies I wanted to write" for a facility. "They were angry with me," she said, "for investigating and told me not to complete the survey."
The Omnibus Budget Reconciliation Act of 1987 established a survey and certification process for states and CMS to verify that Federal standards are maintained in Medicare and Medicaid certified nursing homes.
CMS contracts with state agencies to certify compliance with Federal standards no less than once every 15 months. Additional surveys are also used to investigate complaints. The state uses information from the surveys along with a nursing home's past record to determine what action to take or recommend.
Critics claim that the inspection process has been corrupted by the industry and as a result the large for-profit chains are escaping punishment for blatant violations of federal laws set in place to ensure the proper care of nursing home residents.
A December 2005, Government Accountability Office Report on the quality of nursing home oversight lists 2 consistent and longstanding problems: (1) serious inconsistencies in the results of state surveys; and (2) continual understating of negative findings by state surveyor agencies.
One of the major problems critics say, is that nursing homes are being tipped off about the dates of inspections so that random surveys are seldom random and the predictability allows the nursing home staff to conceal the home's poor quality of care.
Elder abuse Attorney, Phillip Thomas, says, "honest nursing home employees will tell you that the facility knows when the inspectors are coming."
"I have had CNA's flat out tell me that they "always" knew when the inspectors were coming and the facility cleaned up and broke out things like special linens for the occasion," he said.
Attorney Thomas, and attorneys, John Giddens and Pieter Teeuwissen, recently filed 2 lawsuits against the Beverly Enterprises nursing home chain and its related companies in Mississippi.