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."
For example, in Arkansas the nursing home industry was a top contributor for state candidates in 2004, according to Followthemoney.org, a nonpartisan database of campaign contributions. The Arkansas Health Care Association, which represents for-profit nursing homes, gave almost $100,000 to state politicians.
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.
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."
According to the Consumer Report, this pressure "gives facilities the confidence to push back in so many ways, like appealing citations and sanctions because they know that state legislators tend to be very protective of homes in their districts," says Iris Freeman, principal consultant with Advocacy Strategy, a Minneapolis firm that works with community groups on behalf of the elderly and disabled.
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."
"The most honest employees on this issue," he explains, "are low-level employees who do not know that inspections are supposed to be without notice, so they do not know that they are revealing a secret."
"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.
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