The Nursing Home Reform Act requires nursing homes to comply with federal regulations for quality of care and specifically states that "a nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident."
However, Consumer conducted an analysis of state inspections for some 16,000 homes nationwide and reported that "two decades after the passage of a federal law to clean up the nation's nursing homes, bad care persists and good homes are still hard to find," in a September 2006 report.
When nursing home facilities are found to be out of compliance or have deficiencies that put residents in immediate jeopardy, states are required to refer case information to Centers for Medicare & Medicaid Services (CMS) for enforcement action.
Once the state refers a case, CMS determines what enforcement actions are warranted. Mandatory remedies are actions that CMS is statutorily required to take to address egregious or extended cases of noncompliance and include termination of the facility's Medicare contract and the denial of payment for new admissions (DPNA).
In enforcement actions, CMS is required to apply the denial of payment remedy for facilities that fail to return to substantial compliance within 3 months and is required to terminate Medicare contracts with facilities that fail to return to substantial compliance within 6 months, or have unabated immediate jeopardy deficiencies for 23 days.
CMS is required to terminate the Medicare contract when the facility still has not reached compliance after application of the required DPNA at 3 months.
For all facilities found to have provided substandard care on three consecutive surveys, CMS must apply the remedies of DPNA, state monitoring of the facility, and the state must notify the attending physician of each affected resident and the state licensing board.
As part of the Office of Inspector General's (OIG) evaluation of the quality of care in nursing homes, an analysis was recently conducted to determine the extent to which the CMS applied the "mandatory remedies" for nursing homes not in compliance.
The OIG released a report in May 2006, that found that in 55 cases requiring the termination of the Medicare contract during 2000-2002, the CMS did not apply the remedy as required in 30 cases or 55%.
The review found that 23 cases that required termination because they were noncompliant for 6 months were not terminated and through reviews of surveys following the study period, the OIG found that all of the facilities not terminated had new cases of noncompliance, serious enough to again require referral to CMS for enforcement action.
Of the 706 cases in 2002, requiring DPNA remedies, the report said 28% were never applied and 14 percent were applied late.
No doubt tired of waiting for the Federal government to act, state law enforcement agencies are cracking down on abuse and neglect of patients in the nursing homes. On January 6, 2006, New York Attorney General, Eliot Spitzer, announced the arrest of 19 employees at two separate nursing homes where hidden cameras produced evidence of serious patient neglect.
In addition to the prosecution of criminal charges, the Attorney General's office also filed a civil lawsuit against the corporations that control one of the nursing homes, including the primary owner and operator of the facility, Anthony Salerno, and a consulting company he owns known as Healthcare Associates.
"The residents of our state's nursing homes are among our most vulnerable citizens," Mr Spitzer stated in the press release. "My office is committed to doing all it can to protect these individuals, who are sometimes without friends and family to protect their interests."
"With these cases," he said, "we are trying to send a message that law enforcement is watching to ensure that appropriate standards of care are met."
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In 1987, Congress passed landmark legislation aimed at improving nursing home care for the nation's vulnerable elderly population. However, a recent investigation by Consumer Reports found poor care in nursing homes is still extremely common, especially in the for-profit chains that have become the dominant force in the industry.
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