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Nursing homes that fail to protect residents from harm will face immediate penalties, and consumers will have access to more information about the quality of nursing home care, under new rules imposed recently by the Health Care Financ ing Administration (HCFA) in Washington, DC.
HCFA administrator Nancy-Ann DeParle recently announced new steps that she says represent the latest in an ongoing effort to ensure that Americans receive quality care in nursing homes. HCFA instituted these new directives:
• States must impose immediate sanctions, such as fines, against nursing homes in more situations — including any time a nursing home is found to have caused harm to a resident on consecutive surveys.
• States now have more flexibility to encourage speedier action to stop payments for new admissions and to impose other sanctions when nursing homes violate federal health and safety requirements.
• Nursing Home Compare, HCFA’s consumer Internet resource found at www.medicare.gov, has been beefed up to include information about the prevalence of bedsores, weight loss, and other health conditions among residents in individual nursing homes.
• HCFA updated its "Guide to Choosing a Nursing Home" to take families and friends step-by-step through the process of identifying an appropriate home for a loved one.
DeParle said the actions extend the Clinton administration’s aggressive initiative to improve enforcement of federal and state standards and to promote quality care for 1.6 million elderly and disabled Americans in nearly 17,000 nursing homes. HCFA strengthened the inspection process to increase its focus on preventing bedsores, malnutrition, and abuse, and it now requires states to crack down on homes that repeatedly violate health and safety requirements.
For fiscal year 2000, Clinton secured more than $50 million in new resources to support the nursing home initiative, including $18.1 million more for states’ Medicare survey efforts and another $15.6 million in Medicaid matching funds available to states. Other resources will support federal oversight activities and increased legal activity related to enforcement.
More power for the states
HCFA issued additional instructions to the state agencies that conduct nursing home inspections for Medicare and Medicaid. Nursing homes that do not fix problems identified in the inspections will lose their ability to receive Medicare and Medicaid payments.
To encourage sanctions to be imposed more quickly, states also received expanded authority to notify nursing homes when they would be denied payments for new admissions and other sanctions for failing to meet health and safety requirements. In addition, HCFA provided guidance for the use of a new enforcement tool that allows fines of up to $10,000 for each serious incident that threatens residents’ health and safety. In the past, fines could only be based on the number of days a nursing home failed to meet federal requirements.
HCFA this year has conducted an extensive training campaign for nursing home inspectors to help states enforce federal requirements more effectively and consistently. Since this spring, HCFA has trained more than 600 federal and state survey managers, who have trained their staffs. Those actions follow other steps HCFA has taken this year to strengthen the state inspection and enforcement process. It instructed state inspectors to increase their focus on preventing bedsores, malnutrition, and abuse in nursing homes. HCFA also is piloting education campaigns to prevent abuse, neglect, and malnutrition in nursing homes and has established a new requirement for states to focus on complaints alleging harm to residents and conduct investigations within 10 days. In addition, states will continue to be required to investigate complaints alleging the most serious violations within two days and to investigate other complaints in a timely manner.
States now must conduct more frequent inspections of nursing homes that have repeated serious violations without decreasing inspections of other facilities. State inspectors now must make the timing of inspections unpredictable and must conduct some visits on weekends, early mornings, and nights to look for quality, safety, and staffing problems at those times.