GAO report discovers nursing home shortfalls
GAO report discovers nursing home shortfalls
Agency asks HCFA for greater oversight
Despite increased efforts by the Health Care Financing Administration (HCFA) to improve oversight of nursing home care, 25% of the nation’s more than 17,000 nursing homes have deficiencies that "caused actual harm to residents or placed them at risk of death or serious injury," according to a report released by the General Accounting Office (GAO) in Washington, DC.
The most frequent violations causing "actual harm" included inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents’ needs to provide appropriate care, the report states. The report points out, however, that the survey, conducted between December 1997 and March 1999, focused on homes that had been referred to HCFA for enforcement action.
HCFA’s sanctions against noncompliant nursing homes have little impact, the GAO report states. "The threat of sanctions appeared to have little effect on deterring homes from falling out of compliance again because homes could continue to avoid the sanctions’ effect as long as they kept correcting their deficiencies. HCFA has some tools to address this cycle of repeated noncompliance, but has not used them effectively."
Issues that remain to be addressed, according to the GAO report, include the following:
• strengthening the use of civil monetary penalties;
• improving the referral process for sanctions;
• increasing the deterrent effect of terminating homes from the Medicare and Medicaid programs.
HCFA representatives did not return phone calls from Rehab Continuum Report about the report.
At least one industry group has expressed concerns about the report. The American Occupational Therapy Association (AOTA) in Bethesda, MD, has called for an additional study of clinical issues that may be indicators of poor care given the constraints imposed by the prospective payment system. "Our members are reporting to their professional association their experiences of being laid off and having their hours cut substantially," said Jeanette Blair, executive director, in an AOTA statement. Blair added that AOTA members working in nursing homes are "seriously concerned that their removal from treatment plans is jeopardizing patient care."
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