With toothless regulations and ineffective oversight, many nursing homes are still failing the neediest patients. With its budget for overseeing nursing homes slashed in half, the Center for Medicare and Medicaid Services (CMS) has failed to identify failing nursing homes and keep them accountable. As a consequence, some nursing homes are choosing to accept the infrequent fines instead of changing their behavior.
CMS is responsible for overseeing all nursing homes that receive benefits from these federal entitlement programs. CMS routinely inspects nursing homes for any violations, if a violation is found, then CMS has two options. First, CMS can put the facility on “special focus” status – reserved for the worst offenders. A nursing home with this designation would be routinely inspected more often and, supposedly, would be punished more severely for any violations. Unfortunately, federal budget cuts have blunted the amount of nursing homes that can be put under “special focus.” Since 2012, the budget for inspecting facilities with this designation has dropped by half. Consequently, despite regulators identifying 435 facilities that warranted this designation, only 88 nursing homes were actually put on the watchlist. Further, once a facility has been designated as a “special focus” facility, it is only required to pass two inspections to be removed from the watchlist. Not surprisingly, one-fourth of nursing homes are removed from the heighted, and more frequent inspections within a year. Even less surprisingly, more one-third of all nursing homes that were once designated as “special focus” still have a one-star Medicare rating – the lowest possible. Despite the recurring violations and harm to patients, facilities are rarely denied reimbursement from Medicare and Medicaid.
CMS’s second option for poorly performing nursing homes is a fine. Unfortunately, this also appears to fail when it comes to reforming nursing homes. As more nursing homes have come under the corporate umbrella, the fines can be absorbed more easily. In fact, the fines are viewed by some as cheaper than fixing the actual problems. For these nursing homes, it is just “the cost of doing business.”
In addition to failing regulatory oversight, critics also attribute a lack of nurses to the diminished quality of care in America’s nursing homes. Facilities that perform the worst in CMS rankings tend to have the lowest nurse-to-patient ratio. In 2009, LivingCenter-West Shore, in Pennsylvania, was on the “special focus” watchlist for 17 months until it was released by regulators. The facility currently has the worst nurse-to-patient ratio in the country, with each patient receiving only 12 minutes of time with a nurse each day (the state average is 58 minutes.) In 2015, LivingCenter-West Shore was fined $59,150 dollars for, among other things, “allowing a resident’s feeding tube to become infested with maggots.” In addition, the facility’s owner Golden Living paid out $750,000 in settlements to patients that were injured at the facility in the years after it was released from special scrutiny. The facility currently has a one-star Medicare rating, but is not a “special focus” facility – and thus, does not receive any more frequent inspections than a five-star facility.