The Government Accounting Office in March 2007 issued another devastating indictment regarding the lack of federal enforcement against those nursing homes which have "serious quality problems" and cause injury and abuse to nursing home residents.

The GAO found that nearly half of the surveyed "homes with prior serious quality problems, continued to cycle in and out of compliance during fiscal years 2000 through 2005, causing harm to residents. These homes corrected deficiencies only temporarily and ... were again found to be out of compliance." Nearly 43% of the homes were "cited 69 times for deficiencies that warranted immediate sanctions, but [56%] of these cases did not result in immediate sanctions." What a yo-yo!

How many nursing home residents disabilities, regardless of their age, must suffer actual harm or be placed in "immediate jeopardy" by the nursing home, have untreated or preventable pressure ulcers, be illegally restrained, be abused, receive substandard quality of care, or die, BEFORE the federal government and state government stop these nursing homes?

Why doesn't the federal government STOP funding the states and the nursing homes that permit these abuses to continue without sanctions? After all, it's mostly state health departments that are supposed to monitor nursing homes. The state health departments know or are supposed to know which nursing homes have "serious quality problems" and especially those with repeated "problems."

Why is the federal government continuing to spend $46 Billion a year of Medical Assistance on any nursing home that injures persons with disabilities? Why are federal funds, which amount to 69% of the nursing home industry's revenues, not ended where there is any repeated abuse or neglect. Why even wait until it is life- threatening?

These injuries are endemic to institutions that warehouse poor disabled persons and this has been widely known for a long time? Since 1998, the GAO itself has issued 15 reports identifying weaknesses in federal and state enforcement processes! We do not need anymore reports or studies; we need federal and state officials to end this abuse, neglect and death.

CMS surveyed the effectiveness of its three most widely imposed sanctions. The findings are distressing.

First, CMS and the states terminated nursing homes, i.e., closed the nursing home involuntarily, in less than one percent of the homes. No need for the nursing home owners to be worried about that "sanction."

Second, "civil monetary penalties" were only $350 to $500 a day, well below even the paltry $3,000 maximum per day. And let's not forget that CMS and your States pay Medical Assistance per day for these residents while they are being injured. These nursing homes receive MA payments every day while they are abusing and injuring residents. From a monetary calculation, it probably "pays" for the nursing home to take the civil monetary penalty while continuing to receive the MA per diem reimbursements.

The third sanction is "denial of payment for NEW admissions." Whoopie! But for all those people already in the institution, the Medical Assistance funds keep on flowing and nursing homes continue to pocket their profits.

CMS claims its enforcement is "hampered by the overall complexity of its immediate sanction policy." One reason may be because CMS' sanction are only "intended to DETER repeated noncompliance." Those institutions with the"worst compliance histories ... escape immediate sanctions." Why aren't the sanctions intended to end the operations of a nursing home that has repeated violations?

The GAO's "recommendations" were incredibly weak. It took a little while to surmise why GAO did not have the courage to really take on these nursing homes. Then we reread the GAO letter to Senator Grassley who requested the study. In the first sentence, GAO states that the "nation's 1.5 million nursing home residents are a highly vulnerable population of elderly and disabled individuals for whom REMAINING AT THOME IS NO LONGER FEASIBLE."

Once you make that assumption, then it follows that you believe that we must have these institutions. But what if a large percentage of the current residents could, with appropriate (and less expensive than nursing homes) home and community-based services, stay at home or return to home? Then you do not need nursing homes that abuse and injure people. That assumption also underlies the CMS goal of only "deterrence," instead of closing down repeated violators.

A few questions for advocates:

Have disability and older American advocates examined what your state Health Department's enforcement process is? How many nursing homes in your state have been cited for "serious quality problems?" Has advocacy has occurred to force your state's to decertify nursing homes that repeatedly injure and abuse residents? What about advocates inspecting the nursing homes?

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.