Nursing Home Standards Enforcement

GAO testified on enforcing nursing home quality-of-care requirements, specifically, ensuring that nursing homes correct identified deficiencies and comply with Medicare and Medicaid regulations. GAO studied the actions of the Health Care Financing Administration (HCFA) and two states and determined that they failed to enforce compliance on a continuing basis. GAO noted that the nursing homes studied failed to ensure that qualified personnel: (1) installed and maintained patients' feeding and drainage tubes; (2) turned bedfast patients; (3) washed patients; (4) periodically released patients from restraints and exercised them; (5) assisted patients at scheduled eating times; (6) provided ordered medication, treatment, or service; (7) recorded important patient information; (8) properly stored food; (9) provided adequate pest control; and (10) properly maintained the buildings. The two states studied took action against homes with serious problems and excluded them from Medicare or Medicaid for a short time before readmitting them to the program once corrective measures were taken; however, most of these homes were later found to be noncompliant with the same requirements. GAO found that HCFA and states could better ensure nursing homes' continual compliance with federal regulations by: (1) clarifying repeat-deficiency policies; (2) emphasizing nursing homes' historical compliance records; and (3) enforcing repeat deficiency regulations.