Nursing Homes

GAO has previously reported that one in four of the nation's nursing homes has deficiencies so serious that they have harmed residents or placed them at serious risk of death or injury. (See GAO/HEHS-99-46, Mar. 1999.) Forty percent of the homes with serious deficiencies were cited for repeat deficiencies. The Health Care Financing Administration (HCFA), which oversees the quality of nursing home care, has announced plans to beef up enforcement at homes found to have repeatedly harmed residents. This includes expanding the definition of homes classified as "poor performers." HCFA's proposal to include homes with repeated isolated actual harm deficiencies would significantly increase the number of homes that would be subject to immediate sanctions without a grace period to correct the problems. If this revised definition had been in effect as of April 1999, GAO estimates that the number of nursing homes meeting HCFA's poor-performer criteria would have risen from about one percent to nearly 15 percent of facilities nationwide. Two-thirds of the poor-performing nursing homes GAO surveyed had repeated violations. As a result, they would have been subject to immediate sanction under HCFA's revised poor performer definition. The current definition allows them an opportunity to correct the problems without sanctions. Most of the repeat violators were cited for the same deficiency, and about one-third were cited for closely related problems. These findings suggest that HCFA's enhanced enforcement of homes found to repeat these serious care problems has merit.

GAO noted that: (1) HCFA's proposed expansion of the poor-performer criteria to include homes with repeated isolated actual harm deficiencies would substantially increase the number of homes that would be subject to immediate sanctions without a grace period to correct deficiencies; (2) if this revised definition had been in effect for the most recent 15-month period ending April 1999, GAO estimates that the number of homes meeting HCFA's poor-performer criteria for imposing immediate sanctions would have increased from about 1 percent to nearly 15 percent of homes nationwide; (3) nearly all of the deficiencies GAO examined represented serious care issues resulting in harm to residents; (4) of the 107 surveys with G-level deficiencies in GAO's sample, 98 percent documented that actual harm had occurred to one or more residents; (5) survey reports depict recurring examples of actual harm such as pressure sores, broken bones, severe weight loss, burns, and death; (6) another 8 of the 107 surveys with G-level deficiencies had a deficiency that did not clearly document harm, but other G- or higher-level deficiencies on the same survey resulted in harm to residents; (7) two-thirds of these 107 nursing homes had repeated violations--the On-Line Survey, Certification, and Reporting data showed they were also cited for isolated actual harm or higher deficiencies in a prior or subsequent survey; (8) therefore, they would be subject to immediate sanction if HCFA's revised poor performer definition had been adopted, whereas the current definition allows an opportunity to correct deficiencies without sanctions; (9) most of the repeat violators were cited for the same deficiency, and 34 percent were cited for closely related deficiencies; and (10) these findings suggest that HCFA's enhanced enforcement of homes found to repeat these serious care problems has merit.