Nursing Homes

Recent federal quality initiatives have generated a host of nursing home oversight efforts that need continued federal and state attention to reach their full potential. Efforts to improve federal oversight of states' quality assurance activities are unfinished or need refinement. States have begun to use the new methods introduced by the initiatives to spot serious deficiencies when conducting surveys, but additional steps needed may not be introduced until 2002 or 2003. Efforts to reduce the predictable timing of surveys, so as to minimize the homes' covering up problems, have been modest. Results showed a marginal increase nationwide in the proportion of homes with documented actual harm and immediate jeopardy deficiencies. States that GAO reviewed were not yet investigating all complaints that alleged actual harm to a resident within 10 days, as now required by the Health Care Financing Administration (HCFA). HCFA has also strengthened its enforcement tools to sanction nursing homes that are cited for actual harm and immediate jeopardy violations. Additional funds were provided in fiscal years 1999 and 2000 to hire new staff to reduce the large number pending appeals by nursing homes and to collect assessed fines faster. GAO summarized this report in testimony before Congress; see: Nursing Homes: Success of Quality Initiatives requires Sustained Federal and State Commitment, by William J. Scanlon, Director of Health Financing and Public Health Issues, before the Senate Special Committee on Aging. GAO/T-HEHS-00-209, Sept. 28 (15 pages).

GAO noted that: (1) overall, the introduction of the recent federal quality initiatives has generated a range of nursing home oversight activities that need continued federal and state attention to reach their full potential; (2) the states are in a period of transition with regard to the implementation of the quality initiatives, in part because the Health Care Financing Administration (HCFA) is phasing them in and in part because states did not begin their efforts from a common starting point; (3) efforts at the federal level toward improving the oversight of states' quality assurance activities have commenced but are unfinished or need refinement; (4) federal initiatives were introduced to strengthen the rigor with which states conduct required annual nursing home surveys; (5) the states GAO visited have begun to use the new methods introduced by the initiatives to spot serious deficiencies when conducting surveys, but HCFA is still developing important additional steps; (6) GAO's results showed a marginal increase nationwide in the proportion of homes with documented actual harm and immediate jeopardy deficiencies, although there was considerable variation across states; (7) the states GAO contacted also have made strides in improving their investigations of and follow-up to complaints, but not enough time has elapsed to consider these efforts complete; (8) for some states, the provision of federal funding to support the nursing home initiatives came too late in the state budget cycle for agencies to capitalize on the additional funds for fiscal year 1999; (9) it is too early to assess the effect of the additional funding on the number of pending appeals because the new staff were only hired within the past year and other changes in enforcement policy are expected to increase the volume of nursing home appeals; (10) to improve nursing home oversight at the federal level, HCFA has made recent organizational changes to address past consistency and coordination problems between its central office and 10 regional offices; (11) it also intends to intensify its use of management information data systems and reports to verify and assess states' oversight activities and view more closely the performance of the homes themselves; and (12) GAO's review showed that an examination of previously available information could have identified shortcomings in a state's survey activities even before they came to light as the result of a criminal investigation.