Most Nursing Homes Out Of Compliance Tougher Standards Find Three-Fourths In Violation

Inspectors are finding nearly three-quarters of nursing homes out of compliance with tougher standards the government began enforcing this summer.

The problems were judged serious enough to threaten life or serious harm to residents in only 3.3 percent of the cases. The inspectors demanded immediate action to remedy those violations.

But most of the nursing homes were given a chance to comply before the government imposes stiff penalties that can include fines of up to $10,000 a day.

The Clinton administration has held off imposing penalties in most cases until Oct. 1 to give the industry and the inspectors time to adjust.

Barbara J. Gagel, director of the Health Standards and Quality Bureau for the Health Care Financing Administration, which runs Medicare and Medicaid, said Monday that 73 percent of the 2,520 homes surveyed since July 1 were not in substantial compliance with the standards.

The quality of care was deemed substandard in 452 homes, or 18 percent, including 83 that had problems severe enough to require immediate action.

Gagel said “the vast, vast majority” of homes will remedy problems before they are reinspected.

So far, only 12 of 146 facilities - 8 percent - were found out of compliance after a second inspection.

Nursing homes always have had to pass yearly inspections. In the past, the government could threaten to cut violators out of the Medicaid and Medicare programs.

“Under the old enforcement system, we didn’t have alternative sanctions,” said Gagel. “Now we do. Now we can fine them, send in temporary management, send in state monitors, (or) deny payment for new admissions.”

The American Health Care Association, an industry group, criticized the way the standards are being enforced.

“We don’t think the surveys right now are focusing on facilities with real quality problems,” said Linda Keegan, an association vice president. The surveyors are given too much discretion in determining what constitutes substandard care, she said.

As examples of the most serious cases, Gagel cited homes in Maryland and Ohio where patients died from strangulation while wearing restraints and an Indiana home where a resident was found with maggots in a wound; and a Florida home where a resident was sexually assaulted by a nurse’s aide.

Some 1.6 million people, most of them elderly, live in the nation’s 17,000 nursing homes. Nursing home care costs $36,000 a year or more, and Medicaid picks up about half the bills.

Republicans in Congress are seeking to save $182 billion over the next seven years from Medicaid. They are hoping to turn the program over to the states as a block grant, with far fewer federal regulations.