Lax oversight practices for ensuring quality care in nursing homes have allowed many privately owned facilities to remain profitable despite repeat health and safety violations.
“The needed reforms tend to be more applicable to for-profit nursing homes because of the corporatization of nursing home care,” said Richard Mollot, executive director of the Long Term Care Community Coalition. “Our focus has been ensuring better accountability for the money that goes into nursing homes because a lot of people are reaping profits off of it.”
Mollot, 57, has led the LTCCC, an advocacy organization dedicated to improving care in nursing homes, since 2005. Since the pandemic began in March 2020, the organization has ramped up its pressure on the federal government to monitor safety practices in nursing homes closely. The coronavirus exposed flaws in the eldercare system, such as poor sanitation practices and medicine mismanagement. Many of those flaws, Mollot said, were evident before the pandemic began.
“Nursing homes tend to have persistent problems. … There is a high incidence of repeat deficiencies, meaning that they’re cited, year after year, for the same violation,” Mollot told the Washington Examiner. “It means that even when they’ve been cited, they have still not taken adequate steps to correct the underlying issues.”
The LTCCC keeps track of recurring health and safety deficiencies recorded during yearly inspections of nursing homes conducted by state survey agencies and reported to the Centers for Medicare & Medicaid Services. Some of the shortcomings cited in these inspections include failing to install equipment to prevent falling injuries, neglecting to fix showers pouring hot water at unsafe temperatures, and disregarding some residents prone to wandering off and accidentally hurting themselves.
Every month, CMS identifies nursing homes with chronic deficiencies to be included in the Special Focus Facility program for enhanced oversight.
Once CMS assigns a failing nursing home to the program, that nursing home has 18 to 24 months to remedy the repeat offenses and put systems in place to prevent the same problems from recurring. If the facility has not met the deadline, CMS has the authority to remove it from Medicare and Medicaid. Due to a lack of resources, the agency limits the number of problematic facilities to participate in the monitoring program to 88.
“The point is that inspectors are only going [to nursing facilities] once a year, so when there is a citation made, the expectation is that there is a robust response to address that,” Mollot said. “We don’t have an inspector who’s standing there every day interrupting or monitoring things, so we need to make sure that those things are implemented broadly and effectively.”
The LTCCC reported in 2017 that deficiencies in nursing homes are quite common, with about seven violations per facility cited yearly. The organization also said that 42% of nursing homes in the United States were guilty of failing to remedy the same problems each year despite inspection citations.
Residents have recourse to grievance officers in nursing homes thanks to federal regulations passed in 2016. They can file grievances to the officers, who then must investigate the problem with facility leadership. The officials must respond to the resident in writing with results from the investigation and steps they will take to prevent it from happening again.
“It’s widely recognized that resident complaints, including complaints from family members, are not taken seriously, so that’s a way of kind of having not a resident advocate but someone who’s going to be responsive to the resident or you know questions about his or her care,” Mollot said.
He added, “The facility doesn’t have to do whatever you say, but they do have to provide a reason for why they’re not going to do it.”
