Wednesday, February 25, 2015

Nursing Home Regulation Standards and Role of the Government

Hurricane Katrina brought with it a tragedy of enormous scale. Thousands lost their lives, loved ones, homes, and property. For the residents of the St. Rita nursing home and Lafon nursing home the battle was lost long before the Hurricane Katrina. Poor quality of care, incompetent management, and lack of reporting standards in these two nursing homes lead to abandonment of their residents who were later found dead by the rescue workers. It is well documented that the care provided in some nursing homes is substandard, some places even inhumane.  Every now and then, news stories of malnutrition, abandonment,  use of restraints and sleeping pills on residents, surface to remind us this growing problem. This article summarizes the lack of federal oversight on Nursing home regulation and proposes simple yet effective changes that can help the nation develop consistent and responsible quality standards for nursing homes and assisted living facilities.

CMS along with the state governments reimburses the nursing home care for qualified individuals, yet it does not directly oversees the quality of care provided in the nursing homes. To be able to receive reimbursements from CMS, the nursing homes have to comply with a set of guidelines and meet certain quality standards. While the federal government sets the inspection procedure and guidelines, the implementation of the inspections is delegated to the state survey agencies (Boemhke, Page 2). These guidelines are therefore subject to interpretation of the inspectors who use their judgment based on local norms and availability of resources. Consequently, states have their own application of standards including licensures and conduct inspections. There are as many reporting standards as there are states, and they are often in disagreement over required standards. This poses a difficulty in interpreting and differentiating standard of care from one state to another, especially for nursing home companies and providers. (Miller and Mor, Page 253).

Along with technical complexities the political system also shapes the standard of care at the nursing homes. The state authorities, especially the legislature is prone to be influenced by the local interest groups and political contributions by interested parties. It has been observed that contributions to both legislators and governor’s office influences survey outcomes. The legislators may ask inspectors to go easy on particular nursing homes, or tamper with the results to formulate a final report that appears more compliant. Therefore a federal level reporting program will provide consistent and fair results for the simple reason that it would be more costly for facilities to influence members of the congress. (Boemhke, Page 25).

It is clear that state health officials need more informed guidance when routinely monitoring quality of nursing homes and assisted living facilities. The data pulled from various inspections across the nation should be compiled and analyzed to create decision support tools that inform and educate the public officials about provider quality standards for the state and local officials to aid their inspections and oversight activities. On a national scale it is desirable to invest in a federally managed program that analyses real time data and creates evidence based “best practices” to be used by the industry (Miller and Mor, Page 269). For home health recipients, the data can include information of the care takers, their living condition etc. These databases will also prove to be beneficial during the times of emergencies to plan and guide the rescue efforts of the frail and the elderly.

1) Edward Alan Miller, Vincent Mor (2008), Balancing Regulatory Controls and
Incentives: Toward Smarter and More Transparent Oversight in Long-Term Care, Journal of Health Politics and Law, Vol 33 No. 2 2008
2) Federick J. Boehmke (2008) Subverting Administrative Oversight: Campaign Contributions and Nursing Home Inspections.

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