Many Nursing Homes Deficient, GAO Reports : One-Third in National Survey Found to Have Repeatedly Violated Federal Care Standards

More than one-third of federally certified nursing homes were found repeatedly deficient in at least one area affecting patient care during a four-year period, the General Accounting Office reported today.

“Repeated non-compliance with nursing home requirements is widespread,” said the report by the investigative arm of Congress.

The biggest problem was found to be in nursing services, which include everything from treatment and medication to preventing bedsores and injuries.

In addition to a survey of compliance reports on 8,298 nursing homes throughout the country, the GAO did in-depth studies of 26 nursing homes in five states.

Four of the states--Arkansas, California, Connecticut and Kansas--were picked because researchers said they “had a large percentage of their facilities repeatedly fail to comply with selected requirements.” Homes in Wisconsin were added for comparison purposes because there were relatively few repeat offenders.

The GAO recommended that Congress strengthen the enforcement of federal standards that nursing homes are supposed to comply with in order to participate in Medicare and Medicaid.

“The ability to avoid penalty even for serious or repeated non-compliance gives nursing homes little incentive to maintain compliance with federal requirements,” the report said.

The Health Care Financing Administration establishes requirements for nursing home participation with health care providers. Agency spokeswoman Pat Muldrow said the agency cannot comment until it has had a chance to review the report.

The GAO found that 3,372, or 41%, of the 8,298 nursing homes surveyed failed to comply during three consecutive inspections with at least one of 126 standards deemed by experts as “most important in ensuring resident health and safety.” For intermediate care facilities, the figure was 2,005 of 5,970, or about 34%.

The harshest penalty, decertification, was invoked about 300 times against either skilled or intermediate care nursing facilities between January, 1980, and September, 1986, the GAO said.

The report was requested by Sen. John Heinz (R-Pa.), ranking minority member of the Senate Special Committee on Aging.

More than 850 nursing homes, or about 10%, were found lax in at least one area of nursing services. About 650, or 8%, were cited in three or more consecutive inspections because the buildings were not kept clean.

While the GAO did not link examples to the specific nursing homes, it described an unidentified Kansas nursing home in which 13 residents in 1985 “had bedsores, and one of the residents had a bedsore on the hip that was four inches in diameter with muscle visible.”

A 1985 inspection at a California home uncovered 10 instances in which care was not adequate to keep residents or their clothing and sheets free from human wastes.