Federal program misses problem nursing homes

The Centers for Medicare and Medicaid Services identifies up to 136 nursing homes as "special focus facilities" subject to more frequent inspections because of their living conditions. In every state except for Alaska, there are between one and six such facilities. But investigators said four times as many homes, or 580, could be considered among the nation's worst.

The report from the Government Accountability Office does not identify the homes.

The chairman of the Senate Aging Committee said it indicated to him that the special focus is too limited. At the least, Sen. Herb Kohl, D-Wis., wants more explicit warnings about nursing homes as people study quality ratings on a Medicare Web site, Nursing Home Compare - http://www.medicare.gov/nhcompare

"If far more than 136 nursing homes boast the bleakest conditions, then perhaps we should consider expanding" the program, said Kohl, who requested the study with Sen. Charles Grassley, R-Iowa.

The GAO said it made just that recommendation two years ago. Federal officials agreed with the concept, but said they didn't have the resources to do so.

The report being released Monday also suggests adjusting the methods used to identify the worst performing nursing homes. The home now under special attention are the worst performing in their state. But not all states are created equal when it comes to nursing home quality. Comparing the homes nationally would ensure that scarce resources go to inspecting the nursing homes that truly need the most attention, according to the report.

CMS officials told the GAO they disagreed with relying solely on a national comparison. The agency said it would consider an approach that allows for a national comparison to have more weight.

Some states have far more poorly performing nursing homes than are designated as special focus facilities. For example, Indiana had 52 nursing homes listed as among the worst performing, but only four are on the special list; California has 40 considered among the worst performing, but only four are on the list.

Ohio has five nursing homes on the special focus list but only three that investigators considered among the nation's worst.

Investigators also found that the worst-performing ones tend to be for-profit facilities affiliated with a chain of nursing homes. They are more likely to be a larger facility, averaging 102 residents, while other nursing homes not identified as among the worst had 89 residents on average.

Nationally, there are about 16,000 nursing homes. So the 580 homes that GAO describes as the worst-performing represents almost 4 percent of the nation's nursing homes.

Grassley urged policymakers and regulators to pay attention to the report, and use the findings to improve quality and better protect nursing home residents.

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On the Net:

Government Accountability Office: http://www.gao.gov

Senate Special Committee on Aging: http://www.aging.senate.gov

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