Pursuant to a congressional request, GAO discussed the quality of care in nursing homes, focusing on: (1) progress in improving the detection of quality problems during annual surveys; (2) how the prevalence of identified problems has changed; (3) the status of efforts to strengthen states' complaint investigation processes and federal enforcement policies; and (4) additional activities occurring at the federal level to improve oversight of states' quality assurance activities.

GAO noted that: (1) overall, the series of federal quality initiatives begun 2 years ago has produced a range of nursing home oversight activities that need continued federal and state commitment to reach their full potential; (2) certain of the federal initiatives seek to strengthen the rigor with which states conduct their required annual surveys of nursing homes; (3) others focus on the timeliness and reporting of complaint investigations and the use of management information to guide federal and state oversight efforts; (4) the states are in a period of transition with regard to the implementation of these initiatives, partly because the Health Care Financing Administration (HCFA) is phasing them in and partly because states did not begin their efforts from a common starting point; (5) HCFA's efforts toward improving the oversight of states' quality assurance activities have begun but are unfinished or need refinement; (6) the results from states' recent standard surveys provide a picture of federal and state efforts in progress; (7) on average, a slightly higher proportion of homes were cited nationwide for actual harm and immediate jeopardy deficiencies on their most recent survey than were cited during the previous survey cycle; (8) while it was expected that more deficiencies would be identified owing to the increased rigor in nursing home inspections, the survey results could also suggest that nursing homes may not have made sufficient strides to measurably improve residents' quality of care; (9) the results also show a wide variation across states in the proportion of homes with identified serious care deficiencies; (10) while these proportions are expected to vary somewhat from one state to another, the wide range may reflect the extent to which the inspection of homes is inconsistent across states; and (11) in GAO's view, the full potential of the nursing home initiatives to improve quality will more likely be realized if greater uniformity in the oversight process can be achieved.