Nursing Homes:

Stronger Complaint and Enforcement Practices Needed to Better Ensure Adequate Care

T-HEHS-99-89: Published: Mar 22, 1999. Publicly Released: Mar 22, 1999.

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Pursuant to a congressional request, GAO discussed the effectiveness of complaint and enforcement practices to protect nursing home residents, and to ensure that homes participating in Medicare and Medicaid comply with federal standards, focusing on the: (1) effectiveness of states' complaint practices in protecting residents; (2) Health Care Financing Administration's (HCFA) role in establishing standards and conducting oversight of states' complaint practices and in using information about the results of complaint investigations to ensure compliance with nursing home standards; and (3) assessment of HCFA's use of sanction authority for homes that failed to maintain compliance with these standards.

GAO noted that: (1) neither complaint investigations nor enforcement practices are being used effectively to ensure adequate care for nursing home residents; (2) as a result, allegations or incidents of serious problems often go uninvestigated and uncorrected; (3) GAO's work in selected states reveals that, for serious complaints alleging harm to residents, the combination of inadequate state practices and limited HCFA guidance and oversight have often resulted in: (a) policies or practices that may limit the number of complaints filed; (b) serious complaints alleging harmful situations not being investigated promptly; and (c) incomplete reporting on nursing homes' compliance history and states' complaint investigation performance; (4) further, regarding enforcement actions, HCFA has not yet realized its main goal--to help ensure that homes maintain compliance with federal health care standards; (5) GAO found that too often there is a yo-yo pattern where homes cycle in and out of compliance; (6) more than one-fourth of the more than 17,000 nursing homes nationwide had serious deficiencies--including inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide appropriate care--that caused actual harm to residents or placed them at risk of death or serious injury; (7) although most homes corrected deficiencies identified in an initial survey, 40 percent of these homes with serious deficiencies were repeat violators; (8) in most cases, sanctions initiated by HCFA never took effect; (9) the threat of sanctions appeared to have little effect on deterring homes from falling out of compliance because homes could continue to avoid the sanctions' effect as long as they kept temporarily correcting their deficiencies; and (10) HCFA has taken a number of recent actions to improve nursing home oversight in an attempt to resolve problems pointed out in earlier studies.

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