Nursing Homes:

Proposal To Enhance Oversight of Poorly Performing Homes Has Merit

HEHS-99-157: Published: Jun 30, 1999. Publicly Released: Jun 30, 1999.

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William J. Scanlon
(202) 512-7114


Office of Public Affairs
(202) 512-4800

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) proposal to expand the definition of "poor performing" nursing homes to include homes with repeated actual harm violations (G-level deficiencies).

GAO noted that: (1) HCFA's proposed expansion of the poor-performer criteria to include homes with repeated isolated actual harm deficiencies would substantially increase the number of homes that would be subject to immediate sanctions without a grace period to correct deficiencies; (2) if this revised definition had been in effect for the most recent 15-month period ending April 1999, GAO estimates that the number of homes meeting HCFA's poor-performer criteria for imposing immediate sanctions would have increased from about 1 percent to nearly 15 percent of homes nationwide; (3) nearly all of the deficiencies GAO examined represented serious care issues resulting in harm to residents; (4) of the 107 surveys with G-level deficiencies in GAO's sample, 98 percent documented that actual harm had occurred to one or more residents; (5) survey reports depict recurring examples of actual harm such as pressure sores, broken bones, severe weight loss, burns, and death; (6) another 8 of the 107 surveys with G-level deficiencies had a deficiency that did not clearly document harm, but other G- or higher-level deficiencies on the same survey resulted in harm to residents; (7) two-thirds of these 107 nursing homes had repeated violations--the On-Line Survey, Certification, and Reporting data showed they were also cited for isolated actual harm or higher deficiencies in a prior or subsequent survey; (8) therefore, they would be subject to immediate sanction if HCFA's revised poor performer definition had been adopted, whereas the current definition allows an opportunity to correct deficiencies without sanctions; (9) most of the repeat violators were cited for the same deficiency, and 34 percent were cited for closely related deficiencies; and (10) these findings suggest that HCFA's enhanced enforcement of homes found to repeat these serious care problems has merit.

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