Since July 1998, GAO has reported numerous times on nursing home quality-of-care issues and identified significant weaknesses in federal and state oversight. GAO was asked to assess the extent of the progress made in improving the quality of care provided by nursing homes to vulnerable elderly and disabled individuals, including (1) trends in measured nursing home quality, (2) state responses to previously identified weaknesses in their survey, complaint, and enforcement activities, and (3) the status of oversight and quality improvement efforts by the Centers for Medicare & Medicaid Services (CMS).
Recommendations for Executive Action
|Centers for Medicare and Medicaid Services||1. To strengthen the ability of the nursing home survey process to identify and address problems that affect the quality of care, the Administrator of CMS should finalize the development, testing, and implementation of a more rigorous survey methodology, including guidance for surveyors in documenting deficiencies at the appropriate level of scope and severity.|
|Centers for Medicare and Medicaid Services||2. To better ensure that state survey and complaint activities adequately address quality-of-care problems, the Administrator of CMS should require states to have a quality assurance process that includes, at a minimum, a review of a sample of survey reports below the level of actual harm (less than G level) to assess the appropriateness of the scope and severity cited and to help reduce instances of understated quality-of-care problems.|
|Centers for Medicare and Medicaid Services||3. To better ensure that state survey and complaint activities adequately address quality-of-care problems, the Administrator of CMS should finalize the development of guidance to states for their complaint investigation processes and ensure that it addresses key weaknesses, including the prioritization of complaints for investigation, particularly those alleging harm to residents; the handling of facility self-reported incidents; and the use of appropriate complaint investigation practices.|
|Centers for Medicare and Medicaid Services||4. To better ensure that states comply with statutory, regulatory, and other CMS nursing home requirements designed to protect resident health and safety, the Administrator of CMS should further refine annual state performance reviews so that they (1) consistently distinguish between systemic problems and less serious issues regarding state performance, (2) analyze trends in the proportion of homes that harm residents, (3) assess state compliance with the immediate sanctions policy for homes with a pattern of harming residents, and (4) analyze the predictability of state surveys.|