WASHINGTON — Democratic lawmakers are pressing the Bush administration
to disclose the identity of more troubled nursing homes, saying earlier
efforts to alert consumers did not go far enough.
About six weeks ago, the Centers for Medicare and Medicaid Services (CMS) took the unprecedented step of publishing the names of 54 nursing homes that ranked among the worst in their state. The idea was to goad them into improving care.
The homes selected were among 128 identified as meriting more oversight. Such homes, called “special focus facilities,” undergo inspections at six-month intervals rather than once a year. The move initially generated praise.
But others soon asked the question: Why not identify all 128?
“Choosing a nursing home or long-term care facility is one of the most important decisions seniors and their families can make,” said presidential candidate and Sen. Hillary Clinton, D-N.Y. “They deserve to know everything that CMS knows.”
Clinton and Sen. Tom Harkin, D-Iowa, introduced a bill last month that would require CMS to reveal the names of all nursing homes that get the special focus designation. Nine senators, including Harkin, also urged Health and Human Services Secretary Mike Leavitt to immediately release the full list. They said in a letter that the administration’s policy was “potentially endangering the health and safety of thousands of our most vulnerable citizens.”
So far, the administration has resisted publicizing the names of all 128 nursing homes. The homes that CMS listed fared poorly on an inspection after they had been named a special focus facility.
“They couldn’t get their acts together well enough to pass the next survey,” said acting CMS Administrator Kerry Weems. “The others did, and we don’t want to unduly alarm their staffs, cause staff flight, cause panic among the residents when in fact the facility may be on the road to improvement.”
Most nursing homes have some deficiencies, with the average being 6-7 deficiencies per survey. The special focus facilities typically have about twice that number, and continue to have problems over a long period of time. However, the states determine which nursing homes should get the designation, and inspection standards vary among the states.
“A facility identified in New Hampshire could be substantially better or substantially worse than those identified in Iowa, so we’re not working with an absolute standard,” Weems said.
The nursing homes originally cited came from 33 states and the District of Columbia. There are about 16,400 nursing homes nationwide, and taxpayers spend about $72.5 billion annually to subsidize nursing home care.
Since the initial list of poorly performing homes was released in November, CMS discovered that two homes had shown enough improvement that they should not have been cited.
The nursing home industry applauded the administration’s announcement six weeks ago, but it opposes publicly labeling the homes that may be doing better.
“Why kick them when they’re up?” said Bruce Yarwood, president and CEO of the American Health Care Association. He said the criteria for getting the special focus designation is too vague, as are the criteria for getting rid of the designation.
“To put out red flags and messages that may be mixed does not do much for patients, their families and staffs,” Yarwood said.
Every nursing home receiving federal payments undergoes inspections about once a year. In such inspections, surveyors assess whether the facility meets standards focused on safety and quality of care. Among the things inspectors look for are whether residents get their medicine and assistance with daily living activities such as bathing. They also look at whether the nursing home prevents accidents and infections, and provides the patient with a good diet.
Typically, homes that get the special focus designation do improve. Federal data indicate that about half the special focus homes improve their quality of care significantly within 24-30 months. However, about 16 percent are terminated from Medicare and Medicaid.