Some of the worst problems in the nursing home industry are rooted in insufficient incident reports or reports that go uninvestigated. This decades-old problem is well known, has been the subject of government subcommittee reports since the 1980s, and has inspired legislation like the Omnibus Budget Reconciliation Act of 1987. However, the fight for better reports, more thorough investigations, and more comprehensive inspections is still being waged. Culminating in the most recent, nearly 100-page report from the U.S. Senate Special Committee on Aging in which they identified areas where inspections and investigations failed, leaving nursing home residents at risk.
Important Information
There are about 1.3 million nursing homes residents currently in the U.S. That makes up about 2.4% of the population, and according to Federal data “as of early May 2023, 28 percent of the Nation’s 15,000 nursing homes have not received a comprehensive annual inspection for 16 months or more.” This number is shocking, and means a large portion of nursing home residents are at a higher risk of abuse and neglect.
“One in nine nursing homes across the Nation have not received an annual inspection in two years.”
The U.S. Senate Special Committee on Aging, after looking into these numbers and pushing for answers, found that “State agencies responsible for monitoring nursing homes’ compliance with Federal standards are in crisis.” Among other problems, the agencies responsible for inspections are short staffed and are operating on insufficient budgets to keep up with the workload and conduct the thorough inspections needed.
“31 States and the District of Columbia have vacancy rates of 20 percent or more among the staff responsible for inspecting nursing homes, and nine States have vacancy rates of 50 percent or more. Moreover, a large proportion of the inspection staff on payroll are inexperienced, reducing their effectiveness.”
It is already well-known that staff shortages among nursing home staff can be directly correlated to nursing home abuse, the perpetuation of that abuse can be attributed to understaffed inspection organizations.
Long-Term Care Ombudsmen have written and advocated on behalf of residents. Some of their cases have included instances of abuse that have gone months before any investigation was even started. In an industry already plagued by issues, it is vitally important that the system of checks and balances has a strong foundation and is sufficiently able to quickly and meticulously address abuses and other problems.
Senate Committee Findings
“Federal funding for survey and certification of health facilities—most of which goes to States to devote to oversight of nursing homes—is just 2.5 percent higher today than in FY2015.17. During the same period, the number of Medicare-eligible health facilities across all care settings has increased more than 10 percent; the number of nursing home complaints filed with States has increased more than 20 percent; and the salary of nurses, who make up a large share of the inspection workforce, has increased more than 20 percent.”
The report submitted by the Senate Committee includes information from the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the Government Accountability Office (GAO), and the 2022 nursing home report issued by the National Academies of Sciences, Engineering and Medicine. Additionally, the committee talked to current surveyors and survey agencies to discuss current problems and the solutions needed to improve the system as a whole.
One key problem was staffing. Agencies reported that high staff turnover meant a bigger workload for current employees (surveyors) resulting in a backlog of inspections that have yet to be done. Because surveyors must complete extensive training that takes about 2 years, it is difficult to quickly train new employees.
The second main issue facing the inspection agencies is budget. Since 2014, the budget for these agencies has effectively flat-lined. However, according the FY2024 budget request “The CMS budget request notes that nursing homes alone accounted for 81 percent of the 128,000 initial, recertification, complaint, and infection control surveys conducted during FY2021.” This crisis of funding results in agencies unable to do their jobs.
To improve nursing home quality of life, the quality of the surveys and inspections must improve, which means the salaries and benefits of surveyors must also be addressed. Many state agencies are losing employees to private sectors who are able to offer competitive pay, meaning state agencies are stuck in a cycle of hiring and training.
“The constant training of new staff and the increasing complexity of the complaints, along with increased survey requirements, means surveys and thorough complaint investigations take more time. This severe and urgent workload increases surveyors’ stress and contributes to already-high burnout.”
In short, nursing home issues run deeper than just the nursing home staff and standards of care. All organizations responsible for the care of America’s older generations must be properly supported and funded to ensure all cases of abuse and neglect are correctly addressed and reported.
If you or a loved one have been the victim of abuse or neglect, call Gharibian Law (877-460-1187) today for a FREE consultation and the best legal representation.
