April 22,2019

Chairman Grassley Op-ed: Protecting Vulnerable Seniors Through Congressional Oversight

Last month, I held a hearing on the abuse occurring in nursing homes. The purpose was to shed light on the systematic issues that allow substandard care and abuse to continue within the nursing home industry.

According to the Department of Health and Human Services Inspector General, one-third of nursing home residents experience harm while under the care of federally funded facilities. In more than half of these cases, the harm was preventable. In 2017, the Inspector General also issued an alert, warning the public about deficiencies cited at nursing homes in 33 states. A significant percentage of these cases involved sexual abuse and neglect. Further, news reports have revealed that individuals with a history of settling claims of Medicare and Medicaid fraud have been able to continue participating in programs funded by the Centers for Medicare and Medicaid Services.

Nearly everyone has a loved one who is either currently in a nursing home or may be in the coming years. Although many facilities provide excellent care, discussions about events of neglect and abuse need to happen in order to make things better at poorer-performing facilities. That’s why oversight has been a focus of mine throughout my time in the Senate.

Standards of care at nursing homes, and how CMS rates them, is a critical evaluation tool for families as they decide where their loved ones should live. When these processes fail, families at a disadvantage and elderly residents are put at risk. People should be able to rely on the information being posted by the federal government, but that’s not always the case. Iowans know that all too well.

Last year, Iowans were horrified to learn two elderly women living in the same federally funded facility died due to neglect. That same facility had been cited for failing to address symptoms of three residents as well as failing to notify the residents’ doctors about changes in their conditions. Despite these deficiencies, it still held a five-star rating — the highest possible rating — by CMS. In fact, the nursing home had 19 complaint investigations conducted over the course of five years. Yet after each complaint, CMS reported the facility had come back “into substantial compliance with program requirements.” None of that information was publicly available.

As the former chairman of the Senate Aging and Judiciary Committees, I conducted oversight of the nursing home inspection process and convened hearings focused on enhancing standards and compliance across the nursing home industry. That oversight included a series of letters to CMS Administrator Seema Verma, requesting detailed information on how the agency planned to address the problems infecting the industry.

In November I was encouraged by the news CMS was taking action on many of the issues I raised. Administrator Verma confirmed CMS had implemented a standardized survey methodology across all states for quality care standards, making it easier to identify nursing homes that fall short. The agency also now publishes rates of hospitalization for long-stay residents on its Nursing Home Compare website and created a new system to monitor nursing home staff levels. Both factor into facility ratings and allow families to more easily identify quality facilities for their loved ones.

These changes mark positive progress. However, a new Government Accountability Office report found CMS doesn’t have comprehensive data regarding abuses happening in nursing homes in the state of Oregon. That’s an indication of a potentially larger problem. Incomplete data means an incomplete picture of a facility’s ability to care for its elderly residents.

As chairman of the Senate Finance Committee, I’ll continue conducting diligent oversight of the nursing home industry. Later this summer, the GAO and the Department of Health and Human Services Office of Inspector General will issue reports on nursing home abuse. Once these reports are available and I’ve had time to review their findings, I intend to hold another hearing to learn the facts and find workable solutions.

Ensuring some of our nation’s most vulnerable citizens have access to quality long-term care in an environment free from abuse and neglect must be a top priority. It’s our job to protect seniors and prevent them from becoming victims.