September 16,2019

Grassley op-ed: Oversight is necessary to ensure quality care in nursing homes

Oversight is necessary to ensure quality care in nursing homes

By Senate Finance Committee Chairman Chuck Grassley 

Oversight is often a vehicle for change in the federal government. In order to solve a problem, you need to know what it is, how bad it is and why it’s happening. Oversight is an important tool to find answers to those questions as well as ensure the appropriate steps are taken to solve the problems.

A significant amount of the work I do in the Senate centers on oversight. From health care to the Pentagon, I care deeply about rooting out waste, fraud and abuse in the federal government in order to make it function better for the people of Iowa and the entire country. My oversight team works regularly with whistleblowers to identify problems in the federal government, but often it’s Iowans who contact me with issues they’re facing that begin my most important oversight work. One example of this is elder abuse.

Through letters, phone calls and at my annual 99 county meetings, Iowans with loved ones in nursing homes have approached me about concerns they’ve had regarding the treatment of their family members. Their concerns have ranged from lackluster facility conditions to claims of negligence and abuse. Their concerns have inspired my decades-long work to preserve the dignity of older Americans. 

As the former chairman of the Senate Aging and Judiciary committees, as well as earlier in my tenure as Senate Finance Committee chairman, I conducted oversight of the nursing home inspection process and convened hearings focused on enhancing quality standards and compliance across the nursing home industry. I’ve continued that work this Congress as I’ve stepped back into the Senate Finance Committee chairmanship. Part of those oversight efforts have included numerous letters to the Centers for Medicare and Medicaid Services (CMS) requesting information on how the agency is working with facilities to keep these standards high and take action when they fall short.

For example, former Sen. Herb Kohl (D-Wis.) and I released a number of important Government Accountability Office (GAO) reports that exposed serious quality care problems in nursing homes. A 1998 report exposed serious quality of care problems in nursing homes, exacerbated in part by highly predictable annual inspections and few citations for serious deficiencies. Senator Kohl and I held hearings in the Aging Committee about the report and urged action from the Clinton administration, which it later took to improve the inspection process.

In 2009, we released another GAO report on the Special Focus Facility (SFF) Program, which monitors nursing homes that earn the worst quality ratings. The study recommended that SFF be administered by CMS and expanded to accommodate more of the 580 nursing homes GAO found to be the poorest performers. Both in 2010 and 2012, Senator Kohl and I released reports that highlighted under-reporting of serious deficiencies in nursing home care and urged CMS to improve oversight of its system to monitor quality standards.

These ongoing oversight efforts have led to significant positive changes. In 2008, CMS increased the information available on Nursing Home Compare, a government-run website that allows families to compare nursing home facilities as they try to find the right home for their aging loved ones. CMS has also implemented a standard survey methodology across all states for quality care standards, making it easier to identify nursing homes that fall short and quickly work to resolve the problems.

Last year, CMS began publishing rates of hospitalization for long-stay residents on Nursing Home Compare, which factors into facility ratings, and created a new system to monitor nursing home staff levels, which also factors into facility quality ratings because low staff levels often lead to poor care.

After oversight efforts exposed nursing home employees who were taking humiliating and demeaning photos of elderly residents without their knowledge or consent, social media companies moved forward to develop better means of reporting abusive cases and CMS issued additional guidance on social media abuse.

In March of this year, the Finance Committee held a hearing on abuse and neglect occurring in America’s nursing homes. During the hearing, an Iowan testified about her mother’s death due to alleged neglect by staff members at a federally funded nursing home that held a five-star rating on Nursing Home Compare. That same facility had also been the subject of multiple complaint investigations in recent years.

Following the hearing, CMS announced a five-part approach to guide its work to ensure safety and quality in America’s nursing homes. The approach will focus on strengthening oversight, enhancing compliance enforcement, increasing transparency, improving quality and putting patients first – priorities I have advocated for over the past two decades.

Older Americans deserve to maintain their dignity and live in safe, caring environments during their golden years. Oversight of nursing homes and the federal agencies that police them is essential to ensuring that happens.