May 15,2008

Grassley seeks passage of bill to give consumers more information about nursing homes and improve quality of care


TO: Reporters and Editors
FR: Jill Kozeny, for Senator Grassley, 202/224-1308; Ashley Glacel, for Senator Kohl, 202/224-5364
RE: new GAO report on nursing home quality of care
DA: May 15, 2008

Senators Chuck Grassley and Herb Kohl have released a report of the GovernmentAccountability Office. The report – GAO-08-571 – is titled NURSING HOMES FederalMonitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMSOversight Weaknesses. It will be posted today at

The senators said the findings by GAO give Congress more reason to pass theirlegislation to give consumers more information and give nursing homes more incentive tocomply with federal quality of care standards.

Comment from Senator Grassley:

“The report spells out the chain of oversight deficiencies that result in quality of caredeficiencies for nursing home residents continuing to the detriment of residents. We need tomake sure state surveyors have an improved survey methodology and adequate investigativeskills to identify problems. Federal penalties need to be strong enough to achieve accountabilityand encourage compliance. Above all, consumers need access to accurate, meaningful andcurrent data. Our legislative reform effort is about securing transparency. With information,consumers can make the best choices for their loved ones. Collectively, those choices canimprove nursing home safety and quality across-the-board.”

Comment from Senator Kohl:

“This report makes it clear that the nation is due for an overhaul of nursing homestandards. Not surprisingly, some members of the for-profit nursing home industry would preferto maintain the status quo. That's unacceptable to us. We're going to push very hard to have ourbill included in the upcoming Medicare package.”

Last fall, Grassley and Kohl introduced the Nursing Home Transparency andImprovement Act. The legislation is intended to improve the quality of care in nursing homeswith more and better information for consumers provided by the federal government on theNursing Home Compare website, new requirements for accurate reporting of the staff who areproviding direct services in nursing homes, stiffer penalties for serious quality deficiencies, andgreater accountability and transparency about who owns and operates nursing homes.

Grassley is ranking member and former chairman of the Committee on Finance, withjurisdiction over the federal health care programs that cover nursing home care, and formerchairman of the Special Committee on Aging. Kohl is chairman of the Special Committee onAging, a standing committee that conducts oversight of issues related to the health, safety, andfinancial well-being of older Americans.

Serious Deficiencies in Nursing Homes Are Often Missed, Report Says

Source: The New York Times
Date: 05/15/2008
Section: National Desk; SECTA
Page: 23


WASHINGTON -- Nursing home inspectors routinely overlook or minimize problemsthat pose a serious, immediate threat to patients, Congressional investigators say in a new report.In the report, to be issued on Thursday, the investigators, from the GovernmentAccountability Office, say they have found widespread ''understatement of deficiencies,''including malnutrition, severe bedsores, overuse of prescription medications and abuse ofnursing home residents.

Nursing homes are typically inspected once a year by state employees working undercontract with the federal government, which sets stringent standards. Federal officials try tovalidate the work of state inspectors by accompanying them or doing follow-up surveys within afew weeks.

The accountability office found that state employees had missed at least one seriousdeficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectorsmissed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama, Arizona,Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, thereport said.

More than 1.5 million people live in nursing homes. Nationwide, about one-fifth of thehomes were cited for serious deficiencies last year.

''Poor quality of care -- worsening pressure sores or untreated weight loss -- in a small butunacceptably high number of nursing homes continues to harm residents or place them inimmediate jeopardy, that is, at risk of death or serious injury,'' the report said.

Nursing homes must meet federal standards as a condition of participating in Medicaidand Medicare, which cover more than two-thirds of their residents, at a cost of more than $75billion a year.

The study was done at the request of Senators Charles E. Grassley, Republican of Iowa,and Herb Kohl, Democrat of Wisconsin, who is chairman of the Senate Special Committee onAging.

Mr. Grassley and Mr. Kohl have introduced a bill to upgrade nursing home care andincrease the penalties for violations of federal standards. The maximum fine, now generally$10,000, would be increased to $25,000 for a serious deficiency and $100,000 for one thatresulted in a patient's death.

The senators are pushing to have their bill included in a package of Medicare changesthat Congress is expected to pass next month.

But the American Health Care Association, a trade group for nursing homes, opposes theGrassley-Kohl bill in its current form.

Bruce A. Yarwood, president of the association, said: ''We should not be increasing fines,adding auditors and encouraging a 'gotcha' mentality. We should be testing new, less punitiveways to measure and improve the quality of care.''

Influential consumer groups support the bill. David P. Sloane, senior vice president ofAARP, the lobby for older Americans, said it was ''one of the most significant nursing homereform initiatives'' in two decades.

Under the bill, nursing homes would have to provide consumers and the government withmore information about their owners and ''affiliated or related parties,'' including any individualor company that had a role in managing their operations.

Lewis Morris, chief counsel to the inspector general of the Department of Health andHuman Services, said he had often been frustrated in trying to identify the owners of nursinghomes that provided substandard care.

''We have found nursing home residents who were grossly dehydrated or malnourished,''Mr. Morris said. ''We've found patients with maggot infestations in wounds and dead flesh.We've found residents with broken bones that went unmended.''

After discovering such problems, the federal government has required some companies tosign compliance agreements, monitored by outside experts. ''Our experience shows that suchcompliance programs do improve the quality of care,'' Mr. Morris said.

The Bush administration said it agreed with the findings of the accountability office andwould supervise state inspectors more closely.

''We fully endorse and will implement all the G.A.O. recommendations,'' Vincent J.Ventimiglia Jr., an assistant secretary of health and human services, said in written comments onthe report.

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