Government report finds `unconscionable' abuses of nursing home residents. (News & Trends).

One in three U.S. nursing homes was cited for almost 9,000 instances of abuse over a two-year period, and all the violations had at least the potential to harm residents. More than 1,000 of those homes were cited for failure to protect residents from sexual, physical, or verbal abuse, according to a report prepared by the House Committee on Government Reform.

"It would have been intolerable if we had found a hundred cases of abuse; it is unconscionable that we have found thousands upon thousands," said Rep. Henry Waxman (D-Cal.), ranking Democrat on the committee and sponsor of the report.

In addition to health problems commonly found in nursing homes--untreated bedsores, inadequate medical care, malnutrition, dehydration, preventable accidents, and inadequate sanitation and hygiene--the investigation revealed an unexpected trend: Many homes were cited for abusing residents.

For example, in a Missouri nursing home, an 80-year-old stroke victim suffering from dementia and impaired memory was repeatedly abused by staff members--he was locked in a bathroom, hit with a belt, dragged on his knees, and hit in the head with a book.

In a Florida home, a staff member took the call light away from a resident, put it out of reach, and refused to comply with the resident's requests for assistance--for instance, not providing a bedpan at night, forcing the resident to urinate in bed and wait until morning to be cleaned up.

About 1.5 million people live in 17,000 nursing homes in the United States. States inspect Medicare-or Medicaid-certified nursing homes at least once a year; in addition, if a resident, a member of his or her family, or a community member files a complaint about substandard care, the state must investigate. The study found that most abuse violations are uncovered this way.

Researchers analyzed two databases maintained by the U.S. Department of Health and Human Services that contain results of state nursing-home inspections and formal complaints. They also read the inspection reports and citations for the nursing homes that received violations for abuses that caused actual harm to residents.

The study reported that 5,283 nursing homes were cited for abusing residents between January 1999 and January 2001. Many homes had a history of violations or were cited for multiple violations. Among the findings:

* Of the homes cited, 1,345 received citations for violations that harmed residents in some way. Another 256 received citations for violations that risked or resulted in residents' death or serious injury.

* Almost 40 percent of the violations studied came from formal complaints, which uncover the most severe abuse. Researchers noted that because complaints aren't filed in many cases, the incidence of abuse is probably higher. Violations may also be underreported because some nursing homes don't accept Medicare and Medicaid patients and therefore aren't subject to federal inspection and quality-of-care requirements.

* The percentage of nursing homes cited for abuse violations has almost tripled since 1996 and has been rising yearly since then. Although "the reason for this increase is not clear," the researchers said, they noted that it may be due to increased enforcement efforts and better reporting since a 1998 Clinton administration initiative to increase quality of care in nursing homes.

But, they acknowledged, some of the increase may reflect an actual rise in the incidence of abuse. Since 1997, when Congress repealed a measure guaranteeing that homes would receive "reasonable and adequate" Medicaid reimbursement, reimbursement rates may not have kept pace with the rising costs of care. Nursing home operators say lower reimbursement rates make it harder to recruit and retain quality staff.

"Something clearly needs to be done to improve nursing home conditions. The senior citizens who live in nursing homes are frail and vulnerable. Frequently, they are defenseless and cannot even report problems to others. They deserve to be treated with respect and dignity--not to live in fear of abuse and mistreatment," said Waxman, who introduced the Nursing Home Quality Protection Act of 2001 (H.R. 2677) in July.

The act provides for increased funding to help nursing homes recruit and retain staff. It also requires minimum nurse staffing levels; tougher sanctions for violations of federal health and safety standards; increased public disclosure about nursing home conditions; background checks for potential nursing home employees; and inspectors' monitoring of all residents, regardless of whether their care is paid by Medicare and Medicaid.

The report, Abuse of Residents Is a Major Problem in U.S. Nursing Homes, is available at www.house.gov/reform/min/ pdf/nursinghomeabuse.pdf.