Targeting 100 worst homes.

Good idea, but AAHSA questions approach

THE CLINTON ADMINISTRATION'S MOST recent move to target the "100 worst-performing" nursing homes--two in each state--for additional inspections during evenings and weekends has drawn general support for its objective, but reservations about its approach from a major industry group, the American Association of Homes and Services for the Aging (AAHSA).

The White House, tipping its hand on its FY 2001 budget proposal, indicated it would add funds to the Health Care Financing Administration (HCFA) budget to allow surveyors to conduct inspections during irregular hours and to target the so-called 100 worst facilities. Craig Palosky, a HCFA spokesman, said the new funding level was not yet known but that the funds would support HCFA's activities under President Clinton's previously announced nursing home initiative. That includes additional state inspections of facilities with histories of problems to ensure that they stay in compliance.

"We agree in principle that chronically poor-performing homes should be surveyed more often. We have always supported surprise inspections and off-hour surveys. We think those are necessary for a survey process that has integrity," declared Robert Greenwood, a spokesman for AAHSA.

He suggested, however, that selection of the "100 worst" facilities was a "problematic" move. "I'm sure a PR person thought of this. It sounds good to the public," Greenwood said, noting that the "100 worst" are not necessarily the worst nationwide. Rather they are the two lowest-ranking in each state and "we have questions about how they choose those two homes," Greenwood said.

HCFA announced in January that it had instructed states to conduct additional inspections of at least two "special-focus" nursing homes. They will be inspected every six months--twice as often as required for most nursing homes. The "special-focus" homes were selected based on results of their most recent annual inspection and substantiated complaints during the past two years, HCFA explained.

"The good thing about doing two in each state is to see if there are differences among states in how the survey process works in terms of trying to actually improve the quality of care in those chronically poor-performing homes," Greenwood said. "Maybe there is something to be learned from some states that are doing a better job or are not doing such a good job."

Greenwood said the survey process that targets poor-performing homes also should recognize those that consistently receive no deficiencies in surveys. He cited an earlier HCFA proposal that would allow inspectors to skip a follow-up survey of a facility if they found no problems during its initial assessment. "That would save both time and money and would allow them to concentrate more resources on the chronically poor-performing homes," Greenwood said.

Recognizing good homes also would serve as an incentive to facilities to improve their performance, Greenwood said. "They would be able to say to their community, to insurers, and to other providers that would want to partner with them that they have achieved this status. Many homes would want to shoot for that."