Nursing home resident abuse underreported and unpunished, government finds.
It took 26 months for the consequences to catch up with Holmes: In March 2002, she was arraigned on manslaughter charges for the drowning. In the meantime, at another nursing home, she allegedly beat a 91-year-old resident who had resisted being helped into bed. She now faces simple assault charges in that case.
D.C. advocates for the elderly say the Holmes prosecution represents the first time in years that criminal charges have been filed in the city over physical abuse or neglect of a nursing home resident. And it is the kind of case that has attracted the attention of Congress, other federal authorities, and plaintiff attorneys seeking to remedy this growing problem.
The latest in a string of studies on the subject by the U.S. General Accounting Office, released in March, found that nurse aide registries--which are supposed to include lists of aides accused of abusing or neglecting residents--are not current and provide limited information; that local law enforcement authorities are seldom involved in nursing home abuse cases; and that restrictive state policies may hinder referring allegations to investigative agencies. (Nursing Homes: More Can Be Done to Protect Residents from Abuse, GAO-02-312 (Mar. 1, 2002).)
About 1.5 million elderly and disabled people live in almost 17,000 nursing homes in the country. Under the current system, federal, state, and local agencies--including law enforcement--investigate abuse allegations. The Centers for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration (HCFA)) establishes standards that nursing homes must meet to receive Medicare and Medicaid payments.
CMS contracts with state agencies, such as departments of health, to perform annual inspections (called "surveys") and investigate complaints about nursing home care. These agencies may notify state or local law enforcement and other agencies, depending on a state's requirements.
"The federal and state system to enforce and hold nursing homes accountable is ineffective," said Libby Edwards, a Corpus Christi, Texas, attorney who heads ATLA's Nursing Homes Litigation Group. "For example, the system in place right now between [CMS] and the Texas Department of Human Services--that is, between the federal and state agencies responsible for enforcing nursing home standards--is ineffective in cleaning nursing homes' acts up and enforcing the quality of care."
The GAO agrees that systems need to change. Leslie Aronovitz, director of health care issues for the agency, testified in March before the U.S. Senate Special Committee on Aging about the limitations on adequate patient protection. Nurse aide registries do not provide information on other types of employees, are hard to keep current, and don't list offenses committed in other states, she said. Local law enforcement is rarely involved in nursing home abuse cases because reporting is so inconsistent, and state Medicaid Fraud Control Units (MFCUs) (usually part of the attorney general's office), which investigate abuse allegations if they involve criminal activity in the Medicare/Medicaid program, have to rely on cases referred by state survey agencies, which restrict what is reported.
Aronovitz said CMS should establish new safeguards and strengthen old ones, recommending that it clarify its definition of abuse and increase MFCU involvement in examining abuse allegations. "Without such improvements, vulnerable nursing home residents remain considerably ill-protected," she said.
Last year, the House Committee on Government Reform found almost 9,000 instances of nursing home resident abuse over two years. (Government Report Finds "Unconscionable" Abuses of Nursing Home Residents, TRIAL, Oct. 2001, at 84.)
A 1999 GAO report noted deficient oversight of quality of care. It also found weaknesses in states' complaint investigations, annual inspections, and enforcement actions. (Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents, GAO/HEHS-99-80 (Mar. 22, 1999).)
In September 2000, the GAO reported that HCFA had started requiring states to investigate complaints within 10 working days but that state agencies were not doing so consistently. (Nursing Homes: Sustained Efforts Are Essential to Realize Potential of the Quality Initiatives, GAO/HEHS-00-197 (Sept. 28, 2000).)
"Nursing home residents need both stronger and more immediate protections," the March 2002 GAO report concluded. Deciding when to report abuse complaints "can be confusing" for nursing homes, although limited evidence (because incidents are rarely witnessed) usually makes prompt reporting crucial.
While CMS forbids hiring staff convicted of abusing residents, that "does not sufficiently prevent the hiring of potentially abusive individuals." The GAO urged states to impose more stringent hiring requirements so that, for example, child abusers cannot work in nursing homes.
The report also noted that CMS doesn't require criminal background checks of potential employees. Although some states do, the checks may not identify offenses committed in other states, or may not be required for all employees. Further, the CMS definition of "abuse" isn't detailed and leads to spotty reporting by states.
While CMS is studying whether to develop a national abuse registry, promises it has already made are stalled. For example, it has taken more than three years to develop a poster to be placed in nursing homes that would inform residents and family how to report abuse.
Other efforts to help consumers have also been unsatisfactory, say advocates for the elderly. A Department of Health and Human Services online guide to nursing homes, Nursing Home Compare (www.medicare.gov/Nhcompare/home.asp), excluded more than 25,000 violations reported by state investigators, according to the House committee. In many cases, the Web site gave a nursing home a clean bill of health when it actually had serious code violations, some of which contributed to the deaths of residents.
And corrective actions have little follow-through, said Edwards. "Sure, the terribly ineffective regulatory system comes in and pops nursing homes with civil monetary penalties. But when you check how many have been assessed against how many have actually paid the fines, you find something like one-tenth of what was assessed has been collected," she said.
"If you compare that to a motorist driving down the highway who knows the chances of being held accountable for a speeding ticket are 1 in 10, what are the chances of that driver continuing to speed?"
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|Date:||Jul 1, 2002|
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