Center for Medicare Advocacy Issues New Report on Nursing Home Decisions:
Weak Enforcement of Serious Errors Highlights the Need for Stricter Oversight

Nursing home decisions issued by the Department of Health and Human Services' Departmental Appeals Board (DAB) in 2007 highlight serious failures in care that cause residents to suffer unnecessary pain, injury, trauma, and death. "Despite the serious deficiencies reflected by these cases, the federal enforcement response is usually modest, at best," said Toby S. Edelman, Senior Policy Attorney with the Center for Medicare Advocacy and author of the just-released report, Nursing Home Decisions of the Department of Health and Human Services' Departmental Appeals Board, 2007, an analysis of nursing home enforcement decisions issued by the DAB. "The federal government imposes only minor fines for these deficiencies," she continued, citing a case where a trivial $4050 fine was imposed when a resident strangled to death on her bedrail, after having fallen out of bed numerous times and been found caught by the bedrail in the same way a week before.

The Center for Medicare Advocacy's study of the 85 decisions is the first study ever made of the administrative appeals filed by nursing homes when federal remedies are actually imposed against them for poor care. "The study shows not only that the problems in care are serious and that penalties are modest, but also that facilities choose to appeal these enforcement actions through the administrative appeals process. Almost always, the facilities lose their cases," Edelman said. The government won 66 of the 71 cases that reached the merits of the appeals - a 93% success rate.

The Center for Medicare Advocacy recommends that the regulatory system, unchanged for more than a decade, be updated. The Center calls for a stronger and faster enforcement response to the serious noncompliance that these cases reflect. The federal enforcement system should impose larger fines for facilities' failure to provide residents with the care they need, not just for failing to correct problems, and it should include a broader array of federal remedies to impose against facilities that harm residents.

In addition, said Edelman, "more public information is needed about the survey and enforcement systems and about the appeals process." Medicare's informational website, Nursing Home Compare, does not describe the facts supporting deficiencies and contains no information about enforcement actions. "Consumers need information about surveys and enforcement to help them choose facilities and to monitor the care their loved ones receive."

The full report is available at www.medicareadvocacy.org\SNF_08_05.13.DABNursingHomeDecisions.pdf

Toby Edelman is available to comment on the report.