Study Highlights Nursing Home Dangers

July 16, 2003 — -- When Sheila Albores' mother was admitted to an Illinois nursing home to help her learn how to care for a newly inserted breathing tube, Albores believed she would only stay for a few days. But in a few days, 57-year-old Anna Carrasco was dead.

"I just think a total lack of concern, no matter the complaints I voiced … [they] just fell on deaf ears," Albores said.

Albores and her attorney believe the nursing home is to blame. When she visited her mother that first afternoon, Carrasco had not yet been cared for, she says.

"The paramedics that brought her from the hospital had placed her in a bed, and no one had admitted her or taken care of her needs by the time I arrived," said Albores.

The nursing home says a state investigation found no serious problems with its care.

But a report by the General Accounting Office that will be released Thursday on Capitol Hill questions whether states are doing a good enough job monitoring and correcting problems in nursing homes.

The GAO, the government watchdog agency, says states seriously underestimate deficiencies at nursing homes. Federal inspectors found 19 percent of homes that the state investigators said were not deficient were in fact causing their patients harm, or putting them in immediate jeopardy.

"I think its extremely disconcerting to see how many problems there are with nursing homes," said Trudy Nearn, an elderly law attorney in Sacramento, Calif. "Even the nursing homes that have had good reputations in the past are having problems now."

One Death Is Too Many

The GAO report also found that many state inspection processes are too predictable, allowing nursing homes to prepare for the inspection. About one-third of the most recent state surveys nationwide occurred on a predictable schedule, allowing homes to conceal problems if they chose to do so.

The study says states are failing to report serious violations to the federal government as required. From January 2000 to March 2002, the states referred 4,310 cases for possible sanctions, but did not report another 711. One of the worst offenders was New York, which reported 22 cases, but failed to report another 140.

Sen. Charles Grassley, who requested the study, believes that in addition to the poor-quality care, it's an issue of responsibility to taxpayers.

"We're spending tens of billions of dollars of federal and state money on nursing-home care, and quality of care is what we're after and we want to make sure it's delivered," the Iowa Republican said. "One death because of substandard care is one death too many."

The report also said the federal government needs to do a better job overseeing the states' monitoring of nursing home. Thomas Scully, administrator of the Centers for Medicare & Medicaid Services, says the government is making headway, but it's a tough problem to solve.

"There are 50 different state programs. There are 50 different state Medicaid administrators, 50 different sets of surveyors. It's a big complicated program, but I think we're making progress," he said.

Some Mixed Signals

The GAO report was not entirely bad news, however. It found that the number of states underreporting deficiencies in nursing homes was down since last checked, and that the number of homes doing harm to patients had also declined, from 29 percent of homes to 20 percent — a drop of nearly one-third.

Despite the problems cited in the report, Dr. Charles Roadman, president and CEO of the American Health Care Association, which represents 12,000 nursing homes nationwide, insists the trend is toward improving care.

"I worry that the good-news story that's here will really get lost in the air of negativity of pointing out that large systems need improvement," he said.

Grassley also acknowledges that some improvement has been made — but not enough.

"It's a little bit like a student in school saying that there's been considerable improvement if they've moved from an F score to a D-minus score. I think we're talking about some improvement … but I think we have a long way to go," he said.

As for Shelia Albores, she remains shocked at what she says she saw at her mother's nursing home.

"What I witnessed in the nursing home … patients moaning and crying out for help and their needs not being met … those images will stay with me forever."