Report: Nearly All U.S. Nursing Homes Cited for Care Deficiencies

More than 90 percent of the nation's nursing homes were cited for violations of safety and health regulations in the last three years, according to a federal report.

The deficiency rates on for-profit homes were even higher, with nearly 94 percent receiving a citation in 2007, Daniel R. Levinson, inspector general of the Department of Health and Human Services, said in the report.

Levinson also said 17 percent of all nursing homes were cited in 2007 for violations that posed actual harm or immediate jeopardy to residents.

The report focused on the nature and extent of nursing home complaints and deficiencies from 2005 through 2007.

It said the average number of deficiencies per nursing home increased slightly each year, from 6.4 in 2005 to 6.9 in 2006 to 7.0 in 2007.

More than 1.5 million people live in the nation's 16,000 nursing homes.

As a condition for participating in the federal Medicare and Medicaid programs, nursing homes undergo inspections by state regulators at least once a year.

There are 190 possible deficiencies for which an inspector may cite a nursing home, according to the report. They fall into 16 separate categories, and the numbers for most of them rose slightly over the last three years.

The most commonly cited deficiencies from 2005 through 2007 involved quality of care, quality of life and resident assessment, according to the report.

The most prevalent quality-of-care deficiencies included the failure to remove accident hazards, prevent and treat pressure sores and urinary tract infections, and provide adequate services to promote residents' physical and mental well-being.

The most common resident-assessment deficiencies listed in the report involved providing comprehensive care plans and meeting professional quality standards.

The most frequently cited quality-of-life violations involved deficient housekeeping and maintenance services, the failure to protect residents' dignity, and the lack of accommodation of residents' needs, the report said.

Nearly 74 percent of all nursing homes were cited for quality-of-care violations, about 58 percent were cited for resident-assessment violations and about 43 percent received citations for quality-of-life issues.

Levinson said for-profit companies operated 67 of the homes covered by the report, while nonprofit organizations owned 27 percent, and 6 percent were government-run.

In 2007, the report said, 93.5 percent of for-profit homes were cited for deficiencies. Meanwhile, 90.5 percent of the government-run homes and 88.4 percent of the nonprofit facilities were cited.

In addition, each for-profit home averaged 7.6 deficiencies last year, compared with 6.3 per government home and 5.7 per nonprofit home.

Levinson also said the deficiency rates varied greatly among the states. The percentage of nursing homes cited for deficiencies in 2007 ranged from 76 percent in Rhode Island to 100 percent in Alaska, the District of Columbia, Idaho and Wyoming, according to the report.

The average number of deficiencies also varied, from 2.5 in Rhode Island to 14.4 in the District of Columbia.

The inspector general also looked at the complaints received about the conditions at nursing homes.

Regulators received 37,150 complaints last year, substantiating[MSOffice1] [LU2]14,394 of them, Levinson said. About 20 percent of the verified complaints relate to resident abuse and neglect. The number of substantiated complaints has declined by 3 percent since 2005, according to the report.

In his conclusion to the report, Levinson noted that the quality of care and services at the nation's nursing homes are not the sole factors affecting the deficiency rates.

"These factors may include an increase in enforcement, additional guidance of training from the states and [the Centers for Medicare and Medicaid Services], legislative changes and state surveyor practices," Levinson said.

In addition to the report, the inspector general issued a new compliance guide to help nursing facilities develop programs to address fraud and abuse related to quality-of-care and billing the federal Medicare and Medicaid programs.

The new guidelines are published in the Sept. 30 Federal Register.

The report is available at http://www.oig.hhs.gov/oei/reports/oei-02-08-00140.pdf.

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