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The federal agency that administers the Medicare & Medicaid programs, the Centers for Medicare & Medicaid Services (CMS), seems to suddenly be on a crusade to identify suspect nursing homes.  Based solely on the facts reported in two reports released by CMS, their new-found backbone is long overdue.

Life Care Planning, Estate Protection, Disability,
VA & Medicaid Assistance Lawyers

Feds Target Nursing Homes That Need Increased Oversight

The federal agency that administers the Medicare & Medicaid programs, the Centers for Medicare & Medicaid Services (CMS), seems to suddenly be on a crusade to identify suspect nursing homes.  Based solely on the facts reported in two reports released by CMS, their new-found backbone is long overdue.

 

In the first of the two reports, CMS released a complete list of U.S. nursing homes that have failed to meet minimal standards for safety and quality of care.

 

The list, which identifies 131 "Special Focus Facilities" that require additional oversight, follows the release in November 2007 of a list of 54 such facilities. At that time, CMS came under intense public criticism for making public only a partial list of Special Focus Facilities while sharing the full list with three associations that represent the nursing home industry.

 

CMS created the Special Focus Facility initiative in 1998 in response to the number of facilities that were consistently providing poor quality of care. Those facilities were periodically instituting enough improvement so that they would pass one inspection, only to fail the next for many of the same problems as before. Facilities with this compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

 

Serious deficiencies include such things as failing to give residents their medications in the correct dose at the correct time, not taking steps to prevent abuse or neglect, inappropriate use of restraints and failure to prevent or properly treat bed sores.

 

Once a facility is selected as a Special Focus Facility, state agencies are responsible for conducting twice the number of standard inspections and, according to CMS, will apply progressive enforcement until the nursing home either significantly improves and is no longer identified as a Special Focus Facility, is granted additional time due to promising developments, or is terminated from the Medicare and/or Medicaid programs.

 

As noted in an article that appeared in the February 19, 2008 edition of The Southern, one facility located in southern Illinois appeared on the list of 131 Special Focus Facilities.  Four other facilities, located elsewhere in Illinois, also were listed as among the worst in the nation.

 

To see the CMS report on the SFF initiative and the Illinois facilities listed, go to http://www.cms.hhs.gov/CertificationandCompliance/Downloads/SFFList.pdf.

 

In the second of the two reports, CMS for the first time has publicly released the names of thousands of nursing homes across the country that don't meet federal standards in rates of using patient restraints or preventing bedsores.

 

Although CMS officials said that the 4,037 nursing homes on the list are "not the worst nursing homes in the country," they said the facilities will be targeted for oversight over the next three years by the private Quality Improvement Organizations (QIOs) that the agency hires to improve care at nursing homes and other facilities.

 

There are 229 Illinois nursing homes on the list, or 5.6% of the national total. In the 27 counties south of Interstate 70 there were 34 nursing homes on the federal list.  This represents nearly 15% of the 229 nursing facilities on the federal list  -  although the population of the 27 counties is only 4.7% of the total population of Illinois.

 

In the 13 southern-most counties in Illinois, there were 10 nursing homes on the list.  This represents more than 5.6% of the 229 Illinois homes slated for greater oversight  -  although the population of the southern 13 counties is only 2.2% of the total population.

 

These are statistics that we in southern Illinois should not be proud of.

 

We can and must do better!

 

To see the 94-page list of facilities targeted for the quality improvement inspections go to http://www.cms.hhs.gov/QualityImprovementOrgs/Downloads/NursingHomeChart.pdf  (may take some time to load).  The Illinois facilities are listed on pages 31 to 37.

 

Richard Habiger is an elder law, VA benefits, and life care planning attorney.  You may contact him at 618-549-4529 or Richard@HabigerElderLaw.com.