A report published by the US Senate on Monday, June 6th, and authored by Pennsylvania senators Bob Casey and Pat Toomey, includes a list of nearly 400 nursing homes across the United States with a “persistent record of poor care.” In statements made in connection with the report’s release, the senators noted that the names of those nursing homes are not publicly disclosed, as are other homes where safety inspections turned up health, safety, or sanitary issues, according to an article in USA Today. Specifically, Senator Toomey said, “When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings.”
Nursing home abuse and neglect is a sadly common phenomenon, the report notes in its introduction. Recent surveys of one Pennsylvania nursing home noted such incidents as “an unnecessary hospitalization resulting from an avoidable pressure sore, an escaped resident with dementia, mismanagement of medications, unsanitary shower and bathroom areas and uncleaned oxygen tubes,” according to the report. In national terms, the list includes a nursing home in Florida which “neglected to clean blood sugar measuring devices between testing different patients, risking infection,” as well as a Texas facility where authorities allegedly did not “fix a waste system backup,” causing staff to serve food even though “a foul-smelling black substance” was emerging through the kitchen drains.
Federal oversight of nursing home facilities includes an initiative known as the Special Focus Facility (SFF) program, which places under heightened scrutiny nursing homes that “substantially fail” to comply with standards of care and protections guaranteed by Medicare and Medicaid laws. The SFF program comprises a maximum of 88 nursing homes, which the report notes is not even 0.6% of the nation’s 15,700 nursing homes. And while the names of SFF participants are made public, the names of about 400 SFF candidates are not made public, nor are they subject to additional oversight, despite their identification as facilities with a “persistent record of poor care.” The problem with this, according to the Senate report, is that “individuals and families making decisions about nursing home care for themselves or for a loved one” probably are not aware of the SFF candidates.
Accordingly, Pennsylvania senators Casey and Toomey published the April 2019 list of SFF candidates. They also wrote to the Centers for Medicare and Medicaid Services (CMS) requesting that the agency disclose future lists of SFF candidates.
Participants in the SFF program, which was enacted in 1987, are surveyed “no less than once every six months,” according to the report; nursing homes not included in the SFF program are required to be surveyed “at least once every 15 months,” and are surveyed on average once a year. The CMS decides how many nursing homes participate in SFF: currently, it includes 88 participants and 435 candidates. More than 900 nursing home facilities have been included on the candidate list since 2005, according to the report. SFF participants are designated by a yellow triangle symbol on the CMS’s Nursing Home Compare tool, which allows users to compare nursing home facilities using information about their staffs, state survey results, and complaints. Whereas most nursing homes receive star ratings—based on three factors: “surveying and infections, staffing data, and quality scores”—SFF participants are exempted from star ratings. Candidates, however, are not. For these reasons, the Senate report argues for the federal government to improve public disclosure of SFF candidates.
Examples of misconduct in SFF candidate facilities are listed in an appendix to the Senate report. They include the following:
-A Delaware facility that did not properly investigate allegations that a staffer committed sexual assault. The victim consequently was not referred for a medical examination “until two days after the incident,” and the nursing home allowed the alleged assailant’s continued employment while the investigation was underway, “with access to the victim.” This nursing home “had staffing and quality ratings of five stars” as of May 29, 2019, according to the report.
-A Hawaii nursing home facility that did not address a pest problem, resulting in the presence of “cockroaches and ants near residents, on countertops and crawling on medical charts.” This nursing home enjoyed a quality rating of five stars and an overall rating of two stars as of the end of May 2019, according to the report.
-A Kentucky nursing home that put a number of residents “in immediate jeopardy” by failing to give them prescribed medication and treatment, then failing to notify their physician that the residents missed their treatment. The report states: “One resident who suffered from a burn wound and was receiving treatment that included a skin graft did not have the dressing changed or showers administered as ordered.” The nursing home enjoyed a four-star staffing rating as of May 29, 2019, and a two-star overall rating.
-A Massachusetts nursing home where “illicit substances” were common enough that patients were concerned about staying sober, and said that “it was easier to obtain illicit substances inside the facility than out on the street.” This nursing home enjoyed a staffing rating of two stars as of the end of May 2019, and an overall rating of one star.
In a letter to Senator Casey, CMS Administrator Seema Verma stated that the number of SFF slots and candidates “are based on the availability of federal resources,” and that budget reductions in 2014 resulted in a reduction of the number of national SFF slots and candidates. She also stated that the CMS is “evaluating the authority to release” the list of SFF candidates, promising to update the Senate on its progress.