Consumers Reports once again has an article about nursing homes and the care provided. In this article they discuss OBRA 20 Years…

Two decades after the passage of a federal law to clean up the nation’s nursing homes, bad care persists and good homes are still hard to find.

In 1987, Congress passed a landmark law meant to improve nursing home care for the elderly. But our investigation reveals that poor care is still all too common, especially at nursing homes run by for-profit chains, now the dominant force in the industry.

Consumer Reports’ analysis found that not-for-profit homes generally provide better care than for-profit homes, and that independently run nursing homes appear to provide better care than those that are owned by chains. In a separate study, we found that many states are lax in penalizing bad homes.

For this report, we analyzed the three most recent state inspection reports for some 16,000 nursing homes across the U.S. We also examined staffing levels and so-called quality indicators, such as how many residents develop pressure sores when they have no risk factors for them.

It’s no secret among CNA’s that for profit chain owned nursing homes are the worst when it comes to quality. We work in these places and we see, firsthand, the reasons for poor care.

The Consumer Reports Nursing Home Quality Monitor, formerly the Nursing Home Watch List, lists facilities in each state that rank in the best or worst 10 percent on at least two of our three dimensions of quality. By examining the kinds of homes that tend to cluster at either end of the continuum, we can make some judgments about how likely a facility is to provide proper care.

This is a good tool. Click on your state to see recommended nursing homes and places to STAY AWAY from. I’m going to add this NHQM to the sidebar here.

Our investigation found that the state agencies responsible for overseeing nursing home care have often failed to correct problems. But consumers can increase their odds of choosing a good nursing home if they narrow their search to certain types. Our findings:

• Not-for-profit homes are more likely to provide good care than for-profits, based on our analysis of inspection surveys, staffing, and quality indicators.

• The same analysis shows that independently run homes are more likely to provide good care than chains.

• Through its influence in politics, the industry has whittled down the protections of the 1987 federal law.

So is OBRA effective anymore?

Some other highlights:

Nursing home researchers say that the most serious problems sometimes show up in small, for-profit chains within a state. In New York, for example, Healthcare Associates, wholly owned by Anthony Salerno, jointly administers a network of 12 separately incorporated facilities. Salerno is the largest shareholder in all the facilities. Three of the homes have been on our quality-monitor list.

Earlier this year Eliot Spitzer, New York’s attorney general, sued one of the three homes, the Jennifer Matthew Nursing and Rehabilitation Center in Rochester, alleging abuse and neglect. Investigators used a hidden camera to show that call bells were placed out of residents’ reach and that patients would go unturned and unwashed for hours. That facility was a four-time repeater on our lists.

And:

One reason the independently owned, not-for-profit facilities might do a better job is that they tend to have more staff, which experts agree is crucial to good care. We found that on average, not-for-profits provided almost an hour of additional nursing care each day per resident, compared with for-profit facilities. They also provided nearly twice as much care from registered nurses.
In 2002, a study conducted for the federal Centers for Medicare & Medicaid Services (CMS) noted that without a daily average of 2.8 hours of care from nurse aides and 1.3 hours from licensed nurses, residents were more likely to experience poor outcomes–pressure sores and urinary incontinence, for example. “Most nursing homes are staffed significantly below that,” says John Schnelle, director of the Borun Center, a joint venture of UCLA and the Jewish Home for Aging that does research on long-term care.

Staffing levels are KEY to good care. No other way around it. HOWEVER the staff must be well trained, have good work ethic and need to be well supervised (not micromanaged).

Nursing homes are not major donors to national political campaigns, but they wield considerable clout in state capitals, where their $500, $1,000, and $3,000 contributions count with gubernatorial, state legislative, and judicial candidates.

In Arkansas, for example, the industry was a top contributor to state candidates in 2004, according to Followthemoney.org, a nonpartisan database of campaign contributions. The Arkansas Health Care Association, which represents for-profit nursing homes, gave almost $100,000 that year to candidates in the state.

Appalling:

Messages from legislators, subtle and not so subtle, filter down to regulators, who have learned that nursing homes will challenge them if they press too hard. Grachia Freeman, a former nursing home inspector in Arkansas, says that supervisors “would not let me write deficiencies I wanted to write” for a facility she was inspecting. Now a nurse at a VA hospital in North Little Rock, she adds, “They were angry with me for investigating and told me not to complete the survey.” We made several efforts to interview regulators in the long-term-care unit of the Arkansas Department of Health and Human Services but were repeatedly rebuffed.

Has anyone seen evidence of this:

Although the number of deficiency citations written by state inspectors has increased 7.6 percent since 2003, according to the CMS, inspectors appear to be watering them down. Each one carries a letter code, from A through L, indicating the scope and severity of the violation. Citations labeled G through L denote actual harm or the potential for death. Codes I through L indicate that the harm was widespread, affecting many people.

State inspectors are now writing fewer deficiencies with codes that denote actual harm, such as avoidable pressure sores and medication errors. “We are going back to a less stringent and simpler enforcement,” says a federal analyst familiar with nursing home inspection data at the CMS. “Everything is becoming a D level. Nursing facilities are going to challenge anything above a D level if it carries a mandatory penalty, can be used in a tort case, or will be publicly disclosed.”

Finally-

The CMS can disqualify a home from the Medicare and Medicaid programs, cutting off federal funds. But that remedy, the most drastic in the agency’s arsenal, is used less frequently than in the past. In 1998, the number of terminations peaked at 51; in 2005 there were only 8.

It’s difficult to say whether nursing homes have improved or not. We see less fines and all, but according to this report there are many factors behind this. It’s a very long article and worth the time to read, no matter how one looks at it.