OIG Releases Memorandum Report: Trends in Nursing Home Deficiencies and Complaints

VHCA (10/3/2008)

Earlier this week, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) issued a final report entitled Trends in Nursing Homes Deficiencies and Complaints,  stating that 91 percent of nursing homes surveyed in 2005, 2006, and 2007 were cited for deficiencies. The American Health Care Association (AHCA) is concerned that the information contained in the report does not provide useful information for the public and in fact, could lead to additional confusion about the quality of care provided in American's nursing facilities. The report analyzed survey data from the Center for Medicare & Medicaid Services’ Online Survey and Certification Reporting System (OSCAR).  Similarly, they obtained complaint data from OSCAR.

On Tuesday, The New York Times published an article using this information in a manner that can only be described as biased and misleading. Mary Jane Koren, Chair of the Advancing Excellence in America's Nursing Homes campaign, responded to the article with a letter citing her disappointment on how the statistics were used.

Based upon initial analysis of the report by AHCA, the OIG report showed that:

• More than 91 percent of nursing homes surveyed in 2005, 2006, and 2007 were cited for deficiencies.  This percentage remained stable during this period of time.  However, the average number of deficiencies per nursing home increased slightly during the same period, from 6.4 deficiencies per nursing home in 2005 compared to 7.0 deficiencies in 2007.
• The most common scope and severity ratings in 2007 were at the D and E level.
• The percentage of nursing homes with substandard quality-of-care deficiencies has risen slightly since 2005, from 3.0 percent in 2005 to 3.6 percent in 2007.
• The number of substantiated complaints decreased nearly three percent from 2005 to 2007.  Less than one-half of the complaints received by survey agencies and investigated were substantiated.

The report notes that deficiency rates varied widely among states.  In 2007, the percentage of nursing homes surveyed with deficiencies ranged from 76 percent in Rhode Island to 100 percent in Alaska, the District of Columbia, Idaho, and Wyoming. Three types of deficiencies have been the most common since 2005.

• Approximately 36 percent of nursing homes surveyed were cited for deficiencies associated with accident hazards each year; 
• Between 33 percent and 35 percent of nursing homes were cited for deficiencies for the improper storage, preparation, distribution, or serving of food; and 
• Almost 28 percent were cited for deficiencies for not providing the care necessary for residents’ highest practicable physical, mental, and psychosocial well-being. 

In 2007, nearly 3 percent of nursing homes surveyed were cited for immediate jeopardy and 15 percent were cited for actual harm deficiencies.  The majority of the nursing homes with actual harm deficiencies had isolated (G-level) rather than pattern or widespread (H- and I- level) deficiencies. 

When discussing this report, it will be important to look at that state’s data in the report (Appendices A & B of the report).   Further, it is important to focus on the quality improvements that have been made at both the state and the facility level. Nationwide, there is a positive trend in the quality measures posted on Nursing Home Compare with improvements in key areas for short-term and long stay patients in pain, restraints, and pressure ulcers. Pain for long term stay patients was improved from a rate of 10.7 percent in 2002 to 4.6 percent in 2007 while pain in short-term patients was reduced from 25.4 percent in 2002 to 20.7 percent in 2007.  The report also reveals that use of physical restraints for long stay patients dropped from 9.7 percent in 2002 to 5.6 percent in 2007.

The disparity between the improvements in quality measures as compared to the slight increase in survey deficiencies supports the argument that AHCA has been making:  The survey system is broken; Americans need a new process that objectively and accurately reflects the quality of care provided by each nursing home. While the OIG reports that 91 percent of nursing homes surveyed were cited for deficiencies, it provides no commentary or analysis to help the public understand what is very important or of less importance.  The OIG reports on 16 categories of deficiencies and gives equal weight to all requirements.  In other words, a dented can in the kitchen, which can result in a deficiency, has equal footing with improperly storing or serving food at unsafe temperatures. 

AHCA is aggressively working to clear up misperceptions contained within the published report and subsequent news reports through efforts with Capitol Hill and the media.  In an effort to assist members with current information on survey trends in the state, VHCA has developed a unique tool available to members to use as a resource for analyzing current survey trends and patterns in Virginia’s nursing facilities.  The Survey Management and Analysis Resource Tool (SMART) is based on an analysis of 2567 deficiency reports entered into the SMART database.  The timely information is accessible to all VHCA members who submit their survey reports.  Contact Beverley Soble at beverley.soble@vhca.org in the VHCA office for more information on how to participate in SMART or how to use the tool to track survey results in Virginia.