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AAJ Comment on New CMS “Conditions of Participation”

Nursing home case is quite expensive–few families are able to pay for that care on their own when the time comes. That is why many residents in these facilitate are in the federal Medicare and Medicaid programs. Payments for the care is usually made by these programs directly to the facility. Our Chicago nursing home abuse lawyers know that that is why regulations by the Centers for Medicare & Medicaid (CMS) can strongly influence the conduct at these homes. By changing requirements for participation in the program, CMS spur action at most facilities across the country.

Recently, CMS issued changes to its clinical standards and quality review of the conditions of participation. The American Association for Justice (AAJ) commented on the changes, which offers a helpful way to understand how the CMS actions might affect the care actually provided to residents.

In general, the news is good as the comment explained that the “AAJ applauds CMS for taking steps to improve safety standards for nursing home and long-term care residents.”

However, AAJ reminded CMS that it was crucial to consider only changes to regulations what would “increase and incentivize patient safety through improved accountability and transparency.”

Our Illinois nursing home lawyers appreciate that while the change to CMS standards have as a partial goal the need to eliminate redundant, burdensome, or obsolete provisions, there is the risk that crucial accountability tools might be lost. It does not take much extrapolation to consider how this goal could lead to elimination of helpful accountability tools in the name of “efficiency.” This should never be allowed, particularly because of the continued inadequate care received by so many residents.

For example, the AAJ article reminds that of the 1.6 million American in these facilities, 23.5% were rehospitalized within 30 days. Many of those hospitalizations may have been avoidable or related to conditions which could have been treated outside of the hospital. In some cases this is directly connected to nursing home neglect and abuse. Not only are these hospitalizations bad for the residents themselves, but they are quite costly. Some estimates suggest that $4 billion can be saved by improving care at these long-term care facility and minimizing those return trips to the hospital.

It is crucial not to let claims of “overburdensome” CMS requirements allow standards to slip which not only do not address the existing problems but exacerbate them. In fact, many balanced efforts have found that requirements need to be strengthened–not weakened. For example, a 2009 Government Accountability Office report found that many state surveys on nursing home quality noted that many were failing to prevent (or even investigate) “high harm complaints.” This mirrors the experience of our Chicago nursing home attorneys who have worked on many cases where caregivers failed to meet basic safety standards and follow-up properly after accidents.

It is important for all those who care about the long-term care of senior residents to advocate for strong standards from CMS. Nursing homes will do what it takes to keep their income flow. If CMS–which provides that income flow–keeps requirements high, it is likely that residents will benefit from the level of care they deserve.

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