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Report on Disparities in Nursing Home Sanctions

ProPublica recently issued a report which explores an important topic related to holding nursing homes accountable for mistakes and ensuring changes are made to prevent future harm. The story takes a look at federal oversight of nursing homes, particularly the scattered penalties for care lapses. Obviously, accountability and enforcement of rules is a crucial way quality standards are upheld at these homes. If there are no consequences for providing inadequate care, many facility owners and operators will provide sub-par services to maximize their own bottom line. In fact, many already do. But when it is well-known that errors will be costly, the incentive to prevent those errors increases dramatically.

Unfortunately, punishments are often not doled out consistently or evenly, perhaps limiting the deterrent function of public oversight.

Different Punishments
The report explores the disparity in outcomes following the accidents that led to resident deaths at nursing homes in two different states. In the first case a resident was eating a cookie when he began choking. The resident went to the nurse’s station, but efforts to dislodge the airway blockage failed. In the second case, a resident pulled out her own breathing tube. Caregivers were not able to catch the problem in time.

Following both of the incidents leading to death government investigations were conducted. In each, the investigators found problems with the care provided during the incident. In the first case the employees did not immediately call 911. In addition, they had not been properly trained to respond to emergencies of that nature–a lapse which may have cost the resident his life. In the second incident, the resident in question had removed her tube twice in the prior month. Investigators determined that the caregivers should have done more to prevent the accident, knowing about the risks. The final reports in each case resulted in essentially the same violations representing “immediate jeopardy” of leading to resident harm.

So what were the punishments for the care lapses?

In the case involving the choking death the nursing home was fined $9,500. In the second case, the facility was hit with over a $350,000 fine. Each fine was based largely on the recommendations of state officials who were also involved in the matter.

The report refers to this reality as the “balkanized” system of nursing home punishments following care lapses and citations. Even though federal money is involved, each state essentially determines its own punishments, resulting in significant disparities. Some locations demand more sizeable sanctions for the most serious problems, while other states are far less demanding. It turns out that while CMS officials have to approve final sanction amounts, they almost always rubber-stamp the state suggestion.

Many argue that the failure to standardize these violations allows the poorest facilities to go by without improvement. A nursing academic interviewed for the story explains, “If you don’t go after these really bad violations and try to force these nursing homes to improve quality, they’re going to continue to cause harm and jeopardy.”

This is just one of many reasons why it is always important for individual family members to come forward after their loved ones have been harmed and perhaps file a lawsuit to ensure full accountability is had to prevent future problems.

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