Pennsylvania Secretary of Health Karen Murphy: “From January 2015 until today it’s very clear through the actions we have taken that we are very concerned and that we take the quality issues very seriously.”
By Gary Rotstein / Pittsburgh Post-Gazette
Six months after the Pennsylvania Department of Health faced new scrutiny and criticism over its enforcement of quality care in nursing homes, data show it has quietly been increasing the penalties assessed to substandard operators.
The number of fines and provisional licenses for regulation violations among the 700 nursing homes more than tripled in the second half of 2015 from the first six months of the year, according to figures provided by the department. The combination of 52 fines and licensing actions last year were the most in the state since 2009.
The jump in punishment comes on the heels of a lawsuit filed in July by the Pennsylvania attorney general’s office against a national nursing home chain operating 36 facilities in Pennsylvania. The suit alleging a range of problems at the Golden Living Center homes, including two in Monroeville and Mt. Lebanon, did not directly accuse the health department of failing to do its job, but it noted inspectors had identified numerous flaws in patient care that failed to result in penalties.
PG graphic: Nursing home enforcement actions increased. (Click image for larger version)
A June report released by Community Legal Services of Philadelphia had been more pointed, highlighting the lack of enforcement actions in recent years while accusing the state of failing to properly investigate complaints or label substandard conditions as a serious violation of regulations.
State Secretary of Health Karen Murphy said in a recent interview that nothing changed recently about the manner in which nursing homes are evaluated or penalized. She attributed the increase in fines and provisional licenses during Gov. Tom Wolf’s first year in office to a growing number of investigations stemming from public complaints about nursing homes, which rose to 2,598 last year from 1,943 in 2014.
Ms. Murphy said she presumed the increase in complaints resulted from dropping a requirement imposed in 2012 that complainants had to identify themselves. In addition to allowing anonymous complaints since July, she said the department has also worked to publicize the complaint avenues, including its 24-hour phone hotline, 1-800-254-5164.
State surveyors are required to conduct a thorough examination of each nursing home every 12 months as well as follow up on public complaints. The annual inspections typically identify at least a few deficiencies in each home, ranging from patient care issues to paperwork problems to upkeep of the facility. So long as a revisit shows problems have been corrected, which is common, deficiencies with no proven harm to patients do not draw penalties.
For more serious deficiencies, the health department has the option of imposing a fine or a six-month provisional license instead of the typical annual renewal, as well as more severe actions, such as admissions bans and closures in rare cases. The fines and licensing downgrades averaged 53 annually from 2005-09 but only 21 a year from 2010 — the last year of the Rendell administration — through 2014.
The number of state enforcement sanctions during the Corbett administration’s 2011-14 tenure dropped to as few as two during all of 2012 — a pair of provisional licenses and no fines in a year when the public filed 1,843 nursing home complaints — though the unusually low number went unnoticed publicly at the time. Ms. Murphy declined comment on any actions that took place before her arrival, and the department refused a request to interview Susan Williamson, director of the nursing home division now as she was during the Corbett years.
Sam Brooks, a Community Legal Services attorney who oversaw June’s report critical of the health department’s treatment of nursing homes, was heartened to hear that enforcement actions have been increasing, whatever the reason.
“We would hope that this is a sign of change in the department of health in looking at violations, scrutinizing them more and taking them more seriously, recognizing that penalties and punitive measures are needed to correct the problems,” Mr. Brooks said.
Each state carries responsibility for monitoring both federal regulations as well as its own for nursing home care, but the investigative arm of Congress, the Government Accountability Office, has found wide variation in their level of aggressiveness in approaching the task.
In Pennsylvania’s case, it has been far less likely in recent years to cite homes for serious deficiencies than is the norm. It has been among the three states least likely to do so, according to separate state-by-state comparisons compiled by the ProPublica investigative group and the Long Term Care Community Coalition, a consumer advocacy organization.
Richard Mollot, executive director of the New York-based community coalition, attributes such differences to variation in states’ care monitoring — not their actual nursing home quality.
“I’m always appalled at how something can be rated as not causing harm,” he said of inspectors’ survey reports that find problems such as pressure sores developed by patients to be minor deficiencies.
Russell McDaid, president of the Pennsylvania Health Care Association, which represents for-profit nursing homes in the state, said the industry disagrees with any suggestion the state has enforced regulations inadequately. He pointed to federal Centers for Medicare & Medicaid Services data showing Pennsylvania’s nursing homes doing better than the national average in a majority of care indicators, including the percentage of residents with pressure sores, depression and injuries in falls.
“We’ve always had strict state and federal regulations covering nursing home operations,” Mr. McDaid said. “We see the same level of [oversight] activity. The department of health continues to be extremely thorough in discharging its duties ... and our members are very proud of the strides we have made in enhancing quality.”
Regardless of any quality indicators, Ms. Murphy acknowledged following the attorney general’s lawsuit in July that review was warranted of how the health department performs its oversight function. Among steps her office took as a result, in addition to changes in the complaint process, it:
• Requested a formal evaluation by state Auditor General Eugene DePasquale of the nursing home complaint and inspection process and results, which Mr. DePasquale said he expects his office to complete by the spring.
• Created a task force of academic experts from inside and outside Pennsylvania to identify how nursing home quality could be improved by any changes in regulations and in how the health department performs its role. Ms. Murphy said she hopes to see recommendations by summer.
• Added seven nursing home surveyors to the existing staff of 141 to keep up with the increased workload from additional complaints, in addition to undertaking internal and inter-agency changes to better process complaints.
Without addressing the department’s performance in the period covered by both the attorney general’s lawsuit and the pronounced drop-off in enforcement actions, Ms. Murphy said, “From January 2015 until today it’s very clear through the actions we have taken that we are very concerned and that we take the quality issues very seriously.”
Gary Rotstein: firstname.lastname@example.org or 412-263-1255.
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