Medicare and Medicaid: Stronger Enforcement of Nursing Home Requirements Needed.

Because of continuing concern about the quality of care provided to nursing home residents, Senator John Heinz, Ranking Minority Member of the Senate Special Committee on Aging, asked GAO to 1 determine the extent of repeated noncompliance with federal requirements that could affect resident health and safety and 2 evaluate the adequacy of federal and state enforcement actions to correct the reported deficiencies. States must determine each nursing homes compliance with federal requirements at least annually. This is done through an inspection of the nursing home. Although the state decide whether nursing homes can participate in the Medicaid program, the Health Care Financing Administration reviews those decisions and can override the states when it disagrees or determines that a state did not follow federal requirements. The decision with respect to certification of nursing homes for the Medicare program is made by the Health Care Financing Administration. Nursing homes can remain in the Medicare and Medicaid programs for years with serious deficiencies that threaten patient health and safety by taking corrective action to keep from being terminated each time they get caught. GAO analyzed the four most recent inspections covering about a 4-year period for nursing homes participating in the programs in November 1985. Forty-one percent of skilled nursing facilities and 34 percent of intermediate care facilities nationwide were out of compliance during three consecutive inspections with one or more of the 126 skilled or 72 intermediate care facility requirements considered by experts to most likely to affect patient health and safety.