WASHINGTON – A Maryland health official said limited resources and unclear federal direction are largely to blame for General Accounting Office findings that the state drags its feet when investigating poor nursing home care.
The director of the state health department’s licensing and certification administration said Tuesday that the report does not look at all the steps Maryland has taken to ensure quality nursing home care — including closing two homes within the past three months.
“It would be misleading to judge Maryland based on the GAO report,” said Carol Benner, the director of licensing and certification.
The report, released Monday at a hearing of the Senate Special Committee on Aging, said Maryland and several other states fail to respond to nursing home complaints in a timely manner, understate the seriousness of complaints and limit their number by encouraging individuals to submit them in writing.
The report found that, as of December, Maryland had not investigated 101 complaints about 56 Baltimore-area nursing homes that it received between January and November 1998.
The report also detailed several shocking cases of patient treatment, including an ambulance crew that reported caring for a nursing home resident who had bedsores, dried blood under his fingernails and caked feces all over his body. It took the state 130 days to investigate that report, according to the GAO.
Another complaint, about a nursing home resident had to be hospitalized after an intravenous tube was inserted improperly, took 139 days to be investigated, the report said.
The GAO said that none of the 642 complaints received in Maryland from July 1, 1997, to June 30, 1998, were labeled “immediate jeopardy” cases — which the federal Health Care Financing Administration (HCFA) requires the state to investigate within two days. Most complaints filed in Maryland were placed in the lowest-priority category, those to be investigated during the next annual survey of a nursing home, it said.
“A Maryland official … acknowledged reducing the priority of some complaints because the state recognized that it could not meet shorter time frames because of insufficient staff,” said the report.
But Benner said that the policy of reducing the priority of complaints was something that HCFA recommended.
She also said that HCFA policy had been to let states wait until the next annual survey of a nursing home to investigate any complaints that did not allege “immediate jeopardy.” The new policy, which was just announced March 16, requires states to investigate any complaint that alleges harm to a resident within 10 working days.
“We cannot do it,” Benner said of the new HCFA policy. “Would we like to do it? Absolutely. Should we do it? Absolutely.
“The problem is a resource one, [we] can’t do that without additional money from the federal government, without additional staff,” Benner said. She said HCFA’s focus has been on Medicare and Medicaid compliance surveys of nursing homes, which is why Maryland has a staff of 35 doing those annual surveys and only four staffers responding to spot complaints against nursing homes.
Benner pointed out that her office diverted 650 hours of staff time from complaint investigations and annual surveys to supervise relocation efforts following one recent nursing home closing.
HCFA officials in their testimony to the committee said that this year’s budget includes an extra $171 million for increased nursing home enforcement efforts and that next year’s budget asks for another $60.1 million.
Benner said she does not think that Maryland is worse than other states but that it is “just Maryland’s turn” to be scrutinized by GAO reports and hearings.
“It’s painful to have to go through this, but helpful,” she said of the committee oversight hearing.