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Penalties few for poor care
Nursing homes usually prepare for 'the game'

Series: Part 2 of 4
By Jim DeBrosse and David Gulliver
 © 1999 Dayton Daily News|

When state inspectors walked into the Bethany Lutheran Village nursing home in October, they didn't hear complaints about staffing problems. They didn't find any incident reports in charts. And if they learned anything they didn't know, it wasn't because some staff member volunteered the information.

That's because at Bethany, officials have made a science out of preparing for the annual visit from the Ohio Department of Health.

Before the inspectors showed up this fall, Bethany administrators distributed a copy of a "surveyor arrival punch list" to the Centerville nursing home's weekend and evening staff members.

LISA POWELL / DAYTON DAILY NEWS

Cost often dictates elder care choices
 Veda Thompson visits her 92-year-old aunt, Thelma Ralls (in bed), and her 89-year-old mother, Goldie Archer (right), at least five days a week at a Xenia nursing home. Thompson would like her mother to move to an assisted living facility, but she can't afford the $75- to $85-per day charge. See sidebar.

Among the suggestions:

  • "Remove any accident/incident reports from charts and place under door of unit manager's office."

  • "Don't talk about being 'short-staffed' or any staffing issues."

  • "Don't volunteer anything unless asked specifically."

  • "If you see something is wrong, don't be afraid to correct immediately . . . try to do it without calling attention to it if the surveyor is with you."

    State inspections have become "this little game played out every year, because the surveyors never see the conditions that are the norm for the other 50 weeks of the year," said a staff member at the 315-bed facility, who asked not to be named. "And it's not just Bethany, but a common, industry-wide routine."

    An eight-month Dayton Daily News examination found that Ohio's nursing home regulatory system fails to protect its most vulnerable charges. It's a system where nursing home operators have little to fear from the people who police them and plenty of opportunities to hide bad care.

    For example:

  • Nursing homes are seldom surprised by "surprise" inspections. State health department inspection records show that just 15 percent of state surveys fall within a year of the previous visit, and 60 percent occur 14 to 15 months after the last inspection. "It's a no-brainer. Homes can usually predict within a few weeks of their next annual survey," said Debby Allen, spokeswoman for the Ohio Association of Regional Long-Term Care Ombudsmen, an umbrella group for agencies that investigate nursing home complaints.

  • Federal funding cutbacks and state hiring freezes have slashed the number of inspectors. Since 1995, the Ohio Department of Health has lost a third of its inspectors -- even as the number of facilities for the aged has grown rapidly. The result is that overstretched inspectors take longer to revisit homes and respond to complaints. "The deficiencies and abuses just go on longer and become harder to correct," said Lisa Hetrick, Ohio coordinator for the Service Employees International Union, which represents the state's inspectors.

  • The enforcement system is so riddled with waivers, appeals and correction periods that most homes cited for providing bad care get off the hook. Three-quarters of all enforcement actions result in no penalties, and the state has shut down just six homes in five years. Even homes repeatedly cited for putting residents in "immediate jeopardy" have stayed in business after persuading state regulators that they've solved the problems.

  • The industry has a revolving door with the agencies that regulate it. The top legal counsels to both of Ohio's trade associations of for-profit nursing homes are former state regulatory officials. So is the executive director of the nursing home association representing non-profits. And one state inspector estimates that 70 percent of her colleagues who have quit the district office find jobs as nursing home consultants or administrators.

    "When (state employees) go to the other side, which happens all the time, their job is to tell providers how to stay within the law and, at the same time, how to get around the law -- 'legally,' I guess," said Gerson Silver, a family counselor in the Montgomery County court system who once headed the nursing home complaint division of the Ohio Department of Human Services.

    There's nothing cozy or unethical about the industry recruiting from the ranks of its own regulators, said Peter Van Runkle, chief legal counsel and lobbyist for the Ohio Health Care Association, the major trade association for Ohio's nursing homes. Van Runkle, as the former top legal adviser to the Ohio Department of Health, was once a regulator himself.

    "If you looked at any other industry, I think you would find the same thing," he said. "Where do you find the people who have the expertise that you need?"

    State health department officials also said Ohio is a national leader in collecting fines.

    "We feel we're pretty aggressive in our enforcement scheme in Ohio," said Alan Curtis, chief of the health department's bureau of regulatory compliance.

    "Our goal, collectively as a division, is not to put facilities out of business but to encourage them to comply and improve their quality of care," said Kurt Haas, who heads the department's inspections office.

    Haas said the department has stepped up its educational services to the industry, offering seminars, speakers and brochures on such topics as how nursing homes can reduce bed sores, falls and the use of patient restraints.

    "There have been some very good outcomes that don't just come from enforcement, enforcement, enforcement," he said.

    - Continued -

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