THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, May 5, 1996 TAG: 9605030031
SECTION: COMMENTARY PAGE: J5 EDITION: FINAL
TYPE: Opinion
SOURCE: MARGARET EDDS
LENGTH: Medium: 75 lines
One of the clearest memories of the three months my father spent in a nursing home last winter is of the week the state inspectors came.
Each morning when I arrived, my father was bathed, dressed and sitting in the hall ready for therapy. To say that this was unusual is an understatement. More frequently in other weeks, if he was to be up before mid-morning, we did the bathing and dressing ourselves.
There was general rejoicing in the nursing home when the inspectors issued a violation-free report and left. I joined the celebration. Praise can be more productive than criticism, sometimes. I wanted this to be a facility where workers felt every incentive to perform well.
But I was left with a nagging awareness that a three-day, violation-free inspection does not equate to 24-hour, year-round, violation-free care. Bedpans typically tossed into beside drawers were stored in plastic that week. Potpourri appeared in the bathroom. Calls for help were answered promptly. Late at night in some other weeks, I heard cries that went on and on.
The experience came to mind recently in reading an article by John Maloney in Richmond's Style Weekly magazine on nursing-home regulation in Virginia. Maloney points to a federal-state gridlock that can delay or even halt sanctions against substandard nursing homes.
Since July 1995, when a new penalty system including civil fines of up to $10,000 a day went into effect nationwide, Virginia regulators have recommended fines for substantial deficiencies against 69 of Virginia's 258 nursing homes or 27 percent.
So far, such penalties have been levied against three, one each in Richmond, Charlottesville and Roanoke. Fines are pending against two others, including the Norfolk Health Care Center.
Some of the delays are valid, reflecting efforts by faulty homes to clean up their problems, said Nancy Hofheimer, director of the state Office of Health Facilities Regulation. But others are an outgrowth of a two-tiered system in which state officials recommend sanctions and federal officials impose them.
In Maloney's inquiry, federal officials said they were waiting for state paperwork; state officials said they were waiting for federal action.
Meanwhile, consumer advocates say the regulatory system is flawed from the start by a shortage of state inspectors. The problem, says Mark Miller, longterm care ombudsman for the state, is not the quality of the inspection staff. ``It's the quantity of the staff.''
Virginia has 28 investigators to conduct state licensure and federal certification inspections, both of which used to be done on roughly an annual basis. Under a change approved by the legislature last winter, the time lag between licensure reviews can be extended to up to two years.
In addition, a five-person investigative team inquires into an estimated 1,400-1,600 complaints statewide each year. Without help from the licensure staff, that's about 300 complaints each.
The system depends substantially on nursing homes self-reporting violations and upon hefty penalties, including loss of Medicare-Medicaid certification, for those who fudge.
But my own experience says that numerous infractions go undetected. Even in a ``good'' nursing home, there were days when severe staffing shortages meant that patients were largely unattended, weeks when showers were skipped to save time. And there were aides who chastized patients for calling too frequently for help.
In an industry where much of the service depends on overworked, minimum-wage staff, the difference between reasonable care and disastrous care often can be family intervention. Show up regularly. Come at irregular times. Advocate for your loved one if something seems amiss, says Hofheimer.
Good advice, but no substitute for a state and federal system that goes looking for trouble, sets penalties when it's found, and follows through to make sure that the penalties are paid. MEMO: Ms. Edds is an editorial writer for The Virginian-Pilot.
by CNB