THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, August 25, 1996 TAG: 9608250050
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 145 lines
Just more than a year ago, nursing homes like Portsmouth's Manning Convalescent Home - which underwent its fourth inspection in six months last week - had little to fear if inspectors found problems.
They rarely, if ever, faced what Manning is facing: the potential loss of the home's Medicaid/Medicare contracts, a financially devastating blow from which few homes could recover.
Before July 1, 1995, enforcement of federal nursing home regulations varied from state to state. And in states like Virginia, enforcement was rare.
But last summer, the U.S. Health Care Financing Administration, HCFA, started strictly enforcing federal nursing home regulations that had been approved in 1987.
The new policy requires that penalties be imposed automatically if nursing homes exhibit certain problems. Those penalties include fines, required staff training or termination of Medicare/Medicaid contracts.
It also alters the inspection process, so that inspectors are ``more likely to cite deficiencies'' on their reports, said Lori Owen, law and policy specialist at the National Citizens' Coalition for Nursing Home Reform, a non-profit group based in Washington.
The new enforcement policy resulted in an Aug. 13 letter to Manning warning that the federal government would revoke the nursing home's Medicaid/Medicare contracts on Sept. 1 because of numerous violations that could affect residents' health and safety. The inspectors found problems ranging from cold food to inadequate care, according to their reports. The federal government also imposed a $500-a-day fine on Manning and restricted any new Medicaid admissions after June 13. The fines keep accumulating until the home passes or fails the final inspection; at that time, the federal government determines when and whether the fines should be paid.
To avoid paying the fines and losing Medicaid/Medicare contracts, Manning must show ``substantial compliance'' with federal regulations on the August inspection, which started last week and may continue on Monday.
``Substantial compliance'' means an inspection with no problems ranked above a C; an A notation is the least serious. Manning had not met that criteria as of its July inspection.
Losing its Medicaid/Medicare contracts could mean that most of the home's residents would have to be moved to other nursing homes.
But Manning is not alone.
Forest Hill Convalescent Center in Richmond lost its Medicaid/Medicare certification in June. The state is waiting for the findings of the completed final inspection to determine whether the Richmond home will have to transfer 143 of its 157 residents.
Accomack County Nursing Home in Parksley, on the Eastern Shore, has been given until Oct. 25 to comply with federal regulations, or risk having its contracts canceled, the state health department said.
It's a level of enforcement activity that has been rare in Virginia. Before July 1995, the state had never even fined a nursing home, an option available to it under Virginia law.
The new emphasis on enforcement has brought praise from Mark Miller, the state's long-term care ombudsman and an advocate for nursing home residents and their families. ``The health department is doing its job, and they're doing it well,'' he said. ``The enforcement process is working.''
Under the new process, inspectors assign a letter between A and L to every problem, with A being the least serious. Penalties depend on ranking. In Manning's case, for instance, citations for failing to supervise a resident who wandered out of the building and failing to help a resident get consent for needed surgery garnered an H ranking. The home had three months to come into substantial compliance, or the state would automatically prohibit the nursing home from accepting new Medicaid patients.
Manning officials say the new enforcement policy is the reason that it hasn't met the criteria.
The number of yearly inspections at Manning has increased since the new enforcement policy began. In 1992, 1993 and 1995, Manning had only one inspection a year. In 1994 it had two. But so far this year, it has had four.
Past inspections at Manning usually resulted in fewer deficiencies, state reports show. In 1992, no problems were cited on the home's report. But in the past three years, the home has had violations on every inspection.
The first 1996 inspection, which began in March, included the statement, ``. . . . significant corrections are required . . . '' to comply with federal and state requirements. It cited problems, including a delay of treatment for one patient that the inspectors concluded was life-threatening. Inspectors cited problems in the May and July reports.
Thurman Manning, the home's owner, and his son Robert, who is the home's administrator, said Wednesday that all problems have been corrected. They have since declined to discuss the issue.
The poor inspections, Robert Manning said Wednesday, are ``due to complete changes in the philosophy of the reading of the rules and regulations.''
``I don't think we were doing a bad job before, and I never resented the deficiencies before,'' Thurman Manning said. ``But when they come in and give you 32 deficiencies, and it's the same people, the same regime. It almost threw me, and I'm a pretty tough nut.''
Nancy Hofheimer, who directs the state's nursing home inspection program at the state health department, said, ``Obviously, change is difficult for everyone.'' But, she said, the state conducted educational programs for nursing-home providers before the new enforcement went into effect.
She also noted that it took nearly 10 years to develop the new enforcement policy; during that time, more than 75,000 public comments appeared in the Federal Register.
The new enforcement policy is a ``mixed bag,'' said Stephen Morrisette, president of the Virginia Health Care Association, a nursing-home industry trade organization based in Richmond. ``We support having the survey process. We understand that the public needs to have a reasonable expectation of quality of care, and this is one way to demonstrate that. But the process itself does have some flaws.''
He said, as did the Mannings, that the state now has a ``zero tolerance'' approach on inspections. The standard sets an unreal expectation for nursing homes, he said.
``We're in a people business. This is not like building widgets, it's not something you can do one time and then have the next time be exactly the same way,'' Morrisette said. ``There is always the possibility for human error, and the survey process really doesn't allow for that.''
He said his organization is working with HCFA to modify some parts of the new enforcement policy ``so it is reasonable - not only for the provider but for the patient. Because, as you know, when you get to the stage where the patient has to be moved, it's very disturbing to the patients and their families,'' Morrisette said.
While the nursing-home industry faults the new enforcement policy as being too strict, nursing-home advocates say the regulations don't go far enough. ``We're seeing across the country that the surveyors are finding problems and writing deficiencies, but we're not seeing generally very much beyond that is happening,'' Owen, the law and policy specialist said.
From July 1995 to May 1996, 13,308 nursing homes around the country were inspected. Thirty-six lost their Medicaid/Medicare contracts, 395 were denied payment for new admissions, and 158 were fined. ``It's not as much as it should be,'' Owen said.
MEMO: Staff writer Diane Tennant contributed to this story. ILLUSTRATION: Color photo
Manning Convalescent Home faces fines, and loss of Medicaid Medicare
contracts
Graphic
NURSING HOME INSPECTIONS, POLICY PRAISED AND CRITICIZED
THE ENFORCEMENT POLICY
Before July 1, 1995, the state had never even fined a nursing
home, an option available to it under Virginia law. Last summer, the
U.S. Health Care Financing Administration started strictly enforcing
federal nursing home regulations that had been approved in 1987.
THE REACTION
Nursing home advocates say the policy doesn't go far enough. The
president of the Virginia Health Care Association says the new
policy sets unreal expectations for nursing homes with its ``zero
tolerance'' approach on inspections.
KEYWORDS: NURSING HOMES INSPECTIONS
REGULATIONS by CNB