It is a reasonable assumption for many people that nursing homes caught in the act of neglecting patient needs, disregarding safety standards and limiting their staff to levels deemed inadequate that fines and sanctions would be a deterrent from future abuses. This would be logical if the fines themselves had teeth and enforcement was both quick and consistent. For many states, however, this is not the case and civil litigation has become the only major deterrent left to motivate nursing chains into improving the quality of the care they provide. Lobbying has helped insulate many chains in certain states through the implementation of caps on compensation so that even civil action is becoming a less effective vehicle toward change.

Pennsylvania Auditor Offers Key Criticism Concerning Sanctions and Enforcement

As lawmakers in Illinois consider a bill that would propose prohibiting anonymous nursing home complaints, Pennsylvania is emerging from a three year trial of an identical measure which ended in failure. The number of nursing home complaints dropped by two thirds when the ban on anonymous complaints went into effect and the use of fines and other punitive measures was scrutinized by the state’s Auditor General, Eugene DePasquale.

After performing a year-long audit, DePasquale concluded that the vast majority of legitimate complaints are ignored because state inspectors either fail to follow through, rely on information provided by the nursing facility being accused of wrongdoing or the complaints aren’t taken seriously. Things came to a head in July of last year when the state’s Attorney General filed a lawsuit against Golden Living over systemic neglect and injustices throughout its 25 facilities in the state.

A review of the way fines were used revealed that 90% of nursing home complaints are dismissed and no fine or punitive action is taken. Investigators are not actually taking statements from residents and visiting the facilities to verify or dispute the complainants’ claims and the nursing companies themselves provide most of the data they use to determine the legitimacy of the claims. The most alarming reveal was that facilities were only punished 0.2% of the time for failing to meet the requirement that homes provide a minimum or 2.7 hours of care per patient. The federal standard is 4.1 hours.

Also concerning was the fact that during the period of the audit, the Health Department only issued $172,350 in fines. Comparatively, the federal government issued over $2 million in fines over the same period.

Regulators Seek to Set Example with Boston Area Home

In a rare move, federal regulators took stringent action against the Woodbriar Health Center after two deaths and a spat of complaints arose in a matter of months. The center now faced $278,900 in state fines and will incur additional fines of $7,100 per day until regulators conclude that the improvements promised by the home’s ownership are fulfilled and adequate to ensure the safety and comfort of residents.

Also at risk will be access to Medicare and Medicaid funding, which is the primary means by which most patients can afford to receive care. The Woodbriar Health Center is also owned by a nursing chain and regulators believe that the multitude of problems impacting residents stem from indifference toward patient’s needs, emotions, comfort or physical safety. In other words, companies in business to provide assistive living services for the elderly and infirm are often more concerned about the profits they receive than delivering the services they agreed to provide.

Many members of the legal community in Massachusetts call the fines imposed on the Woodbriar Health Center an unprecedented measure that is the byproduct of authorities reaching a breaking point. For a long time, many nursing homes have shrugged off fines because they were insignificant compared to their revenue. In the case of Woodbriar, regulators clamped down when an inspection following the initial review only two months later showed insignificant improvement in limited areas and further decline in others. The limited progress made only served to show why small fines don’t work and led regulators to take more exacting action.

Nursing Homes Fearful of Stricter Fines and Enforcement

The Pennsylvania Health Care Association represents over 500 health care providers and some of its prominent members are nursing homes. It is no surprise that the association’s President and CEO has voiced his dissent over the decision by Pennsylvania to become more ironclad in its assessment of penalties. In his statement, he did highlight the difficulties facing many nursing care facilities due to drastic cuts to Medicaid funding over the last decade, but this alone is not a valid excuse for the rampant disregard shown toward patient rights and needs over the same timeframe.

Illinois is one of the states with more favorable laws governing the ability of nursing victims to seek compensation for their injuries, but negligent homes throughout the state are still subjected to limited fines for failing to meet safety standards or employing enough skilled staff members. Smaller facilities can get away with only $6,250 in fines for actions that result in the death of a patient, for example.