Nursing Homes: Proposal To Enhance Oversight of Poorly Performing Homes Has Merit Page: 4 of 72
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proposed action comes from an analysis of HCFA's nationwide database of
survey results, the On-Line Survey, Certification, and Reporting (OSCAR)
system as of April 1999. We conducted our work between March and
June 1999 in accordance with generally accepted government auditing
standards. Appendix I contains a more detailed explanation of our scope
Results in Brief HCFA's proposed expansion of the poor-performer criteria to include
homes with repeated isolated actual harm deficiencies would substantially
increase the number of homes that would be subject to immediate
sanctions without a grace period to correct deficiencies. If this revised
definition had been in effect for the most recent 15-month period ending
April 1999, we estimate that the number of homes meeting HCFA's
poor-performer criteria for imposing immediate sanctions would have
increased from about 1 percent to nearly 15 percent of homes nationwide.3
Nearly all of the deficiencies we examined represented serious care issues
resulting in harm to residents. Of the 107 surveys with G-level deficiencies
in our sample, 98 percent (all but 2) documented that actual harm had
occurred to one or more residents. Survey reports depict recurring
examples of actual harm such as pressure sores, broken bones, severe
weight loss, burns, and death. Another 8 of the 107 surveys with G-level
deficiencies had a deficiency that did not clearly document harm, but
other G- or higher-level deficiencies on the same survey resulted in harm
Two-thirds o f these 107 nursing homes had repeated violations-OSCAR
data showed they were also cited for isolated actual harm (G-level) or
higher deficiencies in a prior or subsequent survey. Therefore, they would
be subject to immediate sanction if HCFA's revised poor performer
definition had been adopted, whereas the current definition allows an
opportunity to correct deficiencies without sanctions. Most of the repeat
violators (56 percent) were cited for the same deficiency, and 34 percent
were cited for closely related deficiencies. These findings suggest that
HCFA's enhanced enforcement of homes found to repeat these serious care
problems has merit.
3Our analysis is based on the number of homes meeting HCFA's minimum federal criteria. States have
the option to establish criteria that are more stringent than the federal criteria.
GAO/HEHS-99-157 Poorly Performing Nursing Homes
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United States. General Accounting Office. Nursing Homes: Proposal To Enhance Oversight of Poorly Performing Homes Has Merit, report, June 30, 1999; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc292500/m1/4/: accessed January 16, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.