As state inspectors continue to find a record number of violations in nursing homes, two recent reports highlight significant weaknesses in Tennessee’s oversight of health care facilities.

An audit by the comptroller of the Treasury identified a number of shortcomings in the Board for Licensing Health Care Facilities, including failure to maintain a list of individuals who have abused, neglected or misappropriated the property of vulnerable individuals.

“That’s a very important function to have: a listing of anyone who is considered abusive and shouldn’t be working with vulnerable people,” said Art Hayes, director of state audit at the comptroller’s office and one of the audit’s leaders. “They’re not conducting all the investigations they should, they’re not holding the hearings timely and they’re not tracking people who are removed from the registry.”

The audit also found that the licensing board failed to investigate complaints in a timely manner, which can keep nursing home patients in dangerous situations and make gathering evidence difficult.

The audit was conducted as part of the Board for Licensing Health Care Facilities’ regular reauthorization process, which comes up for evaluation every few years, Mr. Hayes said.

All health care facilities must be inspected by the state licensing board once every 12 to 15 months to prevent their licenses from expiring.

The nursing home industry and its state regulators have corrected many of the problems noted in the audit, said Christy Allen, assistant commissioner of the Tennessee Department of Health’s Bureau of Health Licensure and Regulation. The bureau oversees licensing of health facilities and individuals.

The state performance audit comes on the heels of a May report from the federal Government Accountability Office that lists Tennessee as one of nine states that most often neglected to cite serious violations at nursing homes during inspections between 2002 and 2007.

In federal follow-ups to state surveys of health care facilities, surveyors found that Tennessee inspectors failed to record serious deficiencies 26.3 percent of the time, according to the GAO report.

Walter Ochinko, assistant director for health care with the GAO who was involved in May report, said Tennessee’s board of licensing had a “training problem.”

The results “suggest some of the reasons for the understatement (of deficiencies) were inability to carry out an adequate investigation and determine what deficiencies should be cited,” he said. He noted that the board has brought in regional office surveyors to retrain staff in how to conduct investigations.

Safety concerns

Patrick Willard, advocacy director for the Tennessee AARP, said the GAO report raises serious concerns about the safety of those in nursing homes and other health care facilities, but he noted that the health department has been quick to respond to the citations in the recent reports.

“We need to have faith in the inspections that are being done in the nursing homes,” he said. “I think overall we think (the health department is) taking it seriously, and we want them to continue to do that.”

The committee’s chairman, Sen. Bo Watson, R-Chattanooga, said the panel reauthorized the board for another three years but requested another hearing one year from now to get an update on progress in rectifying the audit’s findings.

“I think this committee’s major primary concern is that people who are going to nursing homes are being well cared for,” he said. “When there is a concern expressed, the licensing board needs to respond in an appropriate manner and an appropriate time frame. That’s what we’re really focusing on.”

HEIGHTENED SCRUTINY?

The number of violations at nursing homes for dangerous living conditions reached record numbers in 2007 and so far this year, according to state records.

Tennessee Department of Health officials suspended admissions to 22 nursing homes in 2007 after serious violations were found. That’s compared with 10 in 2006 and nine in 2005, according to state health department officials.

This year, 13 homes have had admissions suspended temporarily, state officials said.

Some nursing home administrators in Chattanooga said they believe the rising number of violations is because of heightened scrutiny of nursing homes rather than any decline in quality of care.

“When there’s an increase in speeding tickets at the end of the month, does that mean there’s more speeding at the end of the month?” asked Randy Rouse, executive director for Life Care Center of Chattanooga, which has 153 beds. “I think Tennessee as a state has been somewhat brought under scrutiny just because (federal officials) feel the other states that have more citations are doing a better job of enforcement.”

Eric Boston, president and CEO of St. Barnabas Senior Living Services — which serves about 225 people in its nursing home, assisted living apartments and independent living apartments — said inspectors are feeling heightened pressure to find violations.

“Unfortunately in our field, if you don’t find it, there’s an underlying tone that you didn’t look hard enough. That’s discouraging for facilities that are out there and really knocking it out of the park,” he said. “It’s an issue that, given the obvious emotional sensitivity, it can be easy to overlook that progress is being made.”

Ms. Allen said that a July 2007 change in U.S. Centers for Medicare and Medicaid Services policy expanded the type of complaints that must be investigated on site to include self-reported complaints. That policy change contributed to a significant increase in the number of complaints requiring on-site investigation and creating a backlog of complaints.

The department received 3,035 nursing home complaints that required investigation in 2007 compared with 1,516 in 2006.

That increase accounts for the state performance audit’s additional finding that the board did not investigate complaints in a timely manner, she said.

Ms. Allen pointed out that the proportion of complaints that result in an “immediate jeopardy” citation — which results in temporary suspension of admissions at a nursing home — has remained the same as in past years.

Nursing home industry officials say they are focusing on educating facility operators and front-line employees so they understand what actions constitute violations.