Many Nursing Homes In Chicago Have Violations That Cause Actual Harm To Residents

house.gov, Sep 09, 2005

To address these growing concerns, Reps. Janice D. Schakowsky, Bobby L. Rush, and Rod R. Blagojevich asked the minority staff of the Committee on Government Reform to investigate the conditions in nursing homes in the Chicago metropolitan area. There are 290 nursing homes in the Chicago metropolitan area that accept residents covered by Medicaid or Medicare. These homes serve approximately 38,000 residents. This is the first report to evaluate
their compliance with federal nursing home standards. The report finds that there are serious deficiencies in many Chicago nursing homes. Only 21% of the nursing homes in Chicago were in full or substantial compliance with federal standards during their most recent annual inspection. Moreover, 15% percent of the nursing homes in Chicago -- more than one out of every seven -- had violations that caused actual harm to residents or placed them at risk of death or serious injury.

A. Methodology

Under federal law, the U.S. Department of Health and Human Services contracts with the states to conduct annual inspections of nursing homes. These inspections assess whether nursing homes are meeting federal standards of care, such as preventing residents from developing pressure sores (commonly known as bed sores), providing sanitary living conditions, and protecting residents from accidents. State inspectors are instructed to rate the scope and severity
of each violation. There are four general categories of violations: (1) violations that have the potential for only minimal harm; (2) violations that have the potential for more than minimal harm; (3) violations that cause actual harm; and (4) violations that cause actual death or have the potential to cause death or serious injury.

This report is based on an analysis of the most recent annual inspections of nursing homes in the Chicago metropolitan area, which comprises Cook, DuPage, and McHenry Counties. These inspections were conducted from July 1998 to January 2000. When a nursing home was reported to have serious violations, the report also examined the results from the prior round of inspections to assess the home’s compliance history. Because this report is based on recent annual inspections, the results are representative of current conditions in Chicago nursing homes as a whole. Conditions in individual homes can change, however. New management or enforcement activities can bring rapid improvement; other
changes can lead to sudden deterioration. For this reason, the report should be considered a representative “snapshot” of overall conditions in Chicago nursing homes, not an analysis of current conditions in any specific home. Conditions could be better -- or worse -- at any 2

Figure 1: Compliance Status of Nursing Homes in
Chicago
Homes in Full or
Substantial Compliance
Homes with Potential-to-
Harm Violations
Homes with Actual Harm
Violations or Worse individual nursing home today than when the most recent annual inspection was conducted.

B. Findings
Nursing homes in Chicago routinely violate federal standards governing quality of care. State inspectors consider a nursing home to be in full compliance with federal standards if no violations are detected during the annual inspection. They will consider a home to be in “substantial compliance” with federal standards if the violations at the home do not have the potential to cause more than minimal harm. Of the 290 nursing homes in Chicago, only 61 homes (21%) were found to be in full or substantial compliance with the federal standards. In contrast, 229 nursing homes (79%) had at least one violation with the potential to cause more than minimal harm to residents. On average, each of these 229 nursing homes had 5.5 violations of federal quality of care requirements.

Many nursing homes in Chicago have violations that cause actual harm to residents. Of the 290 nursing homes in Chicago, 43 homes -- more than one out of seven -- had a violation that caused actual harm to nursing home residents or placed them at risk of death or serious injury (see Figure 1). These deficiencies involved serious problems, such as the failure to prevent or properly treat pressure sores, malnutrition, inadequate medical treatment, and preventable
accidents. The most frequently cited violations causing actual harm were the failure to prevent or treat pressure sores and malnutrition. These 43 homes serve 6,780 residents and are estimated to receive $75 million each year in federal and state funds.