Tools, questions to see if nursing home oversight is really working in your area

Any story that mentions maggots coming out of a patient’s ear is going to grab my attention.

After recovering from the “yuk” factor, I was appalled after reading Christina Jewett’s account last week of a new federal report on California’s nursing homes.

The report was issued by the Office of the Inspector General of the U.S. Department of Health and Human Services and it paints a sorry picture of nursing home oversight in the nation’s most populated state. It examined three homes that often send patients with severe infections or bed sores to nearby hospitals – an indicator of potentially poor quality care.

Among the study’s findings:

  • Nursing home regulators underestimate the severity of problems they spot in facilities. This happens with 13 percent of findings and may influence homes’ ratings on Nursing Home Compare.
  • Regulators routinely accept plans by nursing homes to correct problems even though these plans don’t meet federal standards. This happens 77 percent of the time.
  • Follow-up inspections are required in all cases in which homes are asked to draft a corrective action plan. But in practice, California inspectors only conduct such inspections when problems are deemed serious or involve a financial penalty.

Want to hear more about those maggots? Jewett notes that example comes from an earlier HHS Inspector General report that examined how California is handling nursing home complaints. She writes:

“That report highlighted the case of a woman who showed signs of neglect based on ‘multiple pressure sores and maggots coming from the resident’s ear.’ State inspectors determined that the nursing home’s ‘wound care nursing documented in the medical record that the resident’s right ear was treated on April 24, 2008, when no treatment was actually provided.'”

The report also found that when complaints were investigated, inspectors tracked violations of state nursing home standards but frequently failed to site federal deficiencies.

How unbearably sad that vulnerable older people have to endure these kinds of conditions in facilities that routinely fail to provide adequate care to residents.

What will you find?

If you’re interested in following up on similar issues, start by checking with the agency in your area responsible for nursing home oversight. How many staff members do they have and how many homes are they responsible for monitoring? Have budget cuts reduced the number of staff, putting pressure on their ability to conduct meaningful oversight?

What kind of process is used to monitor nursing homes in your state? How often do inspectors visit homes? Are inspections announced or unannounced? Are actual inspections conforming to this schedule?

How many complaints have been filed against nursing homes in your state? What happens when inspectors go in and state or federal violations are noted? If homes have to prepare a corrective action plan, are follow-up inspections made to certify that the changes listed were actually made? If not, what assurance is there that such plans make any difference?

Talk to your state’s long-term care ombudsman about the adequacy of its nursing home inspection process. Ask the ombudsmen which, if any, consumer groups are monitoring nursing home conditions.

Check out the ratings on Medicare’s Nursing Home Compare (or use AHCJ’s version in a more manageable format in Excel spreadsheets), and pay special attention to homes that have received one-star ratings (the lowest) several years in a row. USA Today looked at this issue in a recent story which you can read here. Finally, look at AHCJ’s extensive guide to covering the health of local nursing homes for more tips on information sources and what kinds of issues to look for.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society. If you have questions or suggestions for future resources on the topic, please send them to

2 thoughts on “Tools, questions to see if nursing home oversight is really working in your area

  1. Avatar photoIvor Hughes

    Hello Judith,
    I write from New Zealand. Our Health Care is socialised or paid for from our taxes rather than from private insurance .. we do have insurance care but it is not mainstream.

    I am an elder and live in a nursing home and my care is subsidised by the Government, so in one way we do have excellent oversight .. the taxpayer.
    We do have the odd reported case of abuse by Nursing Home Staff (and they are paid minimum wage) but it is rare .. the staff are dedicated .. it does occur but rarely,and when it surfaces then the lord help the abuser.

    It seems from what you have written and trying to see behind the lines perhaps it is the sheer size of the Nation and the fact that it is profit driven then perhaps maggots in every orifice is the outcome .. I guess critisism is easy when one is well served .. but may I suggest some of what you are trying to put out there should have far wider coverage .. it should have ! and if not why not .. this is a Journalists site .. anyway God Bless for what you do.

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