Elders are vulnerable to financial, physical and emotional abuse as well as neglect in nursing homes. Upon admission, they become totally dependent on the provider and staff for all of their basic needs. Elders are entering the nursing home older and sicker than they have in previous decades, and few have relatives who live close enough to visit. This makes regulatory protections and enforcement paramount to their health, safety and well-being.
Florida Senate Bill 1726 and House Bill 731, however, are proposing to reduce the enforcement of basic regulatory protections in nursing homes. These regulatory protections — including rules regarding the physical environment, infection control, quality assurance and residents’ rights -- have already been scaled back under the current federal administration. SB 1726 and HB 731, if passed, will further weaken regulation by reducing the frequency of state surveys and inspections.
Right now, Florida’s nursing homes receive an unannounced inspection once every 15 months. If passed, the bills will change the inspection frequency to “periodic.” Another proposed change is with regard to a nursing home that has been found to have a Class I deficiency (a violation that poses an immediate, serious threat to life or one that has a high likelihood of causing physical or mental harm), two or more Class II deficiencies (violations that directly threaten the physical or emotional well-being, or safety of residents) from separate inspections within a 60-day period, or a nursing home that has three or more substantiated complaints -- with each resulting in a Class I or Class II deficiency. Currently, any of these three conditions results in an inspection to be conducted every six months thereafter for the next two years as well as a $6,000 fine to pay for the inspections. SB 1726 and HB 731 propose much greater leniency with facilities that have been cited for a Class I deficiency or two or more Class II deficiencies within a 60-day period receiving only one additional licensure survey. The bills will also reduce the inspection fine to $3,000.
The significance of what these bills are proposing is best understood in the context of the protections and enforcements afforded under the Federal Nursing Home Reform Act or the Omnibus Budget Reconciliation Act (OBRA) of 1987. Elders in pre-OBRA nursing homes “…receive very inadequate — sometimes shockingly deficient — care that is likely to hasten the deterioration of their physical, mental, and emotional health” and “…are likely to have their rights ignored or violated, and may even be subject to physical abuse,” according to the Institute of Medicine Committee on Nursing Home Regulation. Congress established basic requirements and resident rights and enforcement mechanisms (including improving inspections and establishing financial penalties) that research has shown to have improved quality of care and quality of life. However, problems remain. Data published by the Centers for Medicare and Medicaid Services show that for the most recent cycle, Florida’s 695 nursing homes have a total of 3,582 health deficiencies -- with deficiencies relating to quality of life and care being the most common (followed by deficiencies related to residents’ rights). The data also show a total of 2,313 fire and life safety deficiencies.
How often should nursing homes be inspected? The Institute of Medicine’s 1986 report (later used to support OBRA) said, “Even excellent facilities may fall out of compliance very quickly after key staff, ownership, or resident mix changes. The consensus among consumer, regulator and provider groups is that annual surveys of nursing homes are both reasonable and necessary.” Given that elders in nursing homes are facing increasing deregulation, the enforcement of what regulation remains is increasingly critical.
Lori Gonzalez is a research faculty member at the Claude Pepper Center at Florida State University.