Report examines state survey agency performance

A new report from the Long Term Care Community Coalition (LTCCC) compares enforcement of nursing home standards in several categories across all 50 states and the District of Columbia.

In “Safeguarding NH Residents & Program Integrity: A National Review of State Survey Agency Performance” (PDF), the coalition presents overall state citation rates, the number and amounts of fines that each state imposed for violations of minimum standards in the past three years, and the rates at which the states identified resident harm when they found deficiencies. In addition to presenting information related to state citations as a whole, the report also examines citations issued for pressure ulcers, staffing levels and the use of antipsychotic medications.

“While no data are perfect, we felt that assessing overall citation and penalty rates, as well as citations for three critical quality criteria, would together provide valuable insights into state survey agency performance and the extent to which important problems are being addressed in each state,” Richard Mollot, LTCCC’s executive director and author of the report, said in a statement.

Select information in the report:

• Harm. State survey agencies find harm to residents 3.41 percent of the time that they cite a deficiency, according to the coalition. California and Alabama tied for lowest levels of reported harm in the country, with those survey agencies in those states reporting harm 1.14 percent of the time when definciencies are cited.
• Use of antipsychotic medications. Nationwide, the average antipsychotic medication use rate is 18.95 percent, according to the LTCCC, whereas the average citation rate for inappropriate use of these medications is 0.31 percent. The discrepancy, according to the report, indicates that state survey agencies are not citing a significant amount of inappropriate antipsychotic medication use.
• Pressure ulcers. Pressure ulcers affect more than 86,000 nursing home residents, according to the coalition. State survey agencies, however, cite nursing homes the equivalent of less than 3 percent of the time that a resident has a pressure ulcer, and when states do cite a facility for inadequate pressure ulcer care or prevention, they identify it as harmful to residents in only about one-fourth of cases, the report says. 
• Staffing. The annual rate of staffing deficiencies per resident cited by state survey agencies is 0.042 percent, according to the LTCCC. Less than 5 percent of those deficiencies are identified as resulting in harm, the coalition says. In 21 states, insufficient care staff and resident harm are never reported as linked, according to the report.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.