Despite enhanced guidance from CMS, nursing homes hit by disaster often struggle to execute emergency plans and protect residents, according to testimony (PDF) from the HHS Office of Inspector General to lawmakers last week.
Addressing the Energy and Commerce Committee's oversight subcommittee, OIG's Regional Inspector General Ruth Ann Dorrill said officials went in and looked at deficiencies in nursing homes following Hurricane Katrina in 2005 and found 94% were in compliance.
However, she said: "When we visited a sample of homes actually affected by the hurricanes, we found the plans weren’t practical and up-to-date; in many cases the nurses would pull out a pad and pen when they saw the hurricane coming as opposed to looking at the binder on the shelf."
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More than half of those adverse events were considered preventable had the facilities provided better care.
"Most of the events weren’t the big dramatic events you think about when you think about adverse harm events. They were incremental. They were small. They were surrounding the daily, hourly care provided by nurse assistants and staffing throughout the nursing home," Dorrill said. "This low-level substandard care harms a tremendous amount of people."
These conditions might have been preventable with better guidance and government oversight, she said.
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Her comments to lawmakers were echoed by the Government Accountability Office, which also raised concerns about gaps in reporting in its latest report on nursing home oversight. During the same time period, consumer complaints about nursing home care quality increased while data collected by CMS indicated quality improvements.
The GAO also pointed out that different states use different data-collection methods, which makes it difficult for CMS to make accurate quality comparisons.
The GAO recommended CMS establish and implement a clear plan for ongoing auditing to ensure the reliability of data self-reported by nursing homes, including payroll-based staffing data and data used to calculate clinical quality measures. CMS concurred with this recommendation and said it has begun to take steps to address it.