Ilminen Article Feb. 2002

Complaints Against Nursing Homes Higher for Fifth Consecutive Year

by Gary R. Ilminen, RN © February, 2002
Author of "Consumer Guide to Long-term Care" (University of Wisconsin
Press) for information, go to: http://www.wisc.edu/wisconsinpress/books/3075.htm

(NOTE: This article is protected under United States Copyright law,
however, permission is granted by the author for non-commercial duplication,
use and distribution of this article by consumers, families, advocates,
professionals and anyone concerned about quality of care in nursing homes.
Please share this article in unaltered form with attribution to the
author).
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The number of complaints against nursing homes nationwide has jumped
7.8 percent in 2000, rising by 13,572 complaints to 186,234. This increase
comes on the heels of a 5.6 percent increase in 1999, when consumers filed
172,662 complaints, 9,122 more than the 1998 total of 163,540.

The 2000 total represents a whopping 28.7 percent increase since
1996, when 144,680 complaints were recorded against nursing homes. The
2000 increase marks the fifth consecutive year of significant increase in
the number of formal complaints filed against the nation's nursing homes.
The 1997 complaint total was 157,380.

The complaint data is from the Administration on Aging Long-term Care
Ombudsman program National Ombudsman Reporting System (NORS).

Since the number of nursing home beds has declined each year since
1996, the first year a standardized national data system was in use,
the average number of complaints per nursing home bed has dramatically
increased. In 1996, the complaints per bed ratio was 0.078; in 2000 the
ratio soared to 0.102. In 1996, the total number of nursing home beds in the
nation was 1,845,791; by 2000 the number had fallen to 1,824,428.

However, the ratio is even higher than those AOA figures indicate, because
many nursing home beds are not actually occupied. According to data from
the Center for Medicare and Medicaid Services (CMS), the actual nursing
home occupancy rate is only about 82 percent. That means that the actual
complaint to occupied bed ratio is approximately 0.124.

The most frequent complaints against nursing homes were about resident
care. More than 60,780 complaints about quality of resident care were
received. This category includes problems with accidents, slow response
to call lights and requests for assistance, poor or incomplete care plans,
inaccurate assessments, development of contractures and pressure sores,
medication related problems, poor personal hygiene and symptoms not
attended to. It also includes problems with toileting, rehabilitation,
provision of assistive devices, therapy services and use of physical and chemical
restraints.

Resident's rights violations were the second most frequently heard type of
complaint in 2000. Those complaints totaled 56,829, the fifth consecutive
increase in the category. Resident rights complaints include abuse,
neglect, and exploitation, denial of access to information about resident condition,
rights protections, treatment options and advance directives. Also
included are problems with transfers, discharge, privacy, dignity and personal
choice.

Complaints about resident quality of life also increased for the fifth
consecutive year, rising to 36,326, making it the third most common type
of complaint. This category includes problems with activities, social
services, dietary services, weight loss and dehydration, and cleanliness
of the living environment.

Despite the long history of problems with quality of care since 1996, the
number of citations of deficiency served by state survey agencies for
similar topics in quality of care have not reflected what consumers
are actually experiencing. Indeed, from 1996 to 1999, the most frequently
cited type of deficiency was "food sanitation" followed by "inaccurate
assessments." Quality of care citations only rose from ninth to second
in frequency over the past two years.

These data confirm that the current regulatory system is not improving
quality of care in ways that matter most to consumers and families.
Despite the addition of tougher fine and sanction options by federal
regulators for use by state survey agencies in 1995, quality of nursing
home care has continued to deteriorate, despite efforts by states to
intensify nursing home inspection.

Why has quality of care continued to deteriorate, despite the intensified
inspection by states?

Quality improvement experts such as W. Edwards Deming and Joe Juran
have asserted that inspection alone is not effective in improving products
or services. The data from AOA and CMS prove that they are correct.

Application of their techniques in other service and health care
settings has proven that each organization must improve quality in its own
day-to-day operations. The massive regulations that apply to nursing homes
today contain only six paragraphs about quality improvement. Those
provisions merely require that the nursing home have a quality improvement
committee--nothing else.

A system to train facility staff in effective quality improvement
techniques and a survey system designed to validate that the internal quality
improvement systems are working is required. That fundamental change in approach and
a commitment to expand training for all caregivers to improve both quality
and quantity of nursing home staff are necessary to reverse these
shocking trends.

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