Summary: Overall, despite federal and state oversight, some California nursing homes are not being monitored closely enough to guarantee the safety and welfare of their residents. Unacceptable care continues to be a problem in many nursing homes. GAO found that nearly one in three California nursing homes was cited by state surveyors for serious or potentially life-threatening care problems. Moreover, GAO believes that the extent of serious care problems portrayed in federal and state data is likely to be understated. Nursing homes generally could predict when their annual on-site reviews would occur and, if inclined, could take steps to mask problems. GAO also found irregularities in homes' documentation of the care provided to their residents, such as missing pages of clinical notes needed to explain a resident's injury later observed by a physician. Finally, GAO found many cases in which California Department of Health Services surveyors did not identify serious care problems, including dramatic weight loss, failure to prevent bed sores, and poor management of incontinence. Even when the states identified serious shortcomings, the Health Care Finance Administration's (HCFA) enforcement policies have not ensured that the deficiencies are corrected and stay that way. For example, California state surveyors cited about one in 11 nursing homes in GAO's analysis--accounting for more than 17,000 resident beds--for violations in both of their last two surveys that resulted in harm to residents. Yet HCFA generally took a lenient stance toward many of these facilities. GAO recommends a less predictable schedule of inspections for all nursing homes and prompt imposition of sanctions when violations are found. GAO summarized this report in testimony before Congress; see: California Nursing Homes: Federal and State Oversight Inadequate to Protect Residents in Homes With Serious Care Violations, by William J. Scanlon, Director of Health Financing and Systems Issues, before the Senate Special Committee on Aging. GAO/T-HEHS-98-219, July 28 (16 pages).
