KAALtv reported serious problems with the quality of care at St. Mark’s Lutheran Home in Austin.  Many family members have complained.  The family council –which is made up primarily of family members of residents in the nursing home–are saying quality of care has been a battle with the facility for far too long.

"We’ve continually come to the board and the management, and it seems quite often to us some of the same problems keep reoccuring," says President of the Family Council Dick Heuton.

"St. Marks basically is considered a low performing below average facility," says Jean Mueller, regional ombudsman for the state.

According to Medicare’s website, St. Mark’s Lutheran Home was inspected in April and had 11 deficiencies. Inspectors found they failed in areas of quality care and nutrition.  Inspectors found evidence they failed to prevent or promote the healing of bed pressure sores and they failed to ensure the unpasterized eggs, served to residents, were cooked properly. Another major deficiency is staffing or lack their of, "we have some really good nurses and aids and support staff here, but they just don’t have enough of them," say Huebner.

"A lot of time after the state inspectors have been here, what’s happened is they get a little better for a little time then they just fall right back off, then we’re in the same boat we were in before, " says Huebner.




Erin Jordan from Eastern Iowa Government wrote an article regarding how Iowa taxpayers reimburse nursing homes for legal fees including fees defending abuse and neglect citations.  Eastern Iowa nursing homes sought Medicaid reimbursement for more than $2.2 million in legal fees, accounting fees and professional services in 2010.  The nursing homes get reimbursement even if they lose citation appeals or lawsuits.

All nursing homes receiving tax funds file annual cost reports requiring detailed information about revenue, expenses, equipment purchases, assets and employee statistics. The cost report allows nursing homes to claim expenses for legal fees. Legal fees are an allowable cost and are included in the calculation of the nursing home’s per-bed, per-day Medicaid reimbursement rate.

The Medicaid division of the Iowa Department of Human Services drafted a proposed rules change in late 2009 or early 2010.  The proposal would have forbidden reimbursement for legal fees when a nursing home is defending itself against a criminal or state civil action that it loses or when the Iowa Department of Inspections and Appeals succeeds in suspending or revoking the nursing home’s license.  The rules change also would have prohibited reimbursement for legal fees, expenses and costs for lobbying Congress or the Iowa Legislature.  No final draft has been published.

Medicaid also reimburses nursing homes for association dues for lobbying groups.  Membership dues accounted for more than $950,000 of the Iowa Health Care Association’s budget in 2009, according to the group’s tax report.


The Government Accountability Office issued a new report titled Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment.  Not surprisingly South Carolina is one of the worst offendersReducing understatement is critical to protecting the health and safety of vulnerable nursing home residents and ensuring the credibility of the survey process. Federal and state efforts will require a sustained, long-term commitment because understatement arises from weaknesses in several interrelated areas—including CMS’s survey process, surveyor workforce and training, supervisory review processes, and state agency practices and external pressure.

The conclusions reached include as follows:
Concerns about CMS’s Survey Process.
Survey methodology and guidance are integral to reliable and consistent state nursing home surveys, and we found that weaknesses in these areas were linked to understatement by both surveyors and state agency directors. Both groups reported struggling to interpret existing guidance, and differences in interpretation were linked to understatement, especially in determining what constitutes actual harm. Surveyors noted that the current survey guidance was too lengthy, complex, and subjective. Additionally, they had fewer concerns about care areas for which CMS has issued revised interpretive protocols.

Ongoing Workforce and Surveyor Training Challenges. Workforce shortages in state survey agencies increase the need for high-quality initial and ongoing training for surveyors. Currently, high vacancy rates can place pressure on state surveyors to complete surveys under difficult circumstances, including compressed time frames, inadequately staffed survey teams, and too many inexperienced surveyors. States are responsible for hiring and retaining surveyors and have grappled with pervasive and intractable workforce shortages. State agency directors struggling with these workforce issues reported the need for more readily accessible training for both their new and experienced surveyors that did not involve travel to a central location. Nearly 30 percent of surveyors in high-understatement states stated that initial surveyor training, which is primarily a state activity that incorporates two CMS on-line computer courses and a 1-week federal basic training course culminating in the SMQT, was not adequate to identify deficiencies and cite them at the appropriate scope and severity level. State agency directors reported that workforce shortages also impede states’ ability to provide ongoing training opportunities for experienced staff and that additional CMS online training and electronic training media would help states maintain an experienced, well-informed workforce.

Supervisory Review Limitations.
Currently, CMS provides little guidance on how states should structure supervisory review processes, leaving the scope of this important quality-assurance tool exclusively to the states and resulting in considerable variation throughout the nation in how these processes are structured. We believe that state quality assurance processes are a more effective preventive measure against understatement because they have the potential to be more immediate and cover more surveys than the limited number of federal comparative surveys conducted in each state. However, compared to reviews of serious deficiencies, states conducted relatively fewer reviews of deficiencies at the D through F level, those that were most frequently understated throughout the nation, to assess whether or not such deficiencies were cited at too low a scope and severity level.  In addition, we found that frequent changes to survey results made during supervisory review were symptomatic of workforce shortages and survey methodology weaknesses.

State Agency Practices and External Pressure In a few states, noncitation practices, challenging relationships with the industry or legislators, or unbalanced IDR processes—those that surveyors regard as favoring nursing home operators over resident welfare—may have had a negative effect on survey quality and resulted in the citation of fewer nursing home deficiencies than was warranted.  In one state, both the state agency director and over 40 percent of surveyors acknowledged the existence of a noncitation practice such as allowing a home to correct a deficiency without receiving a citation.  Forty percent of surveyors in four other states also responded on our questionnaire that noncitation practices existed.   Twelve state agency directors reported on our questionnaire experiencing some kind of external pressure. For example, in one state a legislator attended a survey and questioned surveyors as to whether state agency executives were coercing them to find deficiencies. Under such circumstances, it is difficult to know if the affected surveyors are consistently enforcing federal standards and reporting all deficiencies at the appropriate scope and severity levels. States’ differing experiences regarding the enforcement of federal standards and collaboration with their CMS regional offices in the face of significant external pressure also may confuse or undermine a thorough and independent survey process. If surveyors believe that CMS does not fully or consistently support the enforcement of federal standards, these surveyors may choose to avoid citing deficiencies that they perceive may trigger a reaction from external stakeholders. In addition, deficiency determinations may be influenced when IDR processes are perceived to favor nursing home operators over resident welfare.

Recommended Action includes:

Make sure that action is taken to address concerns identified with the new QIS methodology, such as ensuring that it accurately identifies potential quality problems; and clarify and revise existing CMS written guidance to make it more concise, simplify its application in the field, and reduce confusion, particularly on the definition of actual harm.

To address surveyor workforce shortages and insufficient training, we recommend that the Administrator of CMS take the following two actions: (1)  consider establishing a pool of additional national surveyors that could augment state survey teams or identify other approaches to help states experiencing workforce shortages; and (2) evaluate the current training programs and division of responsibility between federal and state components to determine the most cost-effective approach to: (1) providing initial surveyor training to new surveyors, and (2) supporting the continuing education of experienced surveyors.

To address inconsistencies in state supervisory reviews, we recommend that the Administrator of CMS take the following action:
Set an expectation through guidance that states have a supervisory review program as a part of their quality-assurance processes that includes routine reviews of deficiencies at the level of potential for more than minimal harm (D-F) and that provides feedback to surveyors regarding changes made to citations.

To address state agency practices and external pressure that may compromise survey accuracy, we recommend that the Administrator of CMS take the following two actions: (1)  reestablish expectations through guidance to state survey agencies that noncitation practices—official or unofficial—are inappropriate, and systematically monitor trends in states’ citations; and (2) establish expectations through guidance to state survey agencies to communicate and collaborate with their CMS regional offices when they experience significant pressure from legislators or the nursing home industry that may affect the survey process or surveyors’ perceptions

Here is an interesting article about attorney Ken Connor’s appearance for an advocacy group for nursing home reform.  The seminar was titled "Nursing Homes: A Failed Experiment,".  Connor’s appearance was sponsored by the advocacy group Kentuckians for Nursing Home Reform.

Connor said he classified nursing homes as "a failed experiment" because the current system puts the economics of the provider ahead of the life, health and safety of the residents.

"In other words, they put profit over people; they put revenue over residents," he said.

To increase profit, Connor said, staffing is cut. And some nursing homes are run by businessmen who have never been doctors or nurses and don’t have any expertise in the medical field. They are, however, good at making money.

It’s important for people to be educated about this issue — to know what to do if they are confronted with a problem and know where to file a complaint. It’s also good to know where to find support.

Connor urged the crowd to pay attention to signs such as pressure ulcers, infections, urine and feces-stained bed linen and foul odors. Also, the hollow eyes and parched tongues of loved ones display the lack of time devoted to them.

Connor said nursing home problems are pervasive throughout the country.   "Corral your congressmen and senators and make them understand the breadth of the problem," he said.

Kentuckians for Nursing Home Reform work to change state law so criminal background checks and random drug tests are required for all nursing home employees. They are fighting to ensure there is a minimum staffing standard.

Kentucky has cited about one in four nursing homes for serious deficiencies that caused "actual harm" or "immediate jeopardy".