Numerous media outlets have been discussing the ongoing problems with Indiana’s oversight of nursing homes including The Indianapolis Star and The Journal Gazette, Over the past five years, the Health Department has passed along about 300 inspection reports to the attorney general in accordance with a federal law that says health inspectors must report major problems to licensing officials. At some homes, inspectors found such problems year after year. Complaints against nursing home administrators in Indiana are less likely to reach the Indiana State Board of Health Facility Administrators—that state’s nursing home regulatory body—than in other states. Most states take a broader approach to complaints against nursing home administrators, and will file complaints based not just on personal responsibility, but on facility wide or systemic issues.
But from those 300 reports, an Indianapolis Star investigation found, the attorney general brought the board a grand total of six complaints. None since 2009. The Indiana state attorney general’s office has said it only files complaints with the board if it finds the administrator was personally responsible for the infraction. In forwarding a complaint to the state board, the attorney general simply calls for a review. It becomes the state board’s responsibility to follow through and determine if action is warranted.
The connection between Indiana’s abysmal record for nursing home performance and what appears to be lax oversight can’t be a coincidence. The Centers for Medicare and Medicaid Services reported that in 2007, nearly 90 percent of Indiana nursing homes were cited for violations of federal standards. Thirty-five percent of the facilities – almost twice the national average – were cited for causing actual harm or placing patients in jeopardy.
It wasn’t always like this in Indiana. Here is the history:
In 2000 alone, Indiana Attorney General Karen Freeman-Wilson reviewed 300 inspection reports of nursing homes and forwarded 92 of them to a state board for review. At least 40 of the reviews resulted in a fine, reprimand or other discipline.
In November of 2000, nursing home owners and trade groups representing them contributed at least $11,000 to her Republican opponent, Steve Carter. He was elected, and the number of reports resulting in complaints fell dramatically. Of 463 reports forwarded by health officials during his two terms, Carter filed only 38 with the Indiana State Board of Health Facility Administrators.
Greg Zoeller, who served as Carter’s chief deputy and succeeded him in 2009, received 40 inspection reports last year. Not a single report resulted in a review by the state.
Numerous incidents over the last few years show an atmosphere of lax oversight. In June 2008, health officials and police investigated a rape at a Marion nursing home and learned that the administrator knew that the resident accused was a sex offender on parole. The administrator did not convey the history and make sure nurses and aides knew that history and developed no plan to protect other residents. When the attorney general’s office received the report from health officials, it could have filed a complaint, triggering a review by the state board. No complaint was filed; no review of the case was made; no disciplinary action has been taken against the administrator.
In another case, health officials forwarded a report on an Indianapolis nursing home where emergency call lights were disabled for 11 days, leaving residents with no way to summon help. Six residents suffered falls in the meantime. No complaint was filed by the attorney general.
At a Muncie nursing home in January 2009, inadequate heating units in 26 rooms left residents shivering in temperatures in the mid-50s. The inspection report found the administrator was aware of the problem. Again, no complaint.