July 26, 2016; Pittsburgh Tribune-Review

There are 80,000 residents in Pennsylvania nursing homes, all of whom are vulnerable to those who run the institutions in which they reside. Nursing home abuse is widely considered underreported, in part precisely because of the inherent vulnerability embedded in the situation. Complaints, when made, are often anonymous, and it’s so critical that such complaints be investigated that federal policy requires it. But a recent audit found that the Pennsylvania Department of Health took it upon itself recently to prohibit anonymous complaints against nursing homes for close to three years. The audit also found problems in other oversight functions and in sanctions.

On Tuesday, Auditor General Eugene DePasquale called the decision to halt anonymous complaints between 2012 and 2014 “absolutely breathtaking,” and likely “an action intended to silence critics.” He also said that the auditors could not find any records containing a rationale for the practice. Anonymous complaints were accepted again starting in 2015, and complaints increased 63 percent after that, with around 10 percent of them being validated.

DePasquale also said that the health department has done little to enforce a law requiring 2.7 hours of direct nursing care per day for each resident, even though there is a clear correlation between those hours and quality of care.

Even the aspect of basic standardized oversight was clearly wanting. A review of annual surveys from 42 nursing homes found 71 percent of the state’s Department of Health staffing reviews were incomplete, with 10 percent showing no proof that any review of the home’s staffing levels was conducted. The auditor general called the 13 staffing level citations that resulted from 7,325 instances of the agency completing a nursing home survey “an unbelievably low number” and said the penalties imposed on out-of-compliance institutions were nowhere near sufficient. (Pennsylvania’s maximum civil monetary penalty for such violations is $500 per day; by contrast, it’s $100,000 in California, $10,000 in New York, $10,000 in Texas, and $25,000 in Illinois, according to an analysis contained in the audit report.)

Russell McDaid, president and CEO of the Pennsylvania Health Care Association, an industry advocacy group for nursing homes and their residents, applauded the audit but wasn’t so happy with the idea of increased sanctions.

It is important to note that when any sanction or penalty is considered, the most important goal is to identify the practice in question, take steps to correct the practice and ensure that any sanction does not jeopardize the facility’s ability to improve resident care, comfort and safety. Taking financial resources away from the bedside does not improve resident care.

Translation: We support reform completely but we do not want consequences imposed if we blow it off once in a while.

DePasquale praised the current administration for its willingness to aid in the audit and to commit to implementing the 23 recommendations that came from it.—Ruth McCambridge