November 24, 2009

Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment

Under contract with the CMS, states conduct surveys at nursing homes to help ensure compliance with federal quality standards. Over the past decade, the United States Government Accountability Office has reported on inconsistencies in states' assessment of nursing homes' quality of care, including state surveys failing to cite serious deficiencies or cite them at too low a level. In 2008, GAO reported that 9 states had high and 10 had low understatement based on CMS data for fiscal years 2002 through 2007. This report examines the effect on nursing home deficiency understatement of CMS's survey process, workforce shortages and training, supervisory reviews of surveys, and state agency practices. GAO is making seven recommendations to the CMS Administrator to address state and surveyor issues about CMS's survey methodology and guidance, workforce shortages and insufficient training, inconsistencies in the focus and frequency of the supervisory review of deficiencies, and external pressure from the nursing home industry.