Skilled-nursing facilities treat patients who are well enough to leave the hospital, but not well enough to go home. About 90 percent of such facilities in the United States also are certified as nursing homes, providing long-term care for an exceptionally vulnerable population of frail, elderly and disabled patients.
As the federal government revealed last spring, these health care facilities are far from perfect. One-third of all patients were harmed while in residence, and nearly 60 percent of the infections, injuries, medication errors and other problems they suffered were preventable, according to a report issued in March by the U.S. Department of Health and Human Services’ inspector general. The report, based on a national sample of Medicare patients, found that injuries and deaths were caused by substandard treatment, insufficient patient monitoring and delays in or the failure to provide necessary care.
One of the inspector general’s recommendations to improve this sorry situation was for state agencies that inspect skilled-nursing facilities to review efforts to identify and reduce these adverse events. In Hawaii, appallingly, that means acknowledging that the state Department of Health is failing to even inspect all of the state’s nursing homes on a timely basis. This unacceptable situation must be immediately corrected.
Federal law requires nursing homes to be inspected at least every 15 months, but 16 of Hawaii’s 45 nursing homes — or 35 percent — have not been checked within that time frame, the Star-Advertiser’s Rob Perez reported in Sunday’s newspaper. The problem is especially acute on the neighbor islands, where "annual" inspections of 17 facilities on Maui, Kauai and Hawaii island occurred 20 months ago, on average. One Big Island facility hasn’t had a standard survey in 34 months — nearly three years — the longest lag in the state.
The state faces a fine of up to $121,000 by the federal government if all the inspections are not caught up by September. A Hawaii DOH official insists that requirement will be met ahead of schedule, but it shouldn’t have taken the federal government to inject the urgency into this matter.
DOH blames a lack of resources for the lagging inspections. Budgets are tight, no doubt, but this status also reflects the department’s own priorities. Inspecting nursing homes clearly needs to be a higher one.
As the federal report in March highlighted, timely, unannounced inspections are essential to protect patients’ health and welfare. The regulators who interview patients and staff members and pore over records to ensure that a facility is meeting minimum health and safety regulations have a direct impact on the lives of individual patients and on the overall quality of our health care system. By pointing out what facilities are doing well and what they need to do better, the monitors impose standards that may falter without future attention — or at least the expectation of it.
This oversight is essential for patients and their families, and it is important to the taxpayers, too. As the March report noted, more than half the U.S. patients who suffered harm in skilled-nursing facilities transferred to hospitals for corrective treatment, at an estimated cost to Medicare of $2.8 billion in fiscal year 2011.
Nursing-home inspections can help prevent the kind of harm that too many patients suffer throughout the United States. More than 40 percent of all Americans older than 65 will spent time in a nursing home at some point in their lives. Maintaining and improving this sector of our health care system is vitally important for Hawaii. The Department of Health must catch up with its nursing-home inspections, merely as a first step.
