The nursing home industry said it supports a stronger, faster process for investigating and resolving complaints about care but disagreed with the government about how that should be done.
The industry's reaction follows seven reports by two federal agencies criticizing states' enforcement of quality standards and slow grievance processes.
HHS' inspector general's office and the General Accounting Office, Congress' investigatory arm, released the reports at a hearing of the Senate Special Committee on Aging last month.
The inspector general looked at nursing home conditions in the 10 states in which 56% of all Medicaid money for long-term care is spent.
While the total number of deficiencies has dropped in recent years, the inspector general found an increase in 13 of the 25 most serious quality violations. The 13 violations include failure to prevent and treat pressure sores, and poor housekeeping and maintenance.
The inspector general also found that more residents complained about unattended symptoms, dehydration and inadequate nutrition.
However, because of a dearth of state investigators and other resources, state surveyors acted on only 53% of the formal grievances, the inspector general reported.
The GAO report, the latest in a series, supported the inspector general's recommendations by calling for stronger complaint processing and enforcement practices to ensure better care in nursing homes.
HCFA declined an invitation to testify verbally before the Senate committee but submitted written testimony (March 29, p. 72).
"We have made substantial progress in improving nursing home resident protections," HCFA Deputy Administrator Michael Hash wrote in the testimony. "The GAO's new report . . . looks at states where problems are most serious over a time period before we had implemented most provisions of the nursing home enforcement initiative that we announced last July."
Industry officials criticized the reports, however, saying GAO and inspector general surveyors looked only at paper and numbers, not at facilities.
Officials also called for more resources to allow inspectors to target poorly performing homes that are repeat offenders.
"We'd like to see more enforcement done," said Robert Greenwood, a spokesman for the American Association of Homes and Services for the Aging, which represents not-for-profit nursing facilities. "But we also need to give recognition and rewards to homes that are always in compliance with these standards. It would give them an incentive to stay in compliance."