An audit of the Pennsylvania Department of Health found that the agency did not properly staff nursing homes and didn't follow procedures that would make it easier for patients and their families to make complaints.
The 91-page report by the Auditor General Eugene DePasquale reported on a 10-month period from Jan. 1, 2014 to Oct. 31, 2015.
Secretary of Health Karen Murphy requested the audit in July 2015 to review policies and improve quality of care.
A major finding from the audit was that the department lacked procedures to ensure nursing homes were adequately staffed. State law requires nursing homes provide at least 2.7 hours of direct nursing care per resident every day. The report found that during 7,200 inspections, only 13 facilities were cited for inadequate staffing levels.
The department also didn't require facilities to increase staffing levels, “despite numerous instances of poor quality of care at some facilities,” the report noted.
Another major finding was that from July 2012 to July 2015, the department didn't accept anonymous complaints, which is in violation of the CMS' policy. In July 2015, the department began accepting anonymous complaints and the number of complaints increased by 63%.
Another area in need of improvement was better documentation by the department if it decided not to issue a penalty for a facility that could have been cited. The department said it prefers to mandate training when deficiencies are found rather than issue fines.
During the audit period, the department issued 32 fines for $172,350 to nursing homes. In the same period, New York issued 38 fines for $398,000 and Illinois issued 48 fines for $441,400.
According to a news release, the department has already begun to implement recommendations cited in the audit report. In the last year, the department has formed a task force which includes national and state experts who offer recommendations on improving quality of care in nursing homes. It has also begun to work with providers to review regulations and to establish a formal process with the departments of Human Services and Aging to address nursing home care issues.
The department has also doubled the number of citations issued in 2015 from 2014. Increased staff, easy accessibility to online complaint forms and a new telephone system have contributed to more reported complaints.
Approximately 80,000 Pennsylvania citizens live in a nursing home. More than 2.2 million people in the state are 65 or older and an estimated 70% will need long-term care in their lifetime. The state reflects nationwide trends as baby boomers age into the system.
Consequently, efforts to improve quality of care at nursing homes have gained increased federal attention. The CMS issued a 403-page proposed rule last June that outlined proposals at nursing homes to reduce unnecessary hospital readmissions and infections, increase quality of care and introduce new safety measures. Approximately 64% of nursing home residents have their care paid for by Medicaid.