How to police recidivist nursing homes: 3 strikes and you're out

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John O'Connor
John O'Connor

Even in the best of times, running a skilled care facility is a terrific challenge.

Staffing can be a nightmare. New regulations are constantly being offered and implemented. Resident-care needs continue to escalate. And the competition keeps improving.

Yet within this rigorous framework, most operators do a pretty good job of providing post-acute services, dementia care and other kinds of assistance. Most operators, but not all.

A small vein of sketchy operators remains, continuing to do things that could hardly be called God's work. And it's not like they're in hiding. Current and past special focus facility lists are chock full of them. Here you can find facilities that have made substantial caregiving errors. More importantly, it provides a virtual Who's Who of recidivist facilities

A recent Kaiser Health News analysis of inspection data unearthed this little morsel: Among 528 of these facilities that graduated off the list before 2014, 52% have since harmed patients or put patients in serious jeopardy in the past three years. If that doesn't bother you, it should.

To be clear, these are not your typical nursing homes. They are the mavericks that for whatever reason continue to play on the edge.  As a result, many of the residents within their walls face a dramatically higher chance of being harmed, or worse. They do a disservice to us all — particularly the quality care operators who are judged guilty by association.

There is an easy way to largely eliminate the yo-yo routine these outliers have mastered. Hit them where it hurts: in the pocketbook.

All it takes is this simple three-strikes rule: Any current or past special care facility will be permanently terminated from Medicare and Medicaid participation if it receives three F-tags within the H-through L scope and severity categories within five years. Why H-L? Because that means actual harm has occurred.

Am I naive enough to believe such a suggestion has a snowball's chance in you-know-where of passing? Of course not. Were the Centers for Medicare & Medicaid Services to suggest this rule, providers nationwide would be in an uproar.

Which is sort of ironic. Because CMS already has the option of terminating facilities that it deems harmful. But to say the government has been reluctant to do so would be an extreme understatement.

So year after year, most of the really bad operators get to keep doing their thing. And one way or another, the rest of us keep paying for it.

John O'Connor is McKnight's Editorial Director.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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