Playing hardball with recidivists or taking good nursing homes out of the game?

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John O'Connor
John O'Connor

Even if you're not a baseball fan, you're probably familiar with the notion of three strikes and you're out.

If a state lawmaker has his way, it's an approach that might be soon get applied to troubled facilities — and perhaps to other nursing homes as well — throughout Texas. And it's not just Lone Star State facilities that should be taking notice.

At issue are yo-yo nursing homes. These are the operators who always seem to be close to being put out of business, and yet seemingly never are.

At one such facility in Abilene, a resident went into septic shock last March, thanks to an untreated urinary tract infection caused by an unnecessary catheter. A subsequent federal report found “no evidence” that anyone on staff attempted to remove the resident's catheter. When she was transferred to an emergency room, two nurses “had to leave the room vomiting from the overwhelming odor,” according to the report.

In response to these kinds of operators, State Sen. Charles Schwertner (R) has proposed a “three-strikes” rule. His measure would force the state to close nursing homes found to have the highest-level violations of federal quality standards on three separate days within 24 months.

Schwertner insists his rule targets only the “repeated bad actors.” But many providers are concerned that it's not just repeated bad actors who might feel the regulation's wrath.

Facility operators are quick to point out that nursing homes are already among the nation's most regulated businesses. Moreover, rules are already in place to identify problems, get them fixed and penalize operators who are non-compliant, they add.

Regardless of how one feels about what's happening in Texas, this much is clear: Bad facilities are going to find themselves being publicly identified more often.

Independent organizations, media outlets and others are eagerly compiling lists of “worst” nursing homes. It's a safe bet that this practice will only escalate.

And as we just saw with the New York Times coverage of the Five Star rating system,  bad publicity tends to generate a closer look from lawmakers, which in turn gets regulators tuned up. Frequently, the result is the equivalent of a chainsaw being used to “fix” a problem that should have been taken care of by a scalpel.

It's anyone's guess where stepped-up efforts to identify and terminate yo-yo facilities will end. Let's just hope the result isn't that good operators are also taken out of the game.

John O'Connor is McKnight's Editorial Director.

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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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