State nursing home inspections may not reveal the whole truth?

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Many nursing homes received poor grades in state inspections last year, according to an August report. But it's still unclear whether the results reflect declining quality of care or a change in how states evaluate homes.

One finding: The number of U.S. facilities cited for infractions that could put residents in harm's way fell to 15.5% in 2004 from 30% in 1998. Report author Charlene Harrington of the University of California San Francisco downplays the seemingly positive result. She believes states are becoming lax in citing homes for deficiencies.

Other report facts: The average number of violations per facility increased from 5.2 in 1998 to 9.2 in 2004. Also, one-third of nursing homes in the United States have food sanitation problems. The worst performing states are California, Nevada, Delaware, West Virginia and Hawaii, according to the report.

Harrington's research, which is based on state inspection findings, was paid for by the Service Employees International Union. The Centers for Medicare & Medicaid Services is reviewing the report.