Despite “tremendous progress” since 2016, Pennsylvania’s nursing homes need more stringent licensing procedures and a better survey process, a new auditor general report finds.
The Department of Health should explore outsourcing surveyor training to a third party to “allow for a fresh look at training content and to take pressure off of participating employees who may not want to share stories or ask questions of internal training staff,” state Auditor General Eugene DePasquale wrote in his report. He also noted the lack of surprise inspections of nursing homes, with many operators confirming they knew the precise day surveyors would arrive.
This “at least removes the element of surprise and, at worst, enables operators trying to cut corners to add staff temporarily to make it appear that the facility is properly staffed,” DePasquale wrote.
Another major concern is the state’s licensing process for nursing homes, the report examined. While relatively rare, the fall of Skyline and its ties to Golden Living, such as the latter apparently requiring Skyline to buy certain amounts of goods and services from its subsidiaries, should concern regulators, DePasquale wrote.
“DOH’s vetting process should require applicants to provide lease agreements, contracts with subsidiaries and ownership information for these subsidiaries,” he wrote. “The investment trend of private equity firms buying up nursing home chains is a salient example of why state governments need ownership information in order to make license decisions.”
Staffing is another major focus of the report. Pennsylvania Health Care Association President and CEO Zach Shamberg said the industry shares concern over the issue of direct care staffing.
“Sadly, despite an increase in the number of residents requiring assistance with clinically complex medical conditions, there are fewer direct care workers pursuing a career in long-term care than ever before,” he said in a statement.
Both PHCA and LeadingAge Pennsylvania said staffing problems can be directly tied to insufficient Medicaid funding.
“We agree that high quality care must be provided, and that appropriate staffing is critical,” said LeadingAge PA President and CEO Adam Marles. “Not only are we losing some of our best employees, but gross underfunding makes it difficult to compete for new hires. Last year alone, providers lost more than $630 million serving Pennsylvania’s poorest older adults because Pennsylvania will not increase Medicaid funding.”
DePasquale’s other observations included:
• DOH must follow the letter and spirit of the Centers for Medicare & Medicaid Services’ guidance for complaint handling.
• DOH has shown progress by increasing the use of civil monetary penalties for care deficiencies, and it should expand on those improvements by tracking the effectiveness of fines
• Quality healthcare for older adults is expensive and difficult to find in the state, and there is not enough attention paid to older adults
• Public and private systems for preventing elder abuse are lacking.
