State report on nursing homes warns of crisis ahead
Regulators of Pennsylvania’s nursing home industry have improved their efforts to monitor and ensure quality in recent years, but additional steps are needed to ensure a growing number of older persons in need will be well- cared for, state Auditor General Eugene DePasquale cautioned in a new report Tuesday.
Mr. DePasquale’s office followed up on a 2016 audit that was largely critical of the state health department’s oversight of the some 700 facilities that care for nearly 90,000 frail Pennsylvanians. Most of that care is covered by the government’s Medicaid and Medicare programs.
The new report — titled “Who Will Care for Mom & Dad?” — highlighted how even with tougher enforcement actions to monitor the industry, a long- term crisis in care is looming because of potential shortages in the field.
“My team and I spoke with more than 50 experts for this report, and we heard from more than 20 nursing home residents, families and staff members about their experiences,” Mr. DePasquale said. “While much of what we heard was encouraging, we also heard about serious challenges such as staffing, equipment and supply shortages.”
The report noted that since 2016, the health department has been more vigilant in fining nursing homes that are the worst violators of state and federal regulations. At the same time, he noted, it has not shown similar aggressiveness in using provisional licenses, which are a means of putting the facilities on warning and under closer scrutiny to make upgrades.
A Pittsburgh Post- Gazette report in March noted that the health department doubled its fines against nursing homes to $ 2.3 million in 2018 from the prior year, but it issued only three provisional licenses after issuing more than 30 in 2017.
“There needs to be a better balance” involving multiple enforcement actions for the most effectiveness, Mr. DePasquale said at a Harrisburg news conference.
He was joined at the news conference by state Health Secretary Dr. Rachel Levine, who largely agreed with his comments and the report’s suggestions. She said a change in approach has taken place already in the first half of 2019, with 24 provisional licenses issued in addition to $ 1.7 million in fines as of June 30.
In Allegheny County, one nursing home is currently on a provisional license, the Corner View Nursing and Rehabilitation Center in Larimer, formerly known as Forbes Nursing and Rehabilitation Center.
The issue of whether the state requires sufficient staffing by nursing homes arose in the new report, as well as in 2016. Workers are supposed to be able to deliver the
equivalent of at least 2.7 hours per day of direct care to each resident, according to existing regulations, which advocates for nursing home residents contend is insufficient.
The auditor general’s report said, without recommending a specific change, that state inspectors need to pay special attention to staffing levels in their review of the homes. Dr. Levine said that the Wolf administration is undertaking a broad update of nursing home regulations to be released publicly later this year, and the 2.7- hour minimum requirement is one key part of the rules being examined.
The report also said the state needs to do a better job of vetting nursing homes before granting them new licenses in order to be sure of their financial stability and ability to deliver quality care. The New Jersey- based Skyline nursing home chain encountered financial problems in 2018 that led the Pennsylvania Health Department to take over its nine facilities in the state.
Mr. DePasquale called, meanwhile, on state agencies to collaborate with one another and work with the long- term care field and educational institutions to try to address the broad workforce issues, which ultimately may overshadow any problem pertaining to regulations or inspections. The ability to attract, train and retain quality workers is a major challenge in the field already and will only worsen, as detailed in a separate recent report from the Pennsylania Long- Term Care Council.
“By 2030, there will be 38 older adult dependents for every working- age resident,” Mr. DePasquale said. “At about the same time, Pennsylvania is projected to be short by thousands of registered nurses and tens of thousands of direct- care workers — creating a looming workforce crisis that must be addressed.”