Audit finds residents need more protection
Safety, emergency preparedness lacking in N.Y. facilities, federal health regulators say in findings
Federal regulators say New York needs to do more to ensure nursing homes are protecting residents after an audit revealed numerous deficiencies in areas related to the safety of residents and emergency preparedness.
The audit was conducted early last year by the U.S. Department of Health and Human Services Office of Inspector General, as part
of a larger effort to see if states are ensuring nursing homes comply with new and expanded federal regulations designed to protect residents in the event of a fire or other emergency.
A report of the findings were published this month, and reveal that at least 20 nursing homes statewide lack the protections required to keep residents safe. Issues stem from inadequate management oversight and high staff turnover, auditors say.
“While nursing home management and staff are ultimately responsible for ensuring resident safety, we maintain that the (state Department of Health) can reduce the risk of resident injury or death by improving its oversight,” the report concluded.
Specifically, auditors found 205 areas of noncompliance with life safety requirements related to building exits and fire barriers, fire detection and suppression systems, carbon-monoxide detectors, hazardous storage, smoking policies and fire drills, and elevator and electrical equipment testing and maintenance.
They also found 219 areas of noncompliance with emergency preparedness requirements related to written emergency plans; emergency supplies and power; plans for evacuation, sheltering in place, and tracking residents and staff; emergency communications; and emergency plan training.
“As a result, nursing home residents at the 20 nursing homes were at increased risk of injury or death during a fire or other emergency,” the report said.
The 20 unidentified homes selected for review were not a statistically representative sample of all nursing homes in the state, the audit notes. They were selected because of multiple “high-risk deficiencies” previously reported at the homes.
During the audit fieldwork — conducted from January through April of 2018 — auditors found emergency exit doors that wouldn’t open, missing or damaged smoke and fire barriers, missing or blocked sprinkler systems, missing smoke detectors, missing or improperly installed carbon-monoxide detectors. Auditors also discovered improper storage for flammable and hazardous materials, and inadequate training and preparedness for emergencies.
Such issues would have been identified or allayed, the report suggests, if the state Department of Health had developed a standardized life safety training program for nursing home staff or performed more frequent life-safety surveys. The department was also not checking to see whether homes had installed carbon-monoxide detectors, it said.
While New York generally agreed with the audit’s recommendations for corrective actions, it objected to the audit’s timing, sampling methodology, auditor qualifications and certain findings.
The audit began in January 2018 — less than two months after the expanded federal regulations took effect on Nov. 15, 2017, the department said.
“It is impossible to expect that the department would have surveyed or even been able to survey all 20 nursing homes that the OIG selected as the audit sample,” it said.
The Inspector General’s Office disagreed, noting that the requirements took effect Nov. 15, 2016, with an implementation date one year later.
The state also contends the audit was biased from the start, as auditors selected the lowestperforming 3 percent of nursing homes statewide and then projected their findings to the entire state. Federal regulators, however, say their review and audit report never attempted to draw conclusions about the state’s overall oversight practices.
The state also said auditors were not qualified to assess the state’s activities because they had not completed an approved training and testing program in survey certification techniques. As a result, they may have misunderstood or misinterpreted regulatory requirements and reported inaccurate findings.
The Inspector General’s Office said its audit team met “generally accepted government auditing standards” and was led by a certified firefighter, fire instructor, fire officer and safety officer by the National Board on Fire Service Professional Qualifications.
“The New York State Department of Health is committed to ensuring the health and safety of nursing homes and has a nation-leading program to respond to natural disasters that impact nursing homes,” the department said in a statement.
The Centers for Medicare and Medicaid Services awarded New York a National Quality, Safety and Oversight Achievement Award in May for its emergency preparedness resident protection systems, it added.