A new audit of the New York State Department of Health’s oversight of nursing homes notes that the Department should improve its enforcement of violations in nursing homes. According to the February 22, 2016 press release issued about the audit, NYSDOH inspects nursing homes at the expected frequency, and acts relatively quickly on serious complaints, but the auditors found that several facilities had repeat violations that escalated into harm and IJ level deficiencies with “limited consequences.” NYS Comptroller Thomas P. DiNapoli stated, “DOH is not using the full array of enforcement actions available and this trend has recently worsened . . .” related to the scope of fines that are issued to New York nursing homes.
The audit, which reviewed nursing home deficiencies and enforcement actions for January 1, 2007 through September 17, 2015, looked at a random sample of 25 surveys that represented each of the seven area offices and then 25 complaints/incidents. During this time period, NYDOH conducted over 39,000 surveys and issued more than 50,000 citations across the state. Generally, the NYSDOH:
- Met its obligations to conduct surveys within the allotted time frames – Between 2007-2014, NYSDOH generally inspected all nursing homes within the allotted 15.9 month survey cycle and maintained an average of 11.8 months between surveys. NYSDOH properly surveyed facilities with historically larger volumes of citations at about 9.9 months or less between surveys.
- Accurately assessed scope and severity of citations and responded to complaints in a timely manner – IJ complaints were investigated within 2 days 98% of the time.
- Non-IJ High Priority Complaints took longer due to the sheer volume – 90%+ of these complaints were not investigated within the allotted 10 days
So, while the NYSDOH has gotten its survey and certification processes under control, the auditors found that the Department does not use the “full array of enforcement actions” that are available to it to address deficient practices.
- The audit found that for 80%+ of citations, NYSDOH did not penalize the facility with fines. This is part of the NYSDOH policy to not issue fines for deficiencies that fall within the scope and severity of D-F, and only for Actual Harm and Immediate Jeopardy citations.
- The audit also identified inefficient processes that caused delays in issuing potential fines, including limited staff. That resulted in 433 citations in a 3 year period that were eligible for fines, but had not progressed to the point of being ordered. Those fines were for citations including:
- 343 Immediate Jeopardy citations
- 80 “Double G” citations
- 10 F S/S citations with SQC
NYSDOH responded by noting that it finds that alternative remedies such as Directed Plans of Correction and Directed Inservices are a good way to ensure improvements in compliance and quality of care. The Comptroller’s response referenced a thorough example of one facility with had numerous repeat deficiencies and escalated scope and severity, resulting in Actual Harm and Immediate Jeopardy deficiencies that may have benefited from different types of penalties, and noted that it found other nursing homes in similar, less severe patterns of noncompliance.
Read the full audit here.