Federal oversight of nursing homes rolled back by Trump administration

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State advocates are concerned that reduced federal regulation of nursing homes will remove incentives for facilities, including a poorly rated Williamstown nursing home, to improve the care patients receive.

In addition to being regularly surveyed by the state Department of Public Health, nursing homes nationwide are monitored by the Centers for Medicare and Medicaid Services. Advocates and legislators worked for years to secure new protections for residents of nursing homes. The year 2016 brought national long-term care regulatory reform.

The new rules included an increase in infection control, added training for staff and protections against abuse, neglect and exploitation. But those regulations, some of which were due to be implemented in November 2017, were halted by the Trump administration.

In Massachusetts, the move was assailed by the office of Attorney General Maura Healey.

"The federal government's rollbacks of critical nursing home oversight and regulations are shameful and hinder our ability to adequately address misconduct and protect the health and well-being of nursing home residents," said Emalie Gainey, a spokeswoman for Healey. "We will continue to use our full authority to protect seniors and those with disabilities because they deserve to live in safe and healthy environments in which they are treated with dignity and respect."

In May, Healey joined 16 other AGs in a letter condemning the reduction of protections. The letter, addressed to the U.S. Department of Health and Human Services, cited a 2017 report from the inspector general that found the Center of Medicare and Medicaid Services has "inadequate procedures to identity and report incidents of abuse and neglect."

An estimated 22 percent of Medicare beneficiaries experienced adverse events — including infections, pressure ulcers and medication-induced bleeding — during stays at skilled nursing facilities, a report said.

Nearly 70 percent of these adverse events could have been avoided if the facilities had provided better care, according to the letter Healey signed, and over half of residents harmed needed hospital care.

Patients need more protection, not less, the letter said.

In fall of 2017, the Centers for Medicare and Medicaid fined Sweet Brook Nursing and Rehabilitation facility $433,488 over violations, a sum later reduced to $288,267.

The deficiencies included medication errors and poor response time to call bells. In March, inspectors returned and the facility was fined $63,180 for similar violations, which has not yet been paid. The center was also hit with a separate fine of $8,237, which was lowered to $5,354 and paid in July, according to a spokesman from the office of Medicare and Medicaid.

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Arlene Germain, president of the board at the Massachusetts Advocates for Nursing Home Reform, had worked on the revised regulations.

"This is serious. In addition to rolling back some of the protections, they also reduced the amount of financial penalties for nursing homes," said Germain. "So like what happened to Sweet Brook, the amount of money they paid, they wouldn't have to pay (as much) if the situation happened again."

The Centers for Medicare and Medicaid could not be reached for comment Friday.

For more than 20 years, Germain has volunteered with the state advocacy group that advises legislators on laws related to long-term care facilities. She sits on the leadership council of the National Consumer Voice For Quality Long-Term Care.

Many of the violations cited at Sweet Brook, including leaving patients in unhygienic conditions, can be found at underfunded facilities across the country, Germain said.

A combination of low pay and the difficulty of the job contributes to poor staffing rates, she said.

"The federal government did a study back in 2001 that found that, more than likely, it takes four hours of care per resident per day just to prevent harm," Germain said.

Sweet Brook, she said, was found to provide just under three hours of care per resident per day. Several former residents said they didn't even receive that much care.

"There are a lot of nursing homes that are even worse off for staffing in the state," she said. "If there is not enough staffing, no matter how good they are, they can't do the job they're there to do."

In addition to pushing for stricter regulations of nursing homes nationwide, Germain and staff from her organization are collecting data from nursing homes across the state to produce a report on staffing, the use of anti-psychotic medication and the presence of bedsores.

"Ideally, what I'd like to do is collect that kind of data by legislative district, so we can let legislators do how their own nursing homes are doing," she said.

Haven Orecchio-Egresitz can be reached at horecchio@berkshireeagle.com, @HavenEagle on Twitter and 413-770-6977.


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