End pressure to downplay nursing home problems

By The Des Moines Register

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State inspectors downplay nursing home violations or fail to report them at all, according to federal investigations.

But why would regulators minimize problems in institutions caring for vulnerable people?

That's the question the Government Accountability Office was trying to answer when it surveyed more than 2,300 state inspectors and agency directors across the country. It released its findings late last year.

Among the reasons inspectors went too easy on homes: “external pressures” to do so. State agency directors from 12 states reported being pressured by home administrators, industry officials and lawmakers to reduce fines or delete findings of wrongdoing in facilities.

Yes, lawmakers.

The GAO report doesn't identify which states reported such pressure. Instead, congressional investigators refer to “State A” or “State B” in describing specific incidents. Even if you ask, the GAO won't reveal the identity of those surveyed and interviewed.

States, however, can disclose what they told the GAO - if someone asks.

“Is Iowa identified as ‘State A' in the report?” a Register editorial writer recently asked the Iowa Department of Inspections and Appeals.

Yes, the department replied.

And when you reread the report knowing some of the most egregious examples of “external pressure” took place in Iowa, it's especially troubling.

Here's what the GAO said was going on in “State A”:

State lawmakers and industry officials showed up at nursing homes during inspections. Lawmakers came “to question surveyors about their work and whether state agency executives were coercing them to find deficiencies,” according to the GAO.

During one inspection, “a home's lawyer was on site reviewing nursing home documentation before surveyors were given access to these documents.”

Iowa inspectors were under so much “external pressure” that they terminated an inspection of one home and asked federal regulators to complete it. The feds found numerous problems in the home, and also acknowledged the type of interference Iowa officials were reporting.

The above examples offer insight into what goes on behind the scenes in Iowa. And they jive with what Dean Lerner, director of the Iowa Department of Inspections and Appeals, has shared with this newspaper in the past. He has talked about a lawmaker urging him to recertify a home that had been decertified by the federal government for serious care violations. ...

The next best hope: Congress.

Legislation intending to improve oversight of nursing homes was recently introduced. Page 10 of H.R. 6161 imposes a fine of up to $10,000 on anyone - including lobbyists and lawmakers - who attempt to “inappropriately influence” a state inspector.

The measure should become law.

In fact, it should be championed by Sen. Chuck Grassley who requested the investigation that found external pressures influencing state inspectors in “State A” - his home state.