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APHA Scientific Session and Event Listing

Janis A. O'Meara, MPA and Charlene Harrington, PhD. Social and Behavioral Sciences, University of California San Francisco, 3333 California St., Suite 455, San Francisco, CA 94118, 415-502-7098, janis.omeara@ucsf.edu

Inspectors visit nursing homes to determine if there has been a violation of state or federal regulations during annual certification surveys and to investigate complaints. These visits are important indicators of quality of care because they show if the health and/or safety of residents are in danger and if resident's rights are being violated. There are no standards to determine violations or their severity; those decisions are left up to the judgment of inspectors. Complaint investigation time requirements vary depending on the severity of the complaint, which is also determined by inspectors.

The discretionary nature of the enforcement and complaint investigation process make them political. Consumers and consumer groups in California have claimed the state is failing to investigate complaints on a timely basis, and opting to enforce only federal standards during surveys, ignoring some of the more stringent state regulations. The federal government issued two reports that found an understatement of serious care problems on surveys, because inspectors miss them or categorize them as being a lower level of severity than they should be.

Analyses of state deficiency and citation data and complaints and federal deficiency data show there is evidence to support the allegations. The complaint substantiation rate has decreased significantly. The average number of state deficiencies and citations issued decreased considerably while the average number of federal deficiencies has increased. The percent of federal deficiencies categorized as lower level increased substantially while the percent of those considered to be high level has decreased.

Learning Objectives: The purpose of this poster session is to illustrate the political nature of the issuing of deficiencies, citations and complaints in nursing homes in California by presenting data that corroborates claims of consumers and consumer groups and federal government investigators that the enforcement and complaint investigation process are inadequate. Participants will be better able to

• Understand and discuss the enforcement and complaint investigation process.
• Analyze complaint and deficiency data.
• Recognize how changes in policy affect the outcome of nursing home surveys.
• List the types and frequency of deficiency and complaint categories, complaint sources and deficiency scope and severity levels, and trends in the numbers of complaints and deficiencies issued.

Keywords: Nursing Homes, Health Care Politics

Related Web page: www.calnhs.org

Presenting author's disclosure statement:

Not Answered