More Oversight Needed to Improve Nursing Home Quality?

The Herald Tribune recently reported on troubling case of nursing home neglect and Medicaid fraud that is causing many to worry about a lack of industry oversight.

At the heart of the problem are questions about why a nursing home closed in 2011 for repeated quality of care problems was allowed to open at all. The facility was opened in 2006 by two family members (a brother and brother-in-law). Somehow, when screening the pair’s application to open the facility, officials did not register that the two men were both sentenced to three years in prison in the late 1970s for New York Medicaid fraud.

Obviously the owners’ past record of criminally violating Medicaid rules should have raised huge red flags as they tried to again operate a business where they would receive Medicaid funding. But, none of that mattered; the two men made it through the screening and received a license to practice.

They had not learned the error of their ways.

Sadly, it was not just the taxpayers providing Medicaid support that suffered from this problem. Many seniors residents apparently spent years in the facility receiving substandard care. It wasn’t until a resident death at the home caused widespread outrage that investigators looked closely at the facility. They discovered a laundry list of standard problems, resulting in the home’s official closure.

The case has become a rallying point for advocates across the country who are hoping to explain how a lack of government oversight can lead to severe suffering and Medicaid fraud. Most nursing home regulation issues are decided at the state level, and each is able to craft its only rules about how much (or little) oversight to provide.

What does this mean for you?

This “administrative oversight” is another reminder that local residents cannot simply assume a facility is of high quality because it is currently operational. State officials are unable to monitor detailed quality of care indicators on a consistent basis. This means that even poor homes can remain open for years–harming countless New York seniors in the process.

Our elder law attorneys advise families to do as much research as possible before making a final nursing home selection. Resources like the “Nursing Home Compare” website from the Centers for Medicare and Medicaid Services as well as the “Nursing Home Rankings” from U.S. News are good places to start.

For tailored advice on how to apply for Medicaid, secure long-term care insurance, or otherwise deal with the realities of growing older, please feel free to reach out to our legal professionals today.