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Troubling State Disparities between Nursing Home Fines

Experts and researchers have maintained for years that federal fines vary tremendously from state to state. This disparity may be an indication that government oversight is lacking in our nation’s nursing homes. Senior abuse and neglect attorneys are concerned that the quality of care in nursing homes is compromised by this lack of oversight.

ProPublica, a non-profit investigative journalism group, recently requested information from federal nursing home inspections and released this information in a comprehensive online database. The information encompasses deficiencies cited by U.S. Centers for Medicare and Medicaid (CMS) regulators and the penalties imposed over the past three years. The tool also allows visitors to use terms and keywords to search nearly 60,000 nursing home inspections for trends and patterns. One of the major issues illuminated in this database are the immense differences between state penalties, and the inconsistency with which these penalties are imposed.

This disparity is evidenced through two case reports of resident deaths, one in Texas and one in South Carolina. In 2012, a resident of a Hughes Springs, Texas nursing home died while choking on a cookie. The man approached the nurses’ station several minutes before he died, obviously choking. The facility staff did not immediately call 911, and attempted but failed to clear the man’s airway numerous times.

Just a few months earlier, a woman in a North Augusta, South Carolina nursing home pulled her breathing tubes out and died of asphyxiation. Federal inspectors faulted the facility for failing to take appropriate measures to keep the woman from injuring herself. Apparently, the women had pulled out the breathing tubes seven additional times in the months before her death.

Government officials found that the Texas home did not have policy and procedures for a medical emergency, and staff was not trained for emergency procedures. Emergency carts were not stocked with proper equipment and were not readily available. The facility remained out of compliance at a pattern of actual harm, with the potential for more than minimal harm. These failures contributed to a delay in emergency intervention that contributed to the resident’s death.

Inspections at the South Carolina facility indicated many of the same deficiencies. Although the woman was made to wear mittens to prevent her from pulling out her breathing tubes, the facility failed to adequately assess her for the effectiveness of those restraints. She was, apparently, able to easily remove the mittens, which she had demonstrated several times in the months before her death. The Attending Physician agreed that there were more interventions that could have been initiated.

In both cases, Medicare and Medicaid Services (CMS) cited the homes for numerous failures that put resident safety in immediate jeopardy. The consequences, however, were severely different. Texas state officials recommended a fine of $9,500 for the incident, to which CMS officials agreed. In the South Carolina facility, state officials determined the home should be fined upwards of $305,000, to which CMS again agreed. This is a difference of hundreds of thousands of dollars, for relatively the same deficiencies that resulted in resident asphyxiation.

These inconsistencies are not uncommon; in Texas, the average nursing home fine is nearly $7,000, while the average fine for South Carolina homes is more than $40,500. State officials are paid by CMS to inspect nursing homes, and the recommendations of these officials are almost always accepted. Federal regulators say they are working to reduce these disparities.

Nursing home abuse and neglect attorneys are concerned that these penalties are preventing facilities from providing quality care to residents. Families of loved ones in nursing homes should be aware of these inconsistencies, as should state officials. Those state officials interviewed by ProPublica, however, unanimously agreed that they were wholly unaware of where they stood in national comparisons. If you or someone you love was the victim of nursing home neglect or abuse, you have important legal rights, and should seek the guidance of a lawyer for a free legal consultation.