New and Noteworthy from The Gothamist, original article by Karen Yi
According to a new report by New Jersey's state comptroller, 15 nursing homes continuously obtain low health inspection ratings but still receive roughly $100 million in Medicaid funds each year.
Poor performers should not be rewarded if they do not improve, according to the state watchdog's study, which also recommends progressive steps to drive improvements, such as prohibiting repeatedly low-ranking hospitals from receiving extra public funds.
“Bottom line: New Jersey taxpayers should not be funding nursing homes that have failed to improve for years, appear unlikely to improve, and put residents in harm’s way,” Acting Comptroller Kevin Walsh said in a statement.
The comptroller's office looked at New Jersey's 339 nursing homes and discovered that 15 of them received the lowest grade on a national grading system for long-term care institutions for the majority of the quarters in 2020 and 2021. Nursing facilities are rated on a scale of one to five stars, with one being the lowest, according to government rules established by the Centers for Medicare & Medicaid Services in the wake of the COVID outbreak.
“These are facilities that year over year performed poorly in some very critical areas, specifically staffing shortages and the amount of nursing hours that are available,” said Laurie Facciarossa Brewer, the state’s long-term care ombudsperson, who consulted with the comptroller’s office on the report.
“It would appear that there doesn't seem to be an effort by those facilities to improve. It almost seems as if a one-star rating is basically baked in as the cost of doing business,” she said.
During unannounced visits, state inspectors score residents' quality of care, medication management, nursing home administration, and food services over multiple days. In the most recent quarter, one out of every 14 nursing homes in the state received a one-star rating, according to the report.
“It's not the minor stuff that gets you a one-star rating. It's having multiple deficiencies over time in a wide array of areas,” Brewer said.
The report also found that 14 of the 15 lowest performing nursing homes, or 93%, are run by for-profit companies — statewide, 77% of the facilities are run by for-profits.
“They're making a profit off of the one-star facilities all while taxpayers are paying for one-star care,” Walsh said.
According to the report, the 15 low performers received more than $300 million in Medicaid funding between 2017-2019. And many have scored poorly since 2013, the data shows.
The comptroller's office is recommending that the state impose a variety of restrictions on problematic nursing homes, ranging from a warning to prohibiting the facility from taking new patients and, finally, withdrawing Medicaid funds. One of the issues raised in the report is that the state entity in charge of residential care is not the same as the one that distributes the funds.
The state's Medicaid program is overseen by the Division of Medical Assistance and Health Services, which is part of the Department of Human Services, although health inspections and evaluations are handled by the Department of Health.
“The agencies need to work together in order to ensure that the residents' interests and the Medicaid dollars that the state spends are all protected,” Walsh said. He said New Jersey would be the first state to withhold Medicaid dollars from low-rated nursing homes if it decides to accept the recommendation.
According to state data, nursing facilities have been under increasing scrutiny in the last two years after the epidemic sickened and killed over 8,000 residents and 148 staff. The recommendations in the report, according to Brewer, will complement broader reforms currently underway.
Last year, Gov. Phil Murphy signed legislation ensuring minimum staffing levels, raising compensation for direct care workers, and requiring the use of 90 percent of Medicaid funding for direct patient care.
A dashboard of the 15 worst-performing facilities has also been issued by the comptroller's office. Burlington County is home to four of the fifteen. If the state follows the report's recommendations, which could limit the number of patients in these institutions, residents' access to long-term care may be limited.
“It underscores how very difficult it is when you're talking about people's health care,” Brewer said. “Everybody involved has to be really, really mindful of the fact that regardless of how bad the place is, it is where somebody lives.”
DHS spokesman Tom Hester said the department was reviewing the comptroller's recommendations to determine next steps.
"Delivering safe and high quality health care coverage and spending resources effectively is at the core of Medicaid’s mission, and we will continue to work with partners across state and federal government to ensure the best possible care for residents at New Jersey’s long term care facilities," he said in a written statement.
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Gothamist Article:
https://gothamist.com/news/nj-watchdog-says-state-should-bar-poorly-rated-nursing-homes-medicaid