Seeking better care

Our view: Increased nursing home oversight needed

June 02, 2008

In Maryland and across the nation, there's a struggle going on to improve the quality of nursing home care. It's a battle with many fronts, but the outcome is critically important as millions of baby boomers approach retirement age. More than 50 of Maryland's 233 nursing homes have been charged in recent years with significant violations of state and federal health and safety regulations. Regulators and patient advocates say that some of the homes improve their performance, only to be charged again. Other homes have disturbingly large numbers of less-serious violations. Beyond the reported violations, there are concerns about the adequacy of home inspections and nurse staffing levels.

Improving the quality of care in Maryland's nursing homes won't be easy. It's hard to find funding for such efforts when Maryland already spends nearly a billion dollars a year - half provided by the federal government - to provide nursing home care to impoverished Medicaid clients. Fear that Medicaid spending is running out of control has prompted serious cost containment efforts nationally and in Maryland. Medicaid nursing home reimbursement rates are lower than for other payers, which puts economic pressure on facilities with many Medicaid residents.

But the quality of nursing home care can be improved with relatively small investments in resources. For starters, Maryland's Office of Health Care Quality - credited by private advocates for doing a lot with limited resources - needs at least 25 additional inspectors to ensure more oversight that would include audits of the number of nurses on duty. Studies have shown a direct relationship between adequate nurse staffing and improved care.

Last week The Sun reported that two Maryland nursing homes - ManorCare-Rossville in Baltimore County and the Waldorf Center in Charles County - had been placed on a national list of 131 homes that have provided consistently poor care over three years. The decision by the federal Centers for Medicare & Medicaid Services to make the list public on the Internet was a breakthrough. The operators of both nursing homes said they were making improvements - Exhibit A of how spotlighting quality problems can help enhance nursing care.

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