Pennsylvania has about 80,000 nursing home residents. Their care is provided by approximately 700 long term care facilities. These residents are among our most vulnerable citizens. They are reliant on the protections provided by government regulation and inspections of the facilities.

Most nursing homes are regulated by both federal and state agencies. In Pennsylvania, the Department of Health (DoH) serves as the “state survey agency” for the federal government to assess whether the homes meet the federal standards. DoH is thus responsible for overseeing and inspecting nursing homes to ensure that the facilities are meeting federal and state standards and complaints are investigated and resolved.

Last year the Pennsylvania Attorney General’s office filed a lawsuit against a nursing home chain alleging in part that due to under-staffing the 25 facility chain had failed to meet the basic needs of its residents.  One result of that still pending lawsuit was a request from the Secretary of Health that the Pennsylvania Auditor General conduct an audit of DoH performance.

That audit report has now been released to the public. The audit covered the period January 1, 2014, through October 31, 2015.

As noted in its Executive summary, the performance audit presents 13 findings, which are focused on three issue areas 1) resident quality of life/care, 2) complaint processing, and 3) sanctions. It also addresses the status of prior audit recommendations from audits conducted in the late 1990s and 2000.

The report offers 23 recommendations to improve how the DoH regulates Pennsylvania’s nursing homes. These results were discussed with DoH representatives and its response is included.

The report notes weak enforcement of staffing requirements as a key problem. Pennsylvania regulations governing nursing homes require that nursing homes provide at least 2.7 hours of direct nursing care, per resident, per day. The Auditor General found that DoH lacked the requisite policies and procedures to guide its staff to ensure that nursing homes met this regulatory requirement.

In his cover letter to Governor Tom Wolf, Auditor General Eugene DePasquale explains that:

Owing to this lack of procedural standardization, when we reviewed a selection of DoH completed nursing home staffing-level reviews, we found practices varied among field offices.  For example, data was frequently self-reported by the facility with little to no supporting  documentation obtained to verify the claimed figures.  Of greater concern, we found instances where nursing homes failed to meet the state’s minimum standard, yet because DoH used an informal practice of averaging time over a week, the deficiency was not cited.  Additionally, we found that despite DoH possessing regulatory authority, which allows it to order an increase to a nursing home’s nurse-staffing levels, DoH has never used that authority.

Our research also indicated that the state’s minimum standard of 2.7 hours of direct nursing care, per resident, per day, might be too low. Pennsylvania set this threshold in 1999, and given the evolution of clinical services provided by nursing homes, this requirement may need to be revised. 

DoH has acknowledged the issues and findings presented in the performance audit, and management will be starting a corrective action plan to implement the report’s recommendations.

Further Reading:

Auditor criticizes Pennsylvania nursing home oversight on staffing, complaints & sanctions