The main reason a family transitions a loved one into a nursing home is to provide that person with around-the-clock care. That means there will always be someone who is just the “push of a call button” away from responding to a resident.
In addition to medical support, nursing homes are also set up to provide nutritious meals, prescribed physical therapy, and socialization opportunities.
According to the Commonwealth of Pennsylvania’s official website, there are over 80,000 residents living in 700 nursing homes across the state. Each of those nursing homes is required to have a certain number of healthcare professionals on staff during the day and night.
There are additional staff who provide general support and administrative services. The standard of care they provide depends on the quality of personnel who work in the facility.
As a family member with a loved one in this type of care, it is important that you understand who oversees nursing homes in Pennsylvania. Understanding the review structure can help you report any concerns you might have with your loved one’s care.
In extreme cases, you might suspect an issue of nursing home abuse. In those situations, you’ll want to discuss what is going on with the proper oversight agencies.
You’ll also want to discuss what is happening with an attorney experienced in these kinds of complaints. They will be in the best position to provide advice on how to proceed.
Shared Regulations
The majority of nursing homes depend on payments from the federal Medicare and Medicaid programs. This is a major part of their funding, and also how many families can afford the care.
When a facility accepts these payments, it agrees to follow a comprehensive set of rules and regulations designed to provide the standard of care each resident is entitled to and safeguard against nursing home abuse. These regulations cover everything from food preparation to the required number of nurses on each shift.
The task of enforcing those regulations is part of the Commonwealth of Pennsylvania Department of Health. Within that department is the state survey agency that follows the guidelines from the Centers for Medicare and Medicaid Services (CMS). That is an agency within the U.S. Department of Health and Human Services that oversees the state agencies to ensure they oversee the nursing homes.
In addition, the Pennsylvania State Survey Agency also checks nursing homes to make sure they follow state regulations. Confusing? It can be, but these agencies have clear mandates that need to be followed.
Enforcing the Regulations
The only way to truly oversee a nursing home is through regular inspections. The Pennsylvania Department of Health dispatches inspectors to examine nursing homes in one of the following scenarios:
- As part of an annual inspection.
- In response to a complaint.
- In response to an adverse incident report, such as a suspicious death under particular circumstances.
There are around 119 inspectors who work throughout the year across the state. Annual inspections are supposed to take place every 12 to 15 months. The nursing homes are not told when the inspectors are going to show up, and they usually spend up to a week at each facility to get a complete picture of the operation.
When an inspector visits because of a specific complaint or adverse event, their focus is narrowed to the issue. For instance, if a complaint concerns cold food, the inspector will examine the food operations and determine an appropriate response.
Depending on what the inspector finds, a nursing home could be issued a citation. That puts the facility on notice that it needs to comply with the particular issue.
Penalties such as fines, bans on new admission, or, in extreme cases, termination from the Medicare and Medicaid programs can be attached to that citation.
Citation Grading
CMS provides the format for grading citations. A rating system assigns points on a scale from A to L, from the least severe to the most severe. For instance, an “A” grade is zero points, while an “L” grade is 150 points and would require a response.
The inspectors work with a Survey Deficiency Chart with two categories: severity and scope. These are the various levels for the categories:
Severity:
- Immediate jeopardy to resident health or safety
- Actual harm that is not in immediate jeopardy
- No actual harm with potential for more than minimal harm that is not immediate jeopardy
- No actual harm with potential for minimal harm
Scope:
- Isolated
- Pattern
- Widespread
What happens if a nursing home gets a citation? After an inspector has conducted their survey and issued the citation, they will share their findings with their CMS office. Those findings will also include a recommendation for immediate action to remedy the situation, fines, or other possible consequences.
It will fall to the CMS to approve, deny, or adjust those recommendations. In most cases, the CMS will side with the state agency representative.
Disputing Citations
Pennsylvania state regulations allow nursing homes to challenge a citation. That can happen with a formal appeal before an administrative law judge.
That can be time-consuming and costly for the nursing home. The facility could opt to challenge the citation with an informal dispute resolution process. In that scenario, the facility can ask the Department of Health for more detailed information about how they came to their conclusions.
At that time, the nursing home could submit documentation to prove it was in compliance with the regulations.
What about the residents and their families? While all this dispute resolution is going on between the facility and the state, there is still the matter of how the residents should be compensated.
The attorneys at Shrager, Sachs, & Blanco have extensive experience with nursing home abuse cases.
We can step in to advocate for the residents before the citation issue is resolved. What is more important is ensuring the safety and well-being of the residents and finding a remedy for any suffering. If you suspect that your loved one is being neglected at their nursing home, it is vital that you share your story.
