Federal Watchdog Sounds Alarm Over New York Nursing Homes

Nursing homes in New York state surveyed by a federal watchdog failed to meet new safety and emergency preparedness guidelines that require facilities to take precautions like testing fire alarms and sprinkler systems and training staff on evacuation protocols.

A U.S. Department of Health and Human Services’ Office of Inspector General report released this month found more than 400 deficiencies in emergency preparedness and “life safety” requirements during a survey of 20 nursing homes. The deficiencies put nursing home residents at “increased risk of injury or death during a fire or other emergency,” the report said. 

The facilities all participated in Medicare or Medicaid programs and are required to comply with regulations established by the Centers for Medicare and Medicaid Services. The report faulted the New York Department of Health for failing to ensure that nursing home facilities were compliant with the regulations, which were issued in 2016 and expected to be implemented by November 2017.

“While nursing home management and staff are ultimately responsible for ensuring resident safety, we maintain that the State agency can reduce the risk of resident injury or death by improving its oversight,” the report said. “For example, the State agency could explain CMS requirements for life safety and emergency preparedness to nursing homes by providing standardized life safety training and conducting more frequent comprehensive life safety and emergency preparedness surveys at facilities with a history of multiple high-risk deficiencies.”

None of the 20 facilities were compliant with all of the new regulations and deficiencies cited by the report numbered from a low of 13 to a high of 40 at each nursing home. The facilities were not named in the report, however, the inspector general’s office shared the identities of the facilities and the deficiencies found with the state health department.

Auditors from the inspector general’s office visited the 20 facilities between January and April of 2018 to determine their compliance with the regulations.

The New York Department of Heath disagreed with some of the conclusions and the timing of the report, noting that the audit work began before the November 2017 date that facilities were required to be in compliance. The agency also argued that the report should not be used to draw conclusions about the state’s more than 600 other nursing homes that participate in Medicaid and Medicare because the inspector general report specifically targeted facilities with a history of reported deficiencies.

“The auditors selected the lowest-performing 3% of nursing homes and then projected their findings to the entire state,” said Jill Montag, a New York health department spokeswoman.

The vulnerability of elderly nursing home residents was underscored during recent natural disasters. In California, regulators sought to close nursing home facilities where staff had no emergency evacuation plans and abandoned residents during wildfires in 2018. Twelve nursing home residents died after Hurricane Irma knocked out power to a facility in Florida in 2017 and residents were left inside the sweltering building. Four employees were criminally charged this week in connection with the deaths.

The findings detailed in the inspector general’s report focused on New York, but documents attached to the report indicate the survey was expedited in the wake of the nursing home deaths in Florida.  

Among the findings in the report, 18 of the 20 facilities had deficiencies related to either exits or fire barriers in the buildings. Emergency exits in two buildings could not be opened and exit doors at nine facilities were either blocked or impeded, the report found. The report found deficiencies regarding fire detection and suppression in 19 of the 20 nursing homes, including one home that had an inadequate alternative power supply for its fire alarm and 10 homes where fire sprinkler heads were blocked or obstructed. Two nursing homes were without carbon monoxide detectors.

Regulations require nursing homes to have unobstructed exits, and to have an alternate power supply that can sustain fire alarm systems.

The report noted that frequent turnover of nursing home management made it difficult to ensure staff were trained on life safety requirements.  

The report also assessed nursing home facilities’ emergency plans, which CMS regulations require facilities to have and update annually. Auditors found that one facility did not have an official plan in place and four facilities did not update plans annually as required.

The report made four recommendations for the state:

·      Follow up to ensure corrective action is taken at the 20 nursing homes surveyed.  

·      Develop standardized life safety training for nursing home staff.

·      Conduct frequent safety evaluations at nursing homes with a history of multiple high-risk deficiencies.

·      Instruct all nursing homes to install carbon monoxide detectors.

The state health department is required to survey each nursing home in the state every 16 months. The department is “committed to ensuring the health and safety of nursing homes and has a nation-leading program to respond to natural disasters that impact nursing homes,” Montag said.