by James C. Sherlock
Either the title of this article or “the facility failed” is stock language used in every summary of a citation for a nursing home’s violation of federal regulation. It is the truth, but not the whole truth.
Inspectors come to a nursing home in Virginia once every couple of years. The staff of each chain-owned nursing home is instructed on what to do and how to do it and is closely monitored year-round by the chain’s regional operations and nursing representatives.
So, a change in the language seems appropriate.
Perhaps write “the management and staff of chain xxx, and the staff of the facility failed …” for each citation. That is the full truth and would enable both the Centers for Medicare & Medicaid Services (CMS) and state oversight authorities to track chain performance through a new metric.
The author, with a high tolerance for boredom, reads journalist reports and academic and government studies on the effects of ownership structures on the quality of care in nursing homes. Many make a great deal out of small differences. He decided to examine that topic in Virginia.
The differences here are stunning in their scale and consistency.
Consider some of the facts.
Ownership Structures
Virginia has 289 nursing home operating companies certified for Medicare and Medicaid, for Medicare alone or Medicaid alone. Of those, an assessment of ownership records reveals:
- 171 facilities owned by private equity;
- 60 by 501(c)(3)s;
- 23 by corporations;
- 14 by individuals;
- 12 by partnerships; and
- 9 by state or local governments.
CMS provides a Survey Summary database as a baseline to assess compliance with federal nursing home regulations. To that is added for this discussion:
- the names of the chains. Chains control all of the private equity facilities.
- The current staffing ratings and occupancy rates offer context for chain business models.
The chart below shows the chains with the highest average number of health violations per facility in the current inspection cycle.
