SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.
The report, released Thursday by the Department of Health and Human Services’ inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.
One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.
Medicare does not pay for true long-term care (LTC) services, but it is now spending about $30 billion per year on skilled nursing facility services for enrollees who are recovering from serious injuries and illnesses and appear to be on the road to recovery.
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By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.
Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people’s health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation’s sweeping health care overhaul.
“These findings raise concerns about what Medicare is paying for,” the report said.
Investigators estimate that in one out of five stays, patients’ health problems weren’t addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient’s use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.
In other cases, residents got therapy they didn’t need, which the report said was in the nursing homes’ financial interest because they would be reimbursed at a higher rate by Medicare.
In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.
The Office of Inspector General’s report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries’ experiences in skilled nursing facilities.