'No swim' advisory near Naples Pier has been lifted
SPECIAL REPORTS

Feds: FL inspectors didn't ensure hundreds of problems at nursing homes corrected

The Florida agency responsible for overseeing nursing homes failed to ensure that owners corrected hundreds of problems that put patients at risk, according to a federal audit.

The results underscore USA TODAY NETWORK – FLORIDA findings, published in February, that Florida’s Agency for Health Care Administration allows nursing homes with long histories of providing poor care to continue operating. 

Rehabilitation Center at Hollywood Hills

The network's February report found that the AHCA, which licenses and regulates nursing homes, rarely uses the toughest sanctions at its disposal and typically fines nursing homes with violations an average of only a few thousand dollars.

The analysis showed dozens of Florida nursing homes repeatedly scored poorly in inspections with frequent violations for nearly five years, yet they continued operating with little risk that regulators would shut them down.

Neglected:Florida's worst nursing homes left open despite history of poor care, deaths

The U.S. Department of Health and Human Service’s Office of Inspector General audit, published in April, shed some light on that problem. The audit found that the AHCA wasn't even verifying that nursing homes corrected problems after state inspectors cited them.

The audit, first reported by Politico Florida, was one in a series of reviews of state nursing home agencies across the country.

As part of the Florida audit, the inspector general reviewed a sample of 100 of the 2,381 nursing home deficiencies cited by the AHCA in 2015 that required the agency to verify a correction.

The AHCA failed to obtain or retain evidence that nursing homes corrected problems for 18 of the 100 sampled deficiencies cited by state surveyors, the report says. Instead, it relied on facilities to self report that problems were corrected, but it did not always require any evidence to back up the claims.

The report estimates that in 455 cases cited by AHCA in 2015, the agency failed to obtain evidence from the nursing homes that they had corrected the problems. In an additional 130 cases, the report estimates, AHCA could not provide sufficient evidence that it had verified that the homes took corrective actions.

"Without verification of evidence of correction, the state agency cannot ensure ... that residents are adequately protected," the report states.

The report cites as an example a February 2015 survey of a nursing home where staff failed to accurately assess a resident needing oxygen. The following month, the home’s corrective plan states that nursing staff had been trained about the issue.

“However, the state agency was unable to provide us with any evidence of correction to show that the corrections had actually taken place,” the report says. “There was no indication that the resident’s oxygen was corrected and there were no interview notes with nursing staff that attended the training.”

"To know that they're not going back and verifying corrections shouldn't be a shocker," said Brian Lee, former head of Florida's Long-Term Care Ombudsman program in the Department of Elder Affairs.

Nursing homes' self reports have been shown over the years to be unreliable, said Lee, who now heads the nonprofit Families for Better Care.

"When is it that the regulatory agencies are going to realize we can't rely on the credibility of self reported information?"

AHCA leaders took issue with the federal government’s conclusions stating regulations didn’t require inspectors to verify compliance for lower-level violations. The AHCA conceded, however, that it will change compliance verification procedures “going forward” to match the federal government's interpretation of the compliance regulations. 

“The findings involve a small number of isolated incidents in 2015 at nursing facilities that did not involve patient harm,” AHCA spokeswoman Mallory McManus said in an email. 

Low-level deficiencies not involving patient harm can be an indicator of a troubled facility, Lee said. He cited the example of the tragedy at the Rehabilitation Center at Hollywood Hills, where 12 people died after the air-conditioning system failed during Hurricane Irma in September. 

The facility had a history of low-level violations, none of which rose to the level of patient harm, Lee said.