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Nursing Home Fines Drop As Trump Administration Heeds Industry Complaints

Do you support the current approach to nursing home fines?

by Kaiser Health News | Updated on 3.15.19

The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents.

The average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Barack Obama’s final year in office, federal records show.

The decrease in fines is one of the starkest examples of how the Trump administration is rolling back Obama’s aggressive regulation of health care services in response to industry prodding.

Encouraged by the nursing home industry, the Trump administration switched from fining nursing homes for each day they were out of compliance — as the Obama administration typically did — to issuing a single fine for two-thirds of infractions, the records show.

That reduces the penalties, giving nursing homes less incentive to fix faulty and dangerous practices before someone gets hurt.

“It’s not changing behavior [at nursing homes] in the way that we want,” said Dr. Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health. “For a small nursing home it could be real money, but for bigger ones it’s more likely a rounding error.”

Since Trump took office, the administration has heeded multiple nursing home complaints about zealous oversight. It granted facilities an 18-month moratorium from being penalized for violating eight new health and safety rules. It also revoked an Obama-era rule barring homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than go to court.

The slide in fines occurred even as the Centers for Medicare & Medicaid Services issued financial penalties 28 percent more frequently than it did under Obama. That’s due to a policy begun near the end of Obama’s term that required regulators to punish a facility every time a resident was harmed, instead of leaving it to their discretion.

While that policy increased the number of smaller fines, larger fines became less common. The total amount collected under Trump fell by 10 percent compared with the total in Obama’s final year, from $127 million under Obama to $114 million under Trump. (KHN compared penalties during 2016, Obama’s last year in office, with penalties under Trump from April 2017 through March 2018, the most recent month for which federal officials say data is reliably complete.)

CMS said it has revised multiple rules governing fines under both administrations to make its punishments fairer, more consistent and better tailored to prod homes to improve care. “We are continuing to analyze the impact of these combined events to determine if other actions are necessary,” CMS said in a statement.

The move is broadly consistent with the Trump administration’s other industry-friendly policies in the health care sector. For instance, the administration has expanded the role of short-term insurance policies that don’t cover all types of services, given states more leeway to change their Medicaid programs and urged Congress to allow physicians to open their own hospitals.

Beth Martino, a spokeswoman for the American Health Care Association, a nursing home trade group, said the federal government has “returned to a method of applying fines in a way that incentivizes solving problems” rather than penalizing “facilities that are trying to do the right thing.”

Penalty guidelines were toughened in 2014, when the Obama administration instructed officials to favor daily fines. By 2016, those were used in two-thirds of cases. Those fines averaged $61,000.

When Trump took over, the nursing home industry complained that fines had spun “out of control” and become disproportionate to the deficiencies. “We have seen a dramatic increase in [fines] being retroactively issued and used as a punishment,” Mark Parkinson, president of the nursing home group, wrote in March 2017.

CMS agreed that daily fines sometimes resulted in punishments that were determined by the random timing of an inspection rather than the severity of the infraction. If inspectors visited a home in April, for instance, and discovered an improper practice had started in February, the accumulated daily fines would be twice as much as if the inspectors had come in March.

But switching to a preference for per-instance fines means much lower penalties, since fines are capped at $21,393 whether they are levied per instance or per day. Homes that pay without contesting the fine receive a 35 percent discount, meaning they currently pay at most $13,905.

Those maximums apply even to homes found to have committed the most serious level of violations, which are known as immediate jeopardy because the home’s practices place residents at imminent risk of harm. For instance, a Mississippi nursing home was fined $13,627 after it ran out of medications because it had been relying on a pharmacy 373 miles away, in Atlanta. CMS also reduced $54,600 in daily fines to a single fine of $20,965 for a New Mexico home where workers hadn’t been properly disinfecting equipment to prevent infectious diseases from spreading.

On average, per-instance fines under Trump were below $9,000, records show.

“These are multimillion businesses — $9,000 is nothing,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, a nonprofit in Washington.

Big daily fines, averaging $68,080, are still issued when a home hasn’t corrected a violation after being cited. But even in those cases, CMS officials are allowed to make exceptions and issue a single fine if the home has no history of substantial violations.

The agency cautioned that comparisons of average fines is misleading because the overall number of inspections resulting in fines increased under Trump, from 3.5 percent in 2016 to 4.7 percent. The circumstances now warranting fines that weren’t issued before tend to draw penalties on the lower side.

However, KHN found that financial penalties for immediate jeopardies were issued in fewer cases under Trump. And when they were issued, the fines averaged 18 percent less than they did in 2016.

The frequency of immediate-jeopardy fines may further decrease. CMS told inspectors in June that they were no longer required to fine facilities unless immediate-jeopardy violations resulted in “serious injury, harm, impairment or death.” Regulators still must take some action, but that could be ordering the home to arrange training from an outside group or mandating specific changes to the way the home operates.

Barbara Gay, vice president of public policy communications at LeadingAge — an association of nonprofit organizations that provide elder services, including nursing homes — said that, under Trump, nursing homes “don’t feel they’ve been given a reprieve.”

But consumer advocates say penalties have reverted to levels too low to be effective. “Fines need to be large enough to change facility behavior,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, a nonprofit based in Washington. “When that’s not the case and the fine is inconsequential, care generally doesn’t improve.”

This story is part of a partnership that includes NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Kaiser Health News

Written by Kaiser Health News

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(101)
  • Chickie
    Voted Oppose
    03/17/2019
    ···

    #45’s and his administration continues to favor big business ~ no matter the potential harm to senior citizen Americans. Perhaps the industry should just push the elderly in wheelchairs off cliffs? No worries about potential fines as they have an infinite number of funds to pay. #45 continues to solidify his plan of keeping the poor, people of color who are a part of the Working poor, and now our senior citizens, downtrodden, so the will to fight injustice is depleted. This way, #45’s corruptness can continue without reprimand or oversight.

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  • Colleen
    03/17/2019
    ···

    My father in law was in a nursing home in buffalo that was owned by the hospital. the hospital put him in there and kept him there with every excuse they could. Hegot no care. Had no control of his bladder. The only time he was cleaned up was when we came in every day. Whe he crapped over his bathroom and after asking 4 time to get it cleaned I was told it was already cleaned do the day. Fortunately he is out of there. They have received fine upon fine but they get 18 grand a month from private pay so a fine is peanuts. While he was there an article was in the paper about this home and many of them have the same complaints. They not only need to be fined to th max, some need to be shut down

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  • Jim2423
    Voted Support
    03/17/2019
    ···

    The Feds pay out in Medicare and Medicaid. The Nursing homes are located within state, county, and city limits. The reduction in fines stands to reason from a Federal level. What are States, counties or cities doing to monitor nursing homes. What fines are these elements doing to protect their elderly citizens? I am amazed at the number of Americans want the federal government to hold their hands. Take an active role Wilton your community to ensure senior safety. One hour a week is all it takes. When these home are “Watched” by it’s local citizens, things will change. The feds can only do so much, States can only do so much, cities can only do so much. It takes US the citizen to make America Great, not government.

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  • Ken
    Voted Oppose
    03/17/2019
    ···

    It’s too bad we live in a world that says it’s ok to break the rules ,taking human dignity away from many that don’t have the strength or finances to fight back. If an institution such as a senior living complex can’t treat people with some sort of dignity and respect a stiff fine should be the least of the penalty.

    Like (24)
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  • J
    Voted Support
    03/17/2019
    ···

    The information provided does not necessarily suggest the new approach is less effective. Arguably, the old approach was ineffective and caused worse circumstances to occur with fines not being uniform or in accordance with the degree of infraction - money that could be better spent by the institution in securing adequate improvements. Once again, we have a dissemination if information, arguably biased, because it does not include sufficient detail for anyone to adequately conclude what is the best approach.

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  • Jackie
    03/18/2019
    ···

    So this is another example of Trump favoring profit over well being of some of our most vulnerable citizen's. AS former nursing home administrator I can tell you we need more oversight and larger fines.

    Like (2)
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  • OlderNWiser
    Voted Oppose
    03/17/2019
    ···

    And so the corporatocracy rules while taking care of each other ends. If a country is to be judged by how it treats its children, its elders, and it’s minorities, then we are a massive failure. Imagine yourself after a lifetime of being active, helping others, working hard, raising a family, old enough that your family and friends have largely passed away. Then imagine yourself helpless in a nursing home. Without oversight, it is all too easy for abuses and neglects to make our last months or years of life a horror story. We are better than this.

    Like (19)
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  • J. scott
    Voted Oppose
    03/17/2019
    ···

    I am against this practice and I ask my representatives to introduce legislation that will stop this abhorrent practice. Meanwhile, to we the people, we must understand that reelecting a predatory capitalist like Trump can only result in more of the same, his first two years are only the tip of the iceberg — vote him out in 2020. He literally reneges or lies on all his promises or lies about completing them such as his infernal wall. Just remember in November 2020.

    Like (17)
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  • NorthTexas
    Voted Oppose
    03/17/2019
    ···

    We all know that there are too many nursing homes that are little more than a place to leave elderly people to die. Too many of them are poorly run and some of them are downright abusive. They costs are only going up and most of the time that increased money isn’t going to the care or the caregivers it’s going to middle and upper management who just pocket it. Don’t let facilities that aren’t even doing the bare minimum get away with it.

    Like (14)
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  • Linda
    Voted Oppose
    03/17/2019
    ···

    I work in a large hospital on a progressive care unit. If I could have a nickel for each patient that comes to us for nursing home acquired sepsis, I’d be living large now. Very large. Most of the patients that are coming to our unit from nursing homes have pressure wounds large enough to put my fist through. Some are so severe the patients need surgery just to debride the wound. We have patients that come in with UTIs severe enough to require strong IV only antibiotics. This is totally UNACCEPTABLE. When a family places their loved one in a skilled nursing facility, there should be no reason to worry whether or not they are being taken care of. I understand that there are times when the person does get sick and require hospitalization. But things like pressure wounds are preventable. A UTI should not progress to the point of hospitalization. There should be no reason why a patient should get septic at their facility from a different problem. Nursing homes needs to be held accountable for the care they give. Keep patient areas clean. Wash hands and wear gloves when handling patients. It’s not a hard concept. And when a patient complains they are not feeling well, listen. An ounce of prevention is worth a pound of cure later.

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  • KansasTamale
    Voted Oppose
    03/17/2019
    ···

    There are abuses in the nursing home industry that are never get reported because the residents have no family advocates or their family are oblivious of the abuses. These people should be venerated not treated like cattle. So to lessen or do away with fines on nursing homes who abuse & are reported is unconscionable. Trump takes the corporations sides over the people of this country. The fallout from this stance has begun to raise its ugly head in deaths.

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  • Andrea
    Voted Oppose
    03/17/2019
    ···

    The way we treat the elderly and infirm says a lot about this country and this particular administration. Proposed cuts to Medicare, Medicaid, and Social Security, coupled with reduced fines for non-compliant facilities, will only hurt our nation's seniors. Nobody should work their whole adult life only to retire destitute, in an abusive hellhole. Is this the quality of life we want for our parents and grandparents ... and for ourselves?

    Like (11)
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  • Dave
    Voted Oppose
    03/17/2019
    ···

    That reduces the penalties, giving nursing homes less incentive to fix faulty and dangerous practices before someone gets hurt. At some time you, young and old, may end up in a nursing home. The abuse in nursing has been shown to be done. The only way you or your family member might be safe is if some one in the family show up at all odd times, day and night! They are like any industry, what ever they can get alway with! Another hand slap.

    Like (11)
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  • Cassandra
    Voted Oppose
    03/17/2019
    ···

    Healthcare in this country is like everything else. It's about making money not caring for patients. Huge fines hit capitalists the only place they care about. The pocketbook.

    Like (11)
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  • I.Got.an.Idea...
    Voted Oppose
    03/17/2019
    ···

    Examples of how Republicans are building an America that is FUBU, in which For Us By Us, is Corporations and Conservatives. Republicans will continue to abuse Consumers, patients, Citizens for profits and will say if you want to settle any injustices committed against you by corrupt businesses, then you will have to come up with $100’s of thousands of dollars to fight our attorneys, and wait 3-6 years, if you ever want to see a dime from our business killing your Mom in our corrupt nursing home. Conservatives - Harming, diseasing and killing innocent Americans for profit and greed. This is the Conservative’s “AMERICAN DREAM”.

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  • Phillip
    Voted Oppose
    03/17/2019
    ···

    It’s the same old thing. Once you’re a burden on society the GOP figure there’s no profit in keeping you alive

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  • samiam6
    Voted Oppose
    03/17/2019
    ···

    Trump and the GOP take the side of big money and against the American people every time. You'd have to be suicidal to vote Republican.

    Like (9)
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  • Linda
    Voted Oppose
    03/16/2019
    ···

    When you lower the fines, you are telling the homes ,that it's ok to not take care of patients,. A crime.

    Like (8)
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  • Glowurm
    Voted Oppose
    03/17/2019
    ···

    I am appalled and disgusted to hear this. Thank you, Linda, for bringing this to our attention. Good ones Chickie and Dave. Anna and doingmypart, I am still having trouble seeing a lot of your comments. Bummer! 😢 The Idiot keeps ignoring the basic needs people have in order to keep the wealthy rich. He is such a piece of 💩. He allows oil and mining interests to poison our land, oceans and other waterways. He allows them to pollute our air. He denies climate change. All in the name of greed. How can you people not see that HE MUST GO? God, you people just keep ignoring his lies and destruction. When will you stop? Please, before it’s too late...

    Like (8)
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  • Sandra
    Voted Oppose
    03/17/2019
    ···

    "Pro Life"......my Irish hiney!

    Like (8)
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  • Nancy
    Voted Oppose
    03/17/2019
    ···

    Medicare and medicaid coverage is under constant attack . Prescription medications are soaring out of control. Nursing homes are under less scrutiny. This is about favoring industries who profit off of the elderly and the sick. It's not about supporting them in their individual crisis or end of life. Why aren't people more important than the profit line of a corporation?

    Like (7)
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  • Kristen
    Voted Oppose
    03/17/2019
    ···

    Everything Trump touches turns to shit or dies. Less fines because there are less regulations is a worthless policy and fools no one.

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  • ChangeIT
    Voted Oppose
    03/17/2019
    ···

    I should not be surprised that they are doing this. He is NOT for the people and all he does is cater to big businesses. One day his fat bit is going to be old and need help, wait he already is a fat fart! Never mind, carry on!

    Like (7)
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