Maryland lags most of the nation in inspecting high-priority nursing home complaints — a problem past administrations have promised to fix, but that continues to vex state health officials — a federal inspector general has found.
The state failed to investigate nearly 650 allegations of harm at Maryland nursing homes within a required 10-day window, meaning the state missed the federal deadline 74 percent of the time, the inspector general for the U.S. Department of Health and Human Services reported.
Maryland ranked 7th worst in the nation for timely investigations of high-level complaints, according to a Baltimore Sun analysis of the report’s data.
The problem of late investigations at Maryland nursing homes has spanned at least four gubernatorial administrations — federal auditors found similar delays in the state in 1999, 2006 and 2011.
Analysts say it’s harder to substantiate complaints, and correct problems, if investigations are not conducted quickly.
“That’s a real problem in terms of addressing some of the priority issues residents are facing in these facilities,” said Lori O. Smetanka, executive director of the Washington-based National Consumer Voice for Quality Long-Term Care. “It’s critical that agencies look at the resources they have available and … do whatever they can to get there in time.”
The inspector general found four states — Maryland, Arizona, New York and Tennessee — accounted for almost half of all of the late high-priority complaint investigations nationwide. In many cases, the inspector general found, investigations took place weeks after the timeline set out in federal regulations.
The Maryland Health Department wrote last year that it takes 47 days — presumably, on average — to initiate an onsite investigation, a delay it attributed to staffing shortages. The state had 232 licensed nursing homes in 2015. The federal inspector general identified 1,164 complaints during that year.
The Maryland department’s Office of Health Care Quality employs 37 surveyors in its nursing home unit. The office has said the unit is a dozen surveyors short of the number needed to meet its inspection requirements. The agency operates on a $20.6 million annual budget.
A spokesman for the department said in a one-sentence statement that the Hogan administration “remains committed to investigating the complaints about nursing homes and other facilities.”
In its annual report last year, the Office of Health Care Quality wrote that it has never “been adequately staffed to complete our mandates.”
Addressing the 10-day deadline, the office wrote that “the length of time to initiate an on-site investigation is directly proportional to the number of trained … nurse surveyors.”
Oversight of nursing homes that receive federal funding falls to the Centers for Medicare & Medicaid Services. The Woodlawn-based federal agency contracts much of its inspection work to the state agencies that license the facilities.
In complaints involving “immediate jeopardy” to a patient, the agency requires investigations within two days. “High-priority” complaints are to be investigated within 10 days.
Maryland categorized less than 1 percent of its total complaints at the “immediate jeopardy” level in 2015. The office conducted all of its onsite reviews for those complaints within the two-day window. Three-fourths of the complaints, or 873, were categorized as “high priority,” the inspector general reported.
The Centers for Medicare & Medicaid Services has put an increasing amount of information about individual nursing homes, including inspection reports, online. But it is not possible to review individual complaints and track how long it took for to trigger an inspection in each instance.
Part of the problem could be an increase in the volume of complaints. The number of nursing home complaints nationwide increased 33 percent from 2011 to 2015, the inspector general reported. But the increase in Maryland was less steep: a 7 percent bump.
Joseph DeMattos, president of the Health Facilities Association of Maryland, said he believes state regulators are “very engaged,” and nursing homes “find that [the state’s] professionals are in centers frequently.”
DeMattos noted that state investigators are required to respond to complaints even in cases where those concerns turn out to be unfounded.
“The latest data in the report is from 2015,” DeMattos said. “I believe the industry, both in Maryland and across the nation, is making strides every day to provide quality care.”
State officials made a similar argument 18 years ago, when what was then known as the U.S. General Accounting Office hit Maryland for investigating only 21 percent of its high-priority complaints within the 10-day window. In one case, the GAO said, the state took 139 days to investigate a case in which a nurse charted a patient’s intravenous fluid as flowing well when the needle, in fact, had been improperly set.
State officials said at the time that the agency had already started "corrective action on several fronts," including the assignment of additional staff.
Kate Ricks is vice chairwoman of the Maryland-based advocacy group Voices for Quality Care. Each time Maryland officials have been confronted with a similar report, she said, they have taken half-measures and not solved underlying problems.
“We have said to them every year, they need more people. They don’t have enough. They’ve never had enough,” Ricks said. “It’s not the staff that is there, it’s just that there’s not enough of them.”