The CMS 2016 Final Rule: More of the Same for Skilled Nursing Facilities

Abstract

Before her death in 2014, 36-year-old Letasha Mims was a resident in six different nursing facilities.^[1]  In the months preceding Letasha's death, she developed a pressure ulcer which was so deep that the tailbone itself became infected, resulting in death.^[2]  When the Illinois Department of Public Health investigated the circumstances surrounding her pressure ulcer development, they concluded that the facility was in compliance with nursing home regulations.^[3]  Letasha Mims is not alone.  A study conducted by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) in 2014, found that 22% of Medicare beneficiaries experienced an adverse outcome during nursing home stays^[4].  Of these incidents, 59% were considered preventable.^[5]  When viewed in light of the notion that nursing homes are supposedly highly regulated^[6], the current regulatory system is broken, evidenced by patient outcomes like Letasha's that are not adequately addressed through regulatory compliance efforts.

[1] Ward, S. (2016). The Human Cost of Doing Business. ABA Journal, 102(8), 52-56,58-61; (pg.1)

[2] Id. at pg. 2.

[3] supra note 1 at pg. 5.

[4] Kapp, M., & Howard, Philip. (2014). Are Nursing Home Regulations Like Cobwebs? The Gerontologist, 54(5), 886-890. (pg. 887)

[5] Government Report: Office of Inspector General Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries, 2014; (pg. 2)

[6] Bowblis, J., & Lucas, R. (2012). The impact of state regulations on nursing home care practices. Journal of Regulatory Economics, 42(1), 52-72. (pg. 53)