Immediate jeopardy. That’s the bureaucratic term health inspectors use when they cite a nursing home for putting a resident at risk for a big injury or death. And in the past year, 41 citations were issued—that’s nearly twice as many as the year before, when there were 22.

Bonnie Kantor-Burman is director of the Ohio Department of Aging. She says she is concerned about the numbers, but she’s not even sure the yearly number marks an upward trend.

“What we have done is look at it by quarter and it turns out, Bill, that in the last quarter, we only saw two immediate jeopardy citations and that’s a decrease from previous quarters. So it’s unclear to us whether there really is a trend.”

Cohen: “Could you give us some examples of what we’re talking about? Are we talking about a patient being given the wrong medication? Bed rails not being put up on beds, so they might fall out? What are we talking about?”

“We’re talking about falls, talking about bad cases of bed sores; we’re not talking about that which should happen every day as a normal course of business.”

Cohen: “This increase over the past year took place at the same time the state had cut reimbursements to nursing homes. Any cause and effect?”

“I think there’s two things. One, we can’t confirm that there is a real trend. And secondly, we certainly cannot confirm that there is a relationship between what we’re seeing and reimbursement.”

Pete Van Runkle lobbies for about 500 Ohio nursing homes. He calls the number of citations a snapshot in time. That doesn’t necessarily reflect whether a particular facility is giving good overall care.

“An example that I remember form several years ago was a patient who unfortunately, wandered into a cooler. I don’t recall if that he died or just suffered some injury, but obviously that’s a bad thing but the facility was otherwise delivering good care.”

Last year, as Ohio legislators were poised to cut reimbursement levels to nursing homes, for the first time in recent memory, the nursing home industry paid for a barrage of TV ads. They warned if you cut money to nursing homes, they’ll have to cut staffers and the residents’ care will suffer.

Commercial: “You’re cutting doctors. You’re cutting nurses. You’re cutting aides. And you’re cutting vital equipment.”

Assessing the rise in the number of citations over the past year, Van Runkle shies away from drawing a direct link to the cuts in reimbursement levels. But he does hint at an indirect link.

“We’ve reduced what we estimate to be about 7,000 positions, which is about 7 percent. That’s a clear link, and I think there’s no question in anyone’s mind that when you reduce staff, that is going to have an impact on quality. But as far as specific citations, maybe so, maybe not.”

Cohen: “No matter how much money you get from the state and federal government in reimbursements, you have to follow certain rules, certain minimum staffing guidelines: Those are in concrete.”

“Absolutely, yes. There are minimum staffing requirements. The reality is though that over the years, skilled nursing facilities in Ohio typically exceed the minimum requirements oftentimes by a considerable amount. So what we’ve seen is a reduction of staff towards those minimums.

So, next year, when state legislators hammer out a new two-year state budget, expect Van Runkle and nursing home owners to flock to Columbus with a simple message: We need more money.

Click to listen

Other options:

Windows Media / MP3 Download

(0:58)

Let’s say a nursing home doesn’t install simple railings that prevent elderly residents form falling. Or the facilities don’t do preventative measures that help residents avoid bed sores. If failures by the homes involve what’s called immediate jeopardy, they can be cited by inspectors. Over the past year, 41 citations were issued—that’s nearly twice the number of the year before.

Bonnie Kantor-Burman heads the Ohio Department of Aging. She’s concerned, but she adds this may not be a real trend, since during the last quarter, only two citations were issued.

Meanwhile, a nursing home lobbyist notes the industry has cut about 7 percent of its staffer after a state cut on reimbursement levels. Pete Van Runkle says there may not be a direct link between that and the increase in citations, but he says there is an indirect link between state cuts and the level of care for residents.”