Why Such Wide Variation in Scope and Severity Citations Across the US?

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.

In November 2017, ProPublica published a report examining the trend in deficiency citations for long-term care facilities across the country. The interactive map found on the ProPublica website utilized inspection reports from 2014-2017, focusing on the severity of penalties, and concluded that there exists a significant geographical variability in the number of deficiencies and the imposition of Civil Monetary Penalties (CMPs).

The range in the number of significant deficiencies was 1-1272. The states with the greatest number of CMPs include New Mexico followed by Kentucky, Texas, Montana, Arkansas, Kansas, Tennessee, Georgia, South Carolina, and South Dakota.  Of these 10 states, 60% are located in the southern region of the United States. 

The states with the least number of CMPs include New Hampshire, Delaware, North Dakota, Maine, Nevada, Wyoming, Vermont, Virginia, Pennsylvania, and Minnesota.

The table below compares the number of facilities per state with significant Scope and Severity deficiencies (Level I-L):

State      Number of I-J-K-L Deficiencies     Number Facilities    Serious Def/NH

What accounts for the variability between states regarding the number of serious deficiencies? Could the variation be attributed to differences in the inspection process; the education/experience of nursing home personnel; the level of staffing; the degree of corporate support provided to facilities; budget issues; geography or the degree of knowledge to make appropriate interventions to comply with federal regulations? Is the determination of serious violations consistently being applied across state agencies?

Examining the myriad of reasons for the variance in survey data from state to state should be a priority for CMS and the long-term care industry. Being able to compare the delivery of care from facility to facility, across regions and across the country, is necessary in order to ensure that the definitions of quality are being applied appropriately across these settings.  It is also necessary for consumers to have confidence in the inspection process.

Want to respond to this commentary? Join the conversation by sharing your thoughts with the ALTC editors at ALTCEditors@hmpglobal.com