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A new report by the Department of Health and Human Services’ Office of Inspector General (OIG) gives a sober assessment of the state of nursing homes around the country. In 2005, 2006, and 2007, just over 91% of nursing homes surveyed were cited for “deficiencies,” a designation given to facilities that fail to meet one or more federal requirements. For-profit nursing homes were cited more often (94%) than not-for-profit (88%) and government nursing homes (91%), although all the numbers are very high. For-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.

The most common deficiency categories cited all three years were quality of care (73.6% in 2007), resident assessment (58.2%), quality of life (43.3%), and dietary services (42.9%). These same four categories were cited in the OIG’s last report, in 2003, in the same order. “Quality of care” issues include treatment of bedsores and urinary tract infections, and medication errors. “Resident assessment” issues include the use of physical or chemical restraints, abuse, punishment, and involuntary seclusion. “Quality of life” issues include care that enhances dignity and a safe, clean, homelike environment.

The report noted three deficiencies that have been the most common since 2005:

• Around 36% of homes were cited for accident hazards.
• Between 33% and 35% of homes were cited for improper storage, preparation, distribution, or serving of food.
• Almost 28% were cited for failing to provide the care necessary for residents’ “physical, mental, and psychosocial well-being.”

Additionally, 17% of nursing homes—nearly one in five—surveyed in 2007 were cited for deficiencies that caused “actual harm or immediate jeopardy.”

The report contains a breakdown by state, and these numbers varied widely. For 2007, 100% of nursing homes in Alaska, Idaho, Wyoming, and the District of Columbia were cited for deficiencies; in California, 99.1% were cited. States reporting the lowest number of citations were Rhode Island (76.3%, a number that has decreased since 2005), Massachusetts (80.3%, which also has gone down), and Oregon (81.4%, a number that has increased).

Of the 38,147 complaints received, 14,781 of them were “substantiated.”

The New York Times says that more than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are supposed to be inspected once a year and must meet federal standards in order to participate in Medicaid and Medicare.