Despite the stringent federal regulation of long-term care facilities, nursing home abuse remains rampant throughout the United States. One of the most cited reasons for this trend has been inefficiency in the enforcement of the federal quality care standards. Studies by the United States General Accounting Office ("GAO") and other government entities have identified several problems, including the frequency with which state inspectors miss important violations during annual surveys. To address this concern, federal inspectors conduct random follow-up inspections of nursing homes after state inspections have been completed. According to a GAO study, federal inspectors report more serious violations than the state inspectors in sixty-nine percent of these circumstances. Although federal law requires that facilities not be given notice prior to their standard survey, the GAO has observed that homes can often predict when their annual on-site surveys will occur and can, therefore, take steps to mask problems otherwise observable during normal operations.
Additionally, where nursing homes are sanctioned for noncompliance, the GAO has noted that nursing homes are only temporarily induced to take action toward correcting the deficiencies. Most homes do conform to regulation at least briefly, to avoid fines or other sanctions, but many do not maintain this status of compliance. In fact, violations often reoccur before the facility's next survey or follow-up inspection. (Kelly Greene 2001) This "yo-yo pattern" of compliance and noncompliance persists even among homes facing the most severe sanctions, such as termination from the Medicare program.
According to a study by the U.S. General Accounting Office, thirty percent of the nation's 17,000 nursing homes have been cited in recent years for abuse violations. Nursing Homes: Many Shortcomings Exist in Efforts to Protect Residents from Abuse: Hearing Before the U.S. S. Special Comm. on the Aging, 107th Cong. 1 [hereinafter Hearings on the Aging] (statement of Leslie G. Aronovotz, Director, Health Care--Program................
