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B. NURSING HOME SURVEYSUnder the current statutory system, the Health Care Financing Administration (HCFA) contracts with state agencies to inspect nursing homes for compliance.(27) Federal officials then randomly reinspect at least five percent of the homes to verify the state surveys.(28) NHRA produced dramatic effects.(29) By 1996, the regulations had cut the use of physical restraints on nursing home residents in half; incidences of dehydration also decreased by fifty percent.(30) Despite these promising results, subsequent reports found many disturbing conditions.(31) Approximately forty percent of all HCFA-certified facilities repeatedly violated federal standards over the past four surveys, including critical aspects of patient care.(32) "[A] quarter of the nation''s nursing homes failed even to assess each patient''s needs or develop individual care plans"(33) and, at the time, "government data show[ed] more than 2/3 of [the nation''s] nursing homes d[id] not fully comply with federal standards."(34) Explanations for the survey results ranged from the "federal inspection guidelines were less than rigorous and enforcement had little teeth ... [because] ... the only fines were minimal("35) claims that the inspection process was too subjective. The primary federal remedy, to deny payment for new admissions after three months of noncompliance,(36) apparently did not suffice to reform the quality of nursing home care.(37)

In addition to using the federal Medicare comparison information, Janelle Carter of the Associated Press offers other suggestions for choosing a nursing home. Consumers should ask nursing home residents and families, community advocacy groups, personal physicians, and clergy about area facilities. She also recommends that consumers visit several nursing homes at varying times of day and on weekends, when staff and services may be less. Each state is also supposed to have a long-term care ombudsman''s office, which acts as an advocate for those in assisted living or nursing homes. The ombudsman may have information about problems with individual facilities. The National Citizen''s Coalition for Nursing Home Reform (www.nursinghomeaction.com or 202-332-2275) tells how to contact the state ombudsman and provides guidance on choosing a facility as well as how to ensure quality care.

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