When one of the 29 inspectors of the Service Facility Regulation Administration arrives at a children's day-care center or another of the 1,255 facilities that the agency examines each year, the inspector is well-armed with paper.
Under D.C. law, most facilities must comply with 62 pages of rules covering everything from quantity of food served to the background of employes. If the facility receives federal money, inspectors carry another 69-page form to certify it for Medicare or Medicaid.
The forms are a maze of check-offs that are incomprehensible to the layman and do not address the question of the overall quality of care. But inspectors, the foot soldiers in the war against poor care and resident abuse, cannot deviate from the forms.
Inspectors may be the only outside observers some residents have, but there is little personal contact. Instead, inspection hours are spent examining a sample of patient records, contracts with suppliers, resumes and time sheets. No independent checks are made. Inspectors say they have to rely on the homes to provide accurate records.
City inspectors earn between $21,299 and $30,888 and work in teams that usually include a nurse, pharmacist, sanitarian and physical therapist. Four city fire inspectors check safety codes.
The federal inspection system, which, like the District's system, relies heavily on paperwork and check-offs, has come under fire for failing to judge adequately the quality of care. Last year a federal appeals court in Colorado ordered health officials to devise a new system that shows whether the government's nursing home dollars buy good medical care. The decision has been appealed to the U.S. Supreme Court.
Despite flaws, inspections form the basic document that the public has to judge a facility's quality. But citizens have had to file written requests with a federal office in Philadelphia and then pay for copies of D.C. inspection reports. Frances Bowie, the city's licensing chief, said she will now release the reports.