More than one-third of federally certified nursing homes were found repeatedly deficient in at least one area affecting patient care during a four-year period, the General Accounting Office reported yesterday.
"Repeated noncompliance with nursing home requirements is widespread," said the report by the investigative arm of Congress.
The biggest problem was found in nursing services, which include everything from treatment and medication to preventing bedsores and injuries.
In addition to a survey of compliance reports on 8,298 nursing homes throughout the country, the GAO studied 26 nursing homes in five states in depth.
Four states -- Arkansas, California, Connecticut and Kansas -- were selected because researchers said they "had a large percentage of their facilities repeatedly fail to comply with selected requirements." Homes in Wisconsin were added for comparison because there were relatively few repeat offenders. No state-by-state compliance records were made available.
The GAO recommended that Congress strengthen enforcement of federal standards that nursing homes are supposed to comply with in order to participate in Medicare and Medicaid.
"The ability to avoid penalty even for serious or repeated noncompliance gives nursing homes little incentives to maintain compliance with federal requirements," the report said.
The Health Care Financing Administration establishes requirements for nursing home participation with health care providers. HCFA spokeswoman Pat Muldrow said the agency could not comment until it reviewed the report.
The GAO found that 3,372, or 41 percent, of the 8,298 nursing homes surveyed failed to comply during three consecutive inspections with at least one of 126 standards deemed by experts as "most important in ensuring resident health and safety." For intermediate-care facilities, the figure was 2,005 of 5,970, or about 34 percent.
The harshest penalty, decertification, was invoked about 300 times against either skilled- or intermediate-care nursing facilities between January 1980 and September 1986, the GAO said.
More than 850 nursing homes, or about 10 percent, were found to be lax in at least one area of nursing services. About 650, or 8 percent, were cited in three or more consecutive inspections because the buildings were not kept clean.