Idaho way behind on inspecting nursing homes, health facilities

BOISE - The state agency responsible for inspecting and certifying Idaho health care facilities, such as hospitals, nursing homes, and assisted living centers, has a huge backlog, including 135 complaints awaiting investigation, state lawmakers learned Tuesday. “We’re barely avoiding financial penalties for our ability to meet all federal performance standards,” Tamara Prisock, administrator of the Division of Licensing and Certification for the state Department of Health and Welfare, told the Joint Finance-Appropriations Committee this morning. The agency is plagued by heavy turnover due to stress and an unmanageable workload, she said. Gov. Butch Otter is recommending a modest budget boost, to add four more health facility surveyors next year in a phased approach. It takes eight months to train a new surveyor, so the division is requesting to hire one immediately, then another as soon as that one’s trained, and so on. Questioned by reporters after her presentation, Priscock said there have been two patient deaths at Idaho assisted living facilities in the past year for which the division has received complaints; at one, in Idaho Falls, where an elderly woman with dementia wandered away from the facility and died, the facility received a serious citation for insufficient supervision. The second case, from the Treasure Valley, still is being investigated. Senate Finance Chairman Dean Cameron, R-Rupert, said the budget request seems reasonable. “I don’t have a better answer for it, so I think that’s the best answer at this point, is better training and add personnel,” he said. Sen. Dan Schmidt, D-Moscow, a physician who serves on JFAC, said he’ll support it. But he said his question is, “Is that enough?” Prisock detailed a backlog of 275 overdue surveys, 135 open complaints awaiting investigation, and 11 facilities waiting for initial licensing or certification surveys. And that doesn’t count the 3,166 regular surveys due in calendar year 2015 or additional complaints that regularly come in, hundreds a year. Turnover has plagued the division, Prisock said, with one worker leaving in 2011, six in 2012, 13 in 2013 and 11 in 2014. For the first three of those years, pay was the main reason the surveyors said they left; after lawmakers approved a pay adjustment last year, the primary reason cited in 2014 was workload and stress. “Pay is no longer the primary reason surveyors leave the division,” Prisock said. “We must do more to address the workload.” The division has 26 health facility surveyors for more than 500 facilities, and eight surveyors for 300 residential assisted living facilities. It has nine surveyors qualified to survey the 2,200 certified family homes; and two to survey 140 developmental disabilities agencies. “Although we continue to struggle with turnover, our productivity has increased,” Prisock told lawmakers. The division currently has five vacancies, and eight of its employees are eligible for retirement in 2015. Rep. Marc Gibbs, R-Grace, the House Appropriations vice-chair, asked Prisock if facilities are being faulted for things like wheelchairs facing the wrong way. “I get complaints that our inspections are much more stringent than in Utah,” he said. She responded, “If we’re talking about Medicare and Medicaid certification, the requirements are the same across the nation.” She said there’s no regulation on which way wheelchairs should face. But she said there could be some variations among states as to their approach. Schmidt said, “I remember looking at this about four years ago – I actually got a call from a facility who couldn’t get licensed. They kept getting delayed.” That involved a firm that wanted to open a skilled nursing facility in his district during the depths of the recession, Schmidt said, and he thought it was unreasonable that state licensing delays would hold up the project. Prisock said the division’s work is prioritized based on patient safety. Some complaints involve life-threatening conditions; in those cases, they’re addressed, and regular licensing surveys are delayed. “Some of the complaints that come in are serious enough that we feel we have to drop everything and get out there,” she said. The issue came up as legislative budget writers entered their second day of a week of budget hearings on divisions of the giant Department of Health and Welfare. Schmidt said, “It’s one of those small parts of Health and Welfare we have to keep our eye on.”