Health Commissioner Cline says low nursing home grade does not reflect progress

OKLAHOMA CITY – Dr. Terry Cline, Commissioner of the Oklahoma Department of Health, has rebutted some conclusions reached by a new national study which gave the state an abysmal rating for nursing care

He contends the quality of nursing home care is slowly improving, and that his agency’s performance is better than in past years.

In an interview with CapitolBeatOK, Cline noted that in 2012, the Health agency (charged with nursing home inspections and monitoring, and many other duties, under state law) managed to complete only 30 percent of “high priority” inspections within ten days. In 2013, after reallocation of some resources internally, the agency was finishing 50 percent of such projects within the 10 day timeframe.

So far in the 2014 cycle (which runs in conjunction with the fiscal year ending September 30), 97 percent of high priority investigations are finished within ten days, Cline said.

Cline said that although the agency welcomes critical analyses, even within in the framework set by Families for Better Care (FBC) — a Florida group that annually gives a ranking of all 50 states and the District of Columbia on nursing home issues — the state health agency is making improvements.

He noted, “Looking at all the measures in this (FBC) document you see that five categories improved, two stayed the same, and one got worse. That’s the overall picture.”

He continued, “Even the one area that got ‘worse’ in the rating is a reflection that we’re doing a better job of getting out there.” That one area was the finding of a seven percent increase (to 98 percent) in the portion of state nursing home facilities with at least one deficiency listed.

Cline commented, “That means we’re finding the problems. We’re doing a much better job of getting out there and doing inspections in a timely fashion. … We want to do well what we do, and we’re making progress.”

He continued, “Our goal is to identify problems or challenges, and correct them. If we were doing fewer inspections and finding fewer deficiencies that would not necessarily be a sign there are fewer problems.”

The Health Department  has increased the number of inspectors in recent years, and data seems to bear out the impact of the increase. In 2012, the agency performed 1,982 investigations and inspections. That number increased to 2,226 in 2013, then to 2,466 thus far in 2014.

The agency and the industry is apparently turning the corner in the raw number of deficiencies, Cline reflected. In 2012, inspectors found a total of 3,671 deficiencies. That number reached 3,989 in 2013, and was at 3,007 so far in 2014, through a few days ago.

Cline told CapitolBeatOK, “What gives me real hope is that the number of findings of ‘immediate jeopardy’ for residents improved.” That number was 90 in 2012, dropping to 77 in 2013 and was at 48 so far in 2014.

Dr. Cline explained, “Let me be clear, every single one is one too many, but you can see the trend line going down. I believe this is because we have more surveyors, more inspections/investigations, better identification of deficiencies, and, ultimately, fewer instances of immediate jeopardy.”

Concerning immediate jeopardy cases, the agency works to get such inspections and recommendations done within two days.

Department of Health inspectors are working with nursing home operators to reduce the use of psychotropic drugs where possible, an objective widely shared in the health care profession.

Cline says he is encouraged to see the work of the Long-term care advisory board, with 27 “stakeholders” involved, which is focused on improving the time between an accusation of wrongdoing or other problems with a nurses’ aide and resolutions, including the aide’s status in the registry for jobs in nursing homes.

Dr. Cline said the agency must, in all investigations, avoid slander and work hard to decrease the time between the start of an investigation and any revision of information posted on the registry.