Despite violations, nursing homes receive bonuses

Despite reports showing that 94 percent of nursing homes have been cited for violations, taxpayer-funded bonuses are dispersed to nursing homes throughout the country. The Des Moines Register reviewed 81 bonus programs in 36 states and found that although the nursing homes are not meeting standards, they receive quality of care bonuses and other bonus payments. These bonuses are being approved by the same agency that is disciplining them for violations. Over 60 of these bonus programs are meant to help nursing homes provide proper care, to pay their employees the minimum wage, and provide safe conditions for the residents. Nursing homes that have documented violations, including negligence and abuse, are still getting bonuses.

The Centers for Medicare and Medicaid Services, CMS, says that it does not know the total cost to the taxpayer. CMS does not track any of the payments made to the bonus programs, but does help with funding of the programs. A spokeswoman for CMS, Mary Kahn, said that “the law does not require- and thus the agency cannot require- that Medicaid-funded bonuses be linked to quality of care.” She also stated, “We approve, up front, a state’s plan to pay incentive payments to their nursing facilities through Medicaid, but we do not have the authority to dictate how they determine what those payments are or what criteria they use to make them.”

Of the 81 programs operating in the 36 states, 15 of them are said to be directly related to care. The remaining 66 are meant to provide bonuses for other areas of services such as efficiency. The CMS has proposed a plan for a program based on performance tying federal grants to nursing home compliance with minimum standards of care, but this has yet to be passed.
Legislation has approved continued use of the bonus programs through June 2009.