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Troubling state audit of nursing homes calls for immediate top-level action

The State Health Department is encouraging infirmity. So concludes an audit by State Comptroller Thomas P. DiNapoli, which notes that the department’s regulators have been lax in fining nursing homes found to be deficient in patient care and safety.

More troubling, the report says, some of those violations have “escalated into more serious problems with limited consequences.” When regulators don’t do their jobs, people suffer.

Health Commissioner Howard A. Zucker, M.D., and his boss, Gov. Andrew M. Cuomo, need to fix this problem immediately. The safety of nursing home residents, who may have little influence over their environment, is not the kind of thing that can wait.

The audit revealed that under the Cuomo administration, it has taken an average of four years between the time a problem at a nursing home is identified and the assessment of a fine – assuming one is assessed at all. In 2007, by comparison, the time lapse was just six months.

The problem is that the Health Department’s interest in preventing serious problems appears to have waned in favor of punishing serious problems that have already caused harm to a patient. Certainly, those infractions are critical and deserve appropriate attention. But some of those problems evidently occurred after – and very likely because – the Health Department failed to respond to the initial issue.

The reason for this, as DiNapoli pointed out, is that nursing homes, which are complex bureaucracies, lose the incentive to respond quickly when the deterrent factor is lacking. Call it a variation on the broken-windows theory of policing, applied to nursing homes rather than neighborhood crime. If you ignore the “little” problems, they will soon enough make way for big ones.

That’s the path the Health Department appears to have been on for the past five years. DiNapoli’s audit found that fines peaked in 2011, Cuomo’s first year in office, and dropped off sharply after that. That may be coincidental, but even if it is, the problem belongs to Cuomo.

For the sake of the many thousands of New Yorkers who depend upon nursing home care for themselves and their loved ones – and for his own political good – he needs to make sure the Health Department brings this problem under control.

Some improvements have been made, but whether they are sufficient to make a long-term difference is at least questionable. While the Department of Health responded that it has addressed many of the more serious issues, DiNapoli retorted that the “core problems that led to the backlog have not been addressed.” In particular, he said, the agency has done nothing to address a six-month delay that it built into the appeals process for nursing homes. “As a result, there is significant risk that a material backlog could recur,” the audit said.

“It’s great to recognize [a problem] when an audit is underway, when folks are looking. The question is what will be the priority placed on this issue a year from now, two years from now?” DiNapoli asked.

New Yorkers should be able to find out, given that the comptroller said he plans a follow-up audit. That’s wise, given the inflexible nature of bureaucracies. Given the nature of politics, though, and the self-interest that Zucker and especially Cuomo have in ensuring that DiNapoli’s return visit paints a far better picture, it’s fair to expect that action will be forthcoming.

New Yorkers shouldn’t have to worry that the regulators whose critical task is to ensure the safe operation of the state’s nursing homes are asleep on the job.