McCaskill: Missouri lacking in nursing home oversight

ST. LOUIS -- Missouri is doing a poorer job overseeing private nursing homes than it was three years ago, according to an audit released Thursday by State Auditor Claire McCaskill.

McCaskill, speaking at a news conference in St. Louis, said she was discouraged by the new audit, which found a decline in the state's regulation of nursing homes during 2005 despite two previous audits that recommended 32 ways to improve oversight.

"This is probably the most depressing day I have had as state auditor," McCaskill said.

Private nursing homes in the state are inspected by a division of the Missouri Department of Health and Senior Services. No individual facilities were singled out in the audit.

McCaskill said the audit found the division did not conduct 11 percent of its mandated annual inspections. It didn't conduct 40 percent of spot inspections between the larger annual inspections.

The health department has made public for years that it is underfunded and understaffed to complete its mandated inspections, said David Durbin, director for the division of regulation and licensing.

Durbin said the division was given new funding in July that will let it add 48 inspectors to a staff of 200. He said the new inspectors are being recruited and trained.

"When they are trained, we'll have a greater capability in the field to complete those investigations," he said.

Along with being state auditor, McCaskill, a Democrat, is challenging Republican incumbent Sen. Jim Talent in this fall's election.

Talent spokesman Rich Chrismer said the audit was politically motivated.

McCaskill said the most recent audit began in early 2005, before she considered running for Senate.

She said the state auditor has no authority to cut funding to nursing homes, and her role is to produce audits that improve oversight.

McCaskill said oversight of the state's 1,159 licensed nursing homes has declined because of bureaucratic inertia and a lack of funding for the health department's inspection unit: The Section for Long-Term Care Regulation.

The division adopted nine of the 32 recommended changes made in previous audits, McCaskill said. She pointedly criticized the division's quality control unit, which she said was established to address concerns raised in a 2000 audit. That unit conducted no investigations during 2005, she said.

Durbin said the 48 new staff members will free up quality control employees so they can conduct more internal inspections.

McCaskill said she was alarmed that state investigators found more violations in nursing homes when they were accompanied by federal inspectors.

"If the federal inspectors are not with state inspectors, then they're not being as aggressive," McCaskill said.

Durbin disputed that notion. He said more violations are noted when federal employees come along simply because there are more inspectors to look around.