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Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment and abuse of patients. As a result, some nursing homes go in and out of compliance with federal standards. Those nursing homes pose a continued threat to the health and safety of patients.

“Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued this week by the Government Accountability Office, an investigative arm of Congress. The Department of Health and Human Services “fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Congress established strict rules for nursing homes in 1987. However, since then little seems to have changed at the worst-performing homes. The Bush administration rarely uses its authority to deny payment to homes with a history of compliance problems. A nursing home in Michigan was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

Congress is likely to use the report to create new legislation requiring stiffer penalties for the most serious violations. Administration officials agreed that higher fines were appropriate in some cases.

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