The number of inspectors for Kentucky nursing homes has steadily decreased since 2005, a situation that federal officials have found often leads to underreporting serious problems in nursing homes.
At the same time, the program's budget has been on the rise.
Officials from Kentuckians for Nursing Home Reform, who reported the understaffing last week, said the decline in inspectors is likely to hurt nursing home residents.
"It means the quality of care will slip, said Bernie Vonderheide, founder and president of the nursing home reform group. "Good enforcement is the key to quality care."
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On June 30, 2005, Kentucky had 90 inspectors; two years later, 85. That number dropped to 72 by April 1.
At the same time, the program's budget has gone up each year — from $5.4 million in 2005 to almost $6.7 million in the fiscal year that ends June 30. The funding comes from federal and state government sources.
Mary Begley, inspector general for the state Cabinet for Health and Family Services, which oversees the inspectors, says the lower numbers are a result of staff turnover.
"Turnover is a challenge in the area of state health care licensing, as it is in health care in general," Begley said in a statement. "The Office of Inspector General is competing in hiring nurses with the private sector, which is able to pay nurses signing bonuses and more competitive salaries."
Many of the inspectors are nurses.
Cabinet officials are trying to recruit more inspectors, Beth Fisher, a spokeswoman for the Cabinet, said Wednesday.
Meanwhile, state money that is not being used to pay the salaries, benefits and travel expenses of nursing home inspectors goes to other programs that the inspector general oversees, state officials said.
Fisher said having fewer inspectors has not put nursing home residents in Kentucky at risk.
"Any time a family member, employee or other citizen wishes to report an issue regarding a health care facility that they believe may pose a risk to patient welfare, they are encouraged to report to the inspector general, and the complaint will be investigated," she said.
Vonderheide said the inspectors conduct standard surveys of nursing homes at least every 15 months, and the statewide average interval between surveys must be 12 months or less. The inspectors are responsible for nearly 600 licensed long-term care facilities in Kentucky, including nursing homes and facilities for the mentally disabled. They also inspect adult day health care programs, Fisher said.
In a comparison of the same three-month period in 2006 through 2009, the declining numbers of inspectors did not result in findings of significantly fewer deficiencies in Kentucky nursing homes, according to the Cabinet's numbers.
However, a November 2009 report from the U.S. Government Accountability Office said officials from several states who answered questionnaires said work force shortages and using inspectors with fewer than two years of experience sometimes contributed to underreporting serious nursing home deficiencies.
The GAO report said Kentucky officials who responded to a survey said they did not have enough staff members who could handle the initial training for new inspectors.
State inspectors check facilities to be sure they are in compliance with federal regulations. Federal officials then review the work of the state inspectors.
Another GAO report released Thursday showed that Kentucky inspectors missed about one out of every 10 serious deficiencies later found by federal inspectors. However, that was better than the national average.
"Obviously, you are going to do a better job if you are 100 percent staffed than when you are 80 percent staffed," said Rick Harris, an Alabama Department of Public Health official who has studied the problem of not enough inspectors.
The federal government contracts with states to conduct inspections, and the federal protocols for those inspections assume states are fully staffed, Harris said.
Harris said Alabama is also understaffed. The job isn't attractive to many people, he said, because overnight travel is required. Also, the pay could be 10 percent to 30 percent lower than it would be in the private sector, Harris said.
"It's very difficult to recruit and retain staff because of the working conditions that nursing home surveyors have to endure," he said.