(WIVB) — Nursing homes are often under a microscope, but one advocacy group contends the state Department of Health has done a poor job of holding the facilities accountable.

The report by The Long Term Care Community Coalition concluded that New York ranks last overall in citations per resident with one violation for every 50 residents from 2018 through 2020. Turns out, the national citation rate is nearly four times that of New York’s, the report found.

In addition, New York regulators are filing fewer citations deemed to be causing harm or immediate jeopardy to the nursing home residents when compared to most other states.

For example, the report found that only 2% of the state’s citations were deemed to fall under the harm category, which ranked 48^th in the nation. And only 0.4% of the state’s citations were deemed to have caused immediate jeopardy, which ranked 49^th in the nation.

Some argue that less violations should be viewed as a good thing because it might mean the nursing homes are doing a better job than the advocacy group has portrayed in the report.

But Richard Mollot, the executive director of Long Term Care Community Coalition, said that’s not the case because the nursing homes in the state rank poorly on other metrics and the enforcement by the state is not present as much as it should be.

Specifically, the group reviewed federal data on infection control, staffing, rates of antipsychotic drugs that are given to residents and those reported to have had pressure ulcers, that all together paints a concerning picture of New York’s nursing home industry. Mollot said each of those metrics are indicators of safety and well-being of residents in nursing homes but rarely are they reflected in the state’s enforcement practices because of the small number of citations deemed to be an immediate jeopardy or cause harm.

For example, the report found that pressure ulcers are a medical issue for some 9,000 nursing home residents in New York, but nursing homes were cited just 0.4% of the time that a resident had a pressure ulcer, ranking 44^th in the nation.

Pressure ulcers are dangerous wounds that caused death to some residents, yet New York health officials only identified substandard pressure ulcer care as harmful to a resident 14% of the time.

The report also found that of the 22,554 infection control citations, only 3.2% were categorized as causing harm or putting residents in immediate jeopardy.

In addition, the report found that despite rampant understaffing, the state filed only 55 citations for staffing issues, which came out to less than a tenth-of-a-percent of citations annually for every 1,000 residents. That ranked New York 46^th in the nation.

“It’s utterly unacceptable,” Mollot said. “The majority of people who reach my age or older … will need nursing home care, so it affects every single family. But as a consumer advocate, from our perspective, is that people are being harmed, people’s lives are sometimes really being destroyed or just living in horrible conditions for no reason while often someone is making a profit off of that care.”

Senator Sean Ryan, D-Buffalo, said New York’s nursing home problems are well known. He said enforcement at the state level was so bad that he joined Erie County Mark Poloncarz a few years ago to support a change in county law that allowed the local health department to levy fines against nursing home operators. That law, known as “Ruthie’s Law”, was overturned by the court last year.

In addition, state lawmakers last year passed legislation that requires nursing homes to spend 70% of revenue on direct patient care and at least 40% of that on resident staffing. These new rules are on hold by the governor in response to the ongoing Covid-19 pandemic.

“Sometimes it feels as though the Department of Health is the three monkeys, see no evil, hear no evil, speak no evil,” Ryan said. “Like you don’t know what’s going on with them and they want to be willfully ignorant. That’s a real problem.”

But Gov. Kathy Hochul will set the tone, Ryan said, and he has some faith that new leadership at the state Department of Health could lead to improvements at nursing homes across New York.

“The governor is going to put her stamp on the Department of Health, and we hope that part of that stamp will be more aggressive enforcement along with more transparency,” Ryan said.

A spokesman for the state Department of Health said that holding nursing homes accountable for the quality of care they provide is “of the utmost importance.”

“In 2020 through 2021 alone, the Department issued around 4,500 citations – 51 at harm level and 36 immediate jeopardies – resulting in over a million dollars in civil money penalties imposed by the federal government,” the state Department of Health said.

While the state stopped short of criticizing the LTCCC’s report, Stephen Hanse, president and CEO of the New York State Health Facilities Association, did not.

Hanse said the report is “flawed,” and said the state’s regulatory framework for nursing homes is “arguably the strictest in the nation.”

“I would argue that nursing homes after nuclear power are the most-regulated industry in the state of New York,” Hanse said.

Hanse said the analogy he comes up with when looking at the report is blaming police officers for a low crime rate.

But, again, Mollot said the state’s enforcement record does not match the poor job he said some nursing homes performed on other metrics, such as pressure sores and infection control measures.

Mollot said the results of the study indicate that even before the Covid-19 pandemic, federal and state regulators response to serious problems in nursing homes was weak.

Much of the money that flows to nursing homes is Medicaid taxpayer money, Mollot said, therefore state citizens deserve more from their state and federal regulators.

Mollot’s report has numerous recommendations, including that state and federal regulators identify, assess and address patterns at nursing homes with low citations that rarely identify resident harm or immediate jeopardy. The report also asks state regulators to increase the frequency of surveys to one for each facility every six to 12 months.

“We’ve looked at these data before in 2016, we came out with a similar report unfortunately,” Mollot said. “We saw that things didn’t change. But we hoped that things can change in the future. We have a new governor, and we can take this in a new direction if we want to.”