Over the last five years, the number of serious problems detected in the nation's nursing homes has dropped. After decades of stressing the need to protect vulnerable nursing home residents, that seemed like an overdue bit of good news. It wasn't.

The nonpartisan Government Accountability Office reported last week that nursing home inspectors are missing or overlooking serious safety problems that "cause actual harm or immediate jeopardy to patients."

Even when states are tipped off about abuse and neglect, it often takes weeks or months to start an investigation.

The lack of uniform standards and enforcement from state to state - and even within a state - also was criticized.

Problems that could result in fines or other penalties in one state might not trigger a slap on the wrist in another. Nursing homes must meet state and federal standards; inspectors are paid by both federal and state government.

But in recent years, as tax revenue has fallen, state and federal budgets for nursing home inspections have been cut. Some states have scaled back their plans to conduct more frequent inspections. Congress has compounded the problem by skimping on money to pay for inspections.

As a result, some experienced nursing home inspectors have resigned or been replaced. The result is that an inspection system that was never adequate is now even further strapped, just as the first wave of Baby Boomers reaches retirement age.The federal government - through Medicare, and especially through Medicaid - pays for about two-thirds of the nursing home beds in the country.

States share regulatory authority with the federal government (only the feds can disqualify a nursing home from receiving Medicare and Medicaid money, which is the ultimate sanction, tantamount to closure.) It makes sense for the federal government to spearhead improvements to nursing home inspections.

The Centers for Medicare and Medicaid Services, the federal agency that oversees both programs, must set new rules to require more timely inspections after complaints, then follow through to ensure that deadlines are met. It must also standardize enforcement across the country.

The best way to do that is to increase federal training for inspectors. The agency also must do something about the timing and notice of inspections. Now, unscrupulous nursing home owners who know in advance when inspectors are coming can call in extra staff to make their homes look better than they are.

The GAO report also criticized the quality of information in inspection reports and nursing home violations posted online.

Transparency in government is a beautiful thing; some of the information is useful to families trying to do their due diligence on a home where a loved one is living. But the GAO report found that too much of the online information is inaccurate or outdated. The right mix of effective enforcement and incentives can improve the quality of care at the nation's nursing homes.

If politicians are serious when they talk about the debt we owe our elders, they will find the money and the will to make that happen.

- St. Louis Post-Dispatch