NURSING HOMES: Clinton Announces Closer Watch
President Clinton yesterday called for stepped-up surveillance of the nation's 17,000 nursing homes, an effort intended to crack down on abuses in the system that government and health officials fear are jeopardizing the health of elderly patients. Background checks on nursing home workers, improved inspections and better state enforcement of regulations are among the executive actions and legislative proposals Clinton announced. The president has pushed for changes in the nursing home industry for several years, and already has tightened federal regulations despite Republican resistance. But improving the nursing home system is more than a political fight; the federal government pours $30 billion into nursing homes each year through its health insurance programs, giving it a huge financial interest in upping the quality of nursing home care (Goldstein, Washington Post, 7/22). "When people living in nursing homes have as much fear from dehydration and poor nutrition as they do from the diseases of old age ... then we are failing our parents and we must do more," Clinton said (AP/Baltimore Sun, 7/22).
'Explosive' Report On The Way
Clinton's call for a tougher regulation of nursing homes follows a similar plea for better oversight from Sen. Chuck Grassley (R-IA). His Special Committee on Aging will hold hearings next week to introduce an "explosive" General Accounting Office report that documents poor care in California nursing homes (Page, USA Today, 7/22). While centered on California homes, the report is expected to send shockwaves through the industry, which cares for almost 1.6 million people nationwide (Sward, San Francisco Chronicle, 7/22).
The Admin.'s Plan
Clinton announced yesterday that nursing home inspections will be held more randomly than they are now, a move officials hope will curtail the predictability of the checks. "[T]he way some states have designed their systems, they inspect every year but they tend not to vary the time or the date every year," Health and Human Services Secretary Donna Shalala said at yesterday's White House announcement. "So what we have said is you've got to do it on weekends, you've got to do it in the evenings, and you've got to have a much more random system so people are genuinely surprised," she added (White House transcript, 7/21). The government also will step up financial penalties to nursing homes that fail inspections, putting more pressure on facilities that previously were given a chance to correct the problems before being slapped with a fine. "[W]henever we find evidence that a nursing home is failing to provide its residents with proper care or even mistreating them, we will fine that facility on the spot," Clinton said (Pear, New York Times, 7/22).
State enforcement agencies will find themselves under the federal government's watchful eye as well: Clinton said agencies that are not adequately monitoring nursing homes will lose their contracts to continue inspections. Shalala said some states -- New York, Arizona and Tennessee among them -- have cited an suspiciously low number of facilities for noncompliance, leading officials to wonder if inspections in those states are up to par (Berger, Chicago Tribune, 7/22). Clinton asked Congress to establish a national registry of nursing home workers and to require criminal background checks of all facility employees (McGinley/Taylor, Wall Street Journal, 7/22).
How's It Playing?
Reaction to Clinton's crackdown from those in the nursing home industry was mixed; some said the changes are a boost to the quality of care, others feared the government is focusing on the wrong issues. "We have standards, but they have not been enforced very well," said Sarah Greene Burger, who heads the National Coalition for Nursing Home Reform. "This is no cure-all, but it is a step in the right direction" (Zaldivar, Charlotte Observer, 7/22). American Health Care Association Executive Vice President Dr. Paul Willging was wary of some of the president's provisions. "Enforcement activity alone is not the answer. In fact, a single-minded emphasis on enforcement will ultimately hurt quality," he said (AP/Richmond Times-Dispatch, 7/22). Willging added: "The president professes to be concerned about the quality of care. But last year he supported legislation that allows states to pay less than it costs to provide such care to Medicaid recipients" (New York Times, 7/22). The American Association of Homes and Services for the Aging applauded the move toward better inspections. "Good nursing homes do not object to unannounced inspections. However, AAHSA would like to go one step further and survey the consistently good homes less often and homes with bad records more often," said AAHSA COO Alan Rosenbloom (AASHA release, 7/21).