NURSING HOMES: White House To Crack Down on Violations

      President Clinton is expanding the category of nursing home violations that receive immediate penalties to include nursing homes that have been found to have imposed harm through abuse or neglect to at least one resident in two or more consecutive inspections. Those violations, which include excessive weight loss or severe bedsores, are subject to fines up to $10,000. Penalties also could include suspending Medicare or Medicaid payments for newly admitted residents or exclusion from those programs entirely. Yesterday's announcement is the latest move in an effort to tighten enforcement of nursing home regulations. Last year, the Clinton administration eliminated a provision that permitted state inspectors to allow nursing homes a grace period to fix problems before penalties were imposed. The new regulations will "trigger immediate mandatory penalties ... at about 12% of [nursing] homes this year," while previous violations covered about 1% of nursing homes. HCFA Director Nancy-Ann DeParle said that regulators "owe it to residents and their families to prevent problems where we can and address them quickly when they occur." But Tom Burke, spokesperson for the American Health Care Association, said that the new rules were "too punitive." He added, "Everybody wants to get quality care. We just don't believe this heavy-handed way is the best way to do it. ... We think there needs to be more of a collaborative approach" (Love, AP/Philadelphia Inquirer, 12/15).

Caregivers Face Higher Mortality Rates
      In related news, elderly people caring for their sick husbands or wives are 63% more likely to die than other spouses, according to a new study published in the Journal of the American Medical Association. Over four years, researchers tracked 819 spouses aged 66-95, 317 of whom were responsible for dressing, bathing or mobilizing their spouses. Of the 317 caregivers, 179 reported strain, had higher levels of depression and were less likely to get enough exercise and rest or to visit a doctor. Richard Schulz, study leader and director of the University of Pittsburgh's University Center of Social & Urban Research, said, "This is the first demonstration that caregiving can lead to mortality." He continued, "My hunch is that these people [in the study] are frail. They're relatively old. They have their own health problems generally" (Coleman, AP/Los Angeles Times, 12/15). Janice Keicolt-Glaser of the Ohio State University College of Medicine said, "We have a lot of data saying a caregiver's health may be impaired in a lot of ways, but this study actually links it to mortality. And it does it in a population of caregivers who are, on the average, probably not that bad off compared to many of the other people who have been studied" (Srikameswaran, Pittsburgh Post-Gazette, 12/15).

A Social Issue?
      The Boston Globe reports that family caregiving "is an issue of mounting importance not only to the invisible army of 15 million family caregivers in this country, but to society, which often must pick up the cost through Medicaid-paid nursing home care when family care systems collapse." According to the National Alliance for Caregiving, family caregiving saves society between $113 billion to $286 billion each year (Knox, Boston Globe, 12/15).