Tuesday, July 28, 1998

White House mounts nursing home offensive

President Clinton has ordered a crackdown on nursing homes, and you might think that's because of an increasing number of violations.

Not so. Despite continuing problems, a recent government report actually shows nursing home care has been improving.

It seems more likely, then, that the president's surge of concern relates to the reported plans of a Republican senator, Charles Grassley of Iowa, to use a series of hearings to excoriate the White House for weak-kneed enforcement.

In taking this stance, Grassley is at odds with past positions of many in his own party. They have held that nursing home regulation should be left to the states, not to a federal government already grown obese and clumsy in its usurpation of ever-more power.

Clearly, there are political dividends for both Democrats and Republicans in talking tough about nursing homes. Today, some 1.6 million people reside in 17,000 of them, many at federal expense.

If most of the homes are well-run, most are also said to be out of compliance with at least some of the standards enacted by Congress in 1987 and belatedly promulgated as rules by the executive branch in 1994.

Stories of outrageous abuses are sometimes heard - of untreated pain and malnutrition, for instance. Friends and families of the patients are often anxious, and not without some justification.

Will the president's orders - such as requiring the recompensed states to conduct more surprise inspections and mandating more severe penalties for repeat offenses - be effective in making the worst of the lot better?

It's certainly wise to monitor these operations closely, especially those whose past causes suspicion, but keep in mind, too, that the improvements the president's own administration cites occurred at a time when, he himself charges, enforcement was erratic.

While the industry may sound self-serving in calling for more public-private cooperation and less tension, non-dramatic policies can sometimes produce important results, too.

And part of the answer may reside outside of any governmental action. A report from the Health and Human Services Department two years ago revealed that a smaller percentage of older Americans was going into nursing homes than a decade earlier.

A major reason was thought to be the competitive growth of increasingly capable home health care services.

Nursing homes may always be necessary for some, but, as Donna Shalala, secretary of the department, has said, there are now more choices for many.