Sunday, July 26, 1998

Belated action on nursing homes

By ANN McFEATTERS

Scripps Howard News Service

WASHINGTON - There's something infuriating about President Clinton's "crackdown" on deplorable conditions in some nursing homes, promising surprise inspections to catch abuses.

Less than two years ago his administration was proposing fewer inspections as a way to save money (while Democrats took thousands from the nursing home industry in campaign contributions). The public uproar forced the White House to back off.

Then Clinton supported a new change in Medicaid so that, nursing homes say, they are reimbursed less than it costs to support an indigent patient.

Clinton has helped to prevent weakening of federal nursing home standards but has not addressed the critical long-term care problem; as the population ages, fewer than 8 percent of Americans are privately insured for lengthy care.

Five and a half years into his presidency seems a long time (given his immersion and intense interest in America's health care system) for Clinton to discover that hundreds of people are still dying from malnutrition, dehydration, sepsis from bed sores and even physical abuse while in nursing homes.

It's also odd that his announcement comes just before hearings by the Senate Select Committee on Aging on his administration's handling of nursing homes.

This is no minor matter. There are now 1.6 million people in nursing homes and more of us will face that fate. It is not unusual to pay $50,000 for a year of care.

Because the demand for care is increasing and because it can be a lucrative business, the number of nursing homes is almost 17,000 and growing.

The history of regulating nursing homes is a sorry saga.

After years of debate and frightening scandals with too many elderly warehoused in people bins, forgotten and mistreated, Congress in 1987 set standards for health and safety.

But not until 1994 were regulations devised to enforce those standards. Although there was an outcry that the feds were stepping on the role of the states, the hope was that gross abuses and neglect of nursing home residents would be eliminated.

Now, according to a new 900-page report to Congress, the overall quality of care in nursing homes has improved but regulations aren't enforced uniformly and two-thirds of all homes don't meet all federal standards.

Inspectors, it turns out, like regular hours and little hassle and tend to show up to inspect at the same time each year during normal weekday hours and often miss flagrant maltreatment.

Clinton says they should be showing up unexpected, sometimes at night and on weekends.

He also wants Congress to spend $13 million more on inspections (a total of $167 million). He wants to charge nursing homes fees for getting Medicare accreditation, and he wants to penalize states for poor inspections.

Clinton wants 6,000 state and local inspectors, under contract to the federal government, to be able to fine nursing homes in violation of standards "on the spot" instead of giving the homes grace time to improve. Fewer than one out of 10 fines imposed are ever paid.

Clinton rejected calls for privatizing the accreditation of homes for participating in Medicare and Medicaid. The potential for private inspectors to overlook substandard facilities is too great, the government concluded.

There are questions about Clinton's plan. Will instant fines (up to $10,000 a day) spur homes to perform better? Where will they get the money?

Will Congress require that nursing homes do criminal background checks for people hired off the street (at wages of $5.15 an hour) and provide a national registry of workers who fail to pass? Would an inspector be reluctant to pinpoint a home that might be prosecuted by the Justice Department?

Many fine nursing homes do wonderful work in difficult situations. It is not an easy business. And, thankfully, thousands of dedicated people care for patients with compassion, commitment and competence.

But if Clinton is correct, there are not enough of them and there are still too many scoundrels who should be doing something else - time in penal institutions, for example.

Nursing home patients can't lobby. It's up to the rest of us to make sure they are treated properly and volunteer to help out when possible. Clinton must follow through to enforce his plan.

Perhaps the best step he plans to take this autumn is to have results of annual inspections of nursing homes posted on the Internet.

Thus families of patients and public watchdogs (almost half of all patients have no known living relatives) could see how specific homes rate.

Demand is high; beds are few. The number of people over 85 will double in 30 years.

Ann McFeatters covers the White House for the Scripps Howard News Service.