Federal Watchdogs

The Reagan Administration has decided, after all, not to drop out of the business of financing and regulating nursing homes, and that is a positive development for the millions of Americans forced into these care facilities. But it is too soon to know whether the change of mind also signals a willingness to go far enough to correct some of the evident problems.

A federal role is appropriate if for no other reason than the fact that more than 1 million persons are being provided nursing home care under Medicare, the program for those 65 and older, and Medicaid, the program for the poor and disabled, called Medi-Cal in California. The federal government has been providing 75% of the cost of inspections of these facilities with the inspections generally implemented by state authorities.

The Health Care Finance Administration seems to have been responding to congressional pressure in its decision to draw up new regulations that could expand the federal role in regulating the homes. Dr. William L. Roper, head of the HCFA, told the New York Times that he was pressing ahead with new regulations in the hope that they would head off legislation, apparently a reference to efforts of Reps. Henry A. Waxman (D-Cal.) and John D. Dingell (D-Mich.) to address some of the nursing home problems.

First indications of the direction of the regulations raise serious doubts about their adequacy. Congressional action may still be required.

Rule changes were proposed early this year by the National Academy of Sciences. Among them was a bill of rights for residents of nursing facilities that would recognize their right to a dignified existence and to knowledge of complaint and appeal procedures. But a recommendation calling for more inspectors and additional funding for inspections, to insure that the rules were respected, has already been dropped from a draft of proposed regulations, the New York Times reports.

Furthermore, the Administration reportedly has rejected a rule that would have barred discrimination in admissions and services against Medicaid patients, the very group that is the largest under the federal program and that often faces the greatest difficulty, because of the relatively low fees provided by Medicaid, in finding facilities.

The new concern about this problem is welcome. It is matched by a current study, ordered by President Reagan, of the problems of financing high-cost, long-term illnesses, the so-called catastrophic illnesses, and of nursing home care, now available on a long-term basis only to those who meet the low-income eligibility standards of Medicaid. Thousands of older Americans have lost their life savings, and been reduced to poverty, through meeting expenses for catastrophic illnesses or long-term nursing care not now generally provided except through Medicaid.