U.S. Drafts New Nursing Home Rules : Guidelines Could Change Industry and Increase Costs

Federal officials, stung by reports that patients in nursing homes across the nation receive substandard care, are proposing sweeping new guidelines that could change the face of the industry and create millions of dollars in extra costs for nursing home operators.

The regulations, which were drawn up by the Department of Health and Human Services, have been debated by several federal agencies for the last few months and could be ready for implementation sometime this year, according to Chuck Kline, an HHS spokesman.

“We feel these guidelines would be a significant strengthening of regulations nationwide,” Kline said Sunday. “It’s all pointed in the direction of providing better and safer care for people in nursing homes.”

‘Pretty Safe Bet’

Meanwhile, members of Congress have introduced similar proposals to regulate an industry that received $10.1 billion last year from the Medicare and Medicaid programs for the poor and the elderly. It is a “pretty safe bet” that new regulations of some sort will be in place soon, said John Rother, legislative director of the American Assn. of Retired Persons.

All of the proposals, however, could face strong opposition from the Office of Management and Budget, a White House agency that is reviewing the HHS guidelines and would also examine any congressionally approved measures for their fiscal impact on taxpayers.

Industry representatives said they welcome the tougher standards promised by the HHS guidelines, but expressed concern about their cost--especially in view of the growing number of Americans being placed in long-term nursing homes.

The sweeping new guidelines are a major turnabout for the Reagan Administration, which stirred controversy in 1982 when it announced plans to relax the federal guidelines that must be met by operators providing care for more than 1.3 million Americans. Under current law, nursing homes must meet specific standards of care in order to qualify for federal grants.

Senior Citizens’ Protests

White House officials, buffeted by angry protests from senior citizen activists, medical practitioners and patient rights organizations, eventually dropped those plans. Several months later, they ordered a study of the nursing home industry by the Institute of Medicine, a branch of the National Academy of Science. The study, issued last year, documented abuses varying from poorly trained practitioners and inadequate supervision to filthy facilities and physical abuse of patients.

Kline said the department’s new guidelines “are certainly” a response to that report. They also represent a major increase in costs for nursing home operators.

Under the regulations, for example, thousands of nursing homes would have to hire additional employees, provide more training and employ round-the-clock licensed nurses in order to receive federal assistance. The last requirement alone could cost the industry $100 million per year, an HHS spokesman said. Consumers would also pick up a portion of the tab in the form of higher nursing home costs and taxpayers would be affected by soaring federal payments for Medicare and Medicaid, which is known as Medi-Cal in California.

The cost aspect is sure to come under study by the Office of Management and Budget. Once it has completed its review of the proposed guidelines, industry officials, seniors groups and other members of the public will have a chance to comment on them, Kline said. If the new rules are not withdrawn by the Administration, he added, the regulations could take effect by the end of the year.

‘Bricks and Mortar’ Review

Rother said the tough new nursing home guidelines are needed because operators have traditionally been subject to little more than a cursory, “bricks and mortar” review by federal officials.

“It used to be that the federal government would basically check to see that a nursing home was physically sound, that a fire extinguisher was mounted in the right place,” he explained. “They didn’t really look to see that people were getting good care.”

Legislation introduced by Rep. Henry A. Waxman (D-Los Angeles), Rep. Pete Stark (D-Oakland) and Sen. George J. Mitchell (D-Me.) would order many of the same changes sought by the HHS guidelines, including skilled nursing around the clock, more training for aides in nursing homes and a variety of financial sanctions for operators who violate the law.

Presently, the main penalty available to regulators is to decertify a nursing home that violates the law and thus deprive it of all federal funds. Regulators have been reluctant to use that weapon, however, because it frequently compels them to shut down an entire facility and deprive many people of care.

“These new (congressional) proposals should give regulators far better options . . . short of terminating all service,” said Rother.