U.S. Inspectors Sent to State’s Nursing Homes

The federal government is sending large numbers of inspectors into California nursing homes in a bitter dispute with the state over the standards of care for thousands of elderly residents, officials said Wednesday.

“We have a responsibility to the elderly to be sure that nursing homes are safe,” said Maria A. Friedman, public affairs director for the federal Health Care Financing Administration, which is dispatching most of its 139 inspectors to California this month.

There is no immediate danger of nursing homes being shut down or the residents displaced. If the dispute isn’t resolved, however, California could eventually face the loss of $1 billion in federal funds, which pays half the cost of caring for 70,000 people in nursing homes. The federal government has never cut off funding for a state, but the current dispute is unprecedented, with California apparently in direct defiance of federal law.

The state and the federal government are battling over California’s refusal to comply with a federal law requiring improved services and staff training at nursing homes.

In Sacramento, a spokesman for Gov. Pete Wilson said the governor “thinks it’s outrageous” that Washington “would deploy an army that sounds like the size of Operation Desert Storm” to inspect the state’s nursing homes.

“We’re going to continue to run our nursing homes the way we think is best for the people of California,” said Wilson’s assistant press secretary, Franz Wisner. “We’re already doing it better than they’re suggesting.”

Kim Belshe, deputy director of the state health and welfare agency, said the governor “isn’t out to pick a fight. He just feels the Health Care Financing Administration has gone beyond the law and the regulations and improperly mandated requirements on nursing homes that would be very costly and unnecessary.”

The heart of the disagreement is money, as the state struggles with the fast-rising cost of the Medi-Cal program, which pays medical bills for the poor. The program cost $8 billion in 1990, including a $900-million rise over the previous year.

The federal law that took effect Oct. 1 requires improvements in nursing home service, including availability of a nurse 24 hours a day. State officials note that California requires the nursing service, except on weekends, and they argue that other requirements in the federal law would add a paperwork burden without helping residents.

California officials say it would cost the state $400 million to $600 million a year to comply with the new law, and the state Legislature agreed to contribute only $100 million.

Federal officials are equally adamant, arguing that California cannot be allowed to evade federal law. When California refused to allow state inspectors to participate in training sessions about the new law, the federal government withheld $5 million.

Federal inspectors are now carrying out the nursing home inspections because state officials are refusing to do the job.

“We are doing what the state is supposed to be doing,” said Friedman. “We want the homes to be able to stay open, and we will do whatever is necessary to keep them open,” she said.

It will not become clear whether the homes are meeting the new federal standards until the inspections are completed, she said. “We do not know if there are violations until we take a look.”

Since the state will not spend its money to meet the new standards, nursing home operators would be forced to raise their rates, or else dip into their profits to meet the standards.

The nursing homes have annual contracts under which they are certified to participate in the Medi-Cal program. As the contracts expire, new inspections are scheduled. “Our inspectors are going in as needed,” Friedman said. Most of the inspection force will be temporarily assigned to the state because a large number of contracts are expiring in March.

The dispute has given rise to two major lawsuits. A group of nursing home residents sued California, arguing the state was depriving them of adequate care by refusing to follow the federal law. A judge ruled in their favor.

The state sued the federal government last week, asserting that the new rules are costly and unnecessary.

Robert Rosenblatt reported from Washington and George Skelton from Sacramento.