Wilson Won’t Back Off on Nursing Homes : Patient care: The governor repeats his opposition to federal reforms, which he had supported as a senator. Meanwhile, U.S. inspectors are dispatched to the state.

Gov. Pete Wilson reiterated Thursday that he will not budge from his opposition to federal nursing home reforms, even as federal inspectors were being dispatched to California to enforce the new standards.

Thursday’s actions, which also included an apparently fruitless negotiating session between state and federal officials, were the latest escalation in the argument between California and the Bush Administration over the implementation of the tough new federal rules.

The reforms, which Wilson supported as a U.S. senator, are intended to raise the level of patient care and give nursing home residents greater control over their own lives. But Wilson has opposed the federal inspection plan attached to the reforms, arguing that it will result in the expenditure of millions of dollars on paperwork, rather than on improved care.

“The irony is that California has led the way in nursing home reform . . . but what we want to do is put the dollars into quality (patient care),” the governor said in a telephone interview Thursday.

However, nursing home advocates complained that Wilson is primarily concerned about the increased cost of the reforms when the state is faced with a mounting budget deficit. Because the state has failed to enforce the federal rules, which became effective last October, the U.S. Health Care Finance Administration disclosed Wednesday that it is sending 139 inspectors to California to determine whether facilities here are complying. Those homes found not in compliance could lose federal funding.

A daylong meeting Thursday between state and federal health care officials in Sacramento designed to resolve these differences failed to produce any solutions, said Gail Wilensky, administrator of the U.S. Health Care Finance Administration.

Wilensky said she remains “cautiously optimistic” that a resolution can be reached.

Caught in the middle of the feud are the state’s 1,150 nursing homes, which provide care for more than 100,000 elderly residents, including about 70,000 whose bills are paid by Medicaid, the government-funded health insurance for the poor.

“It’s a big mess and we don’t know what way to turn,” said David Helmsin, program director of the California Assn. of Health Facilities, representing 900 nursing homes statewide. “We are anxious to cooperate with any reforms that are reasonable. The problem is that the state has said they’re not in a position to fund this.”

The Medicaid program--called Medi-Cal in California--pays about $2 billion a year on nursing home care in the state. Half the money is federal and half comes from the state. Compliance with the reform measure would add an additional $440 million, nursing home industry officials have estimated.

Wilson acknowledged concern about rising Medicaid costs. He noted that at a recent national conference of governors, “every governor . . . was in mortal fear of their state being bankrupted by the rising cost of Medicaid.”

Because state health officials have refused to follow the new guidelines that specify in great detail how nursing homes should be inspected, Wilensky has ordered federal inspectors to take charge. About 85 facilities in various parts of the state will be inspected this month and another 108 will be checked next month. The cost of the inspections--which federal officials said could total $24 million over the course of a year--would be charged to the state. Federal officials already have withheld $5 million in Medicaid funds from the state to pay for the first round of inspections.

Pat McGinnis, an official with California Advocates for Nursing Home Reform, accused Wilson of engaging in “cowboy” politics that jeopardize the care of tens of thousands of destitute elderly people now living in California nursing homes.

At issue is a 1987 federal law that set forth strict new nationwide standards for patient care that will require facilities to significantly improve their staffing levels.

Wilson’s spokesman, Franz Wisner, said that, as a senator, Wilson favored the nursing home reforms when they came before Congress for a vote. However, he objects strenuously to the way federal health officials have interpreted the law and said “he’s not backing off in any way.”

The 200 pages of “interpretive guidelines” developed by officials at the U.S. Health Care Finance Administration will add substantially to the cost of care at the state’s nursing homes, Wilson complained in a letter last month to President Bush. “These added costs will be incurred primarily by facilities documenting compliance with nursing home requirements--not for improved patient care,” Wilson wrote. Furthermore, the guidelines are illegal, because they were developed without the required consultation with state officials, according to a lawsuit state attorneys filed last week challenging the federal law.

Federal health officials would not comment on Wilson’s charges, but nursing home advocates in California accused Wilson of violating federal law “for budgetary reasons” rather than legal concerns.

“Legally, he has no leg to stand on,” said Jeanne Finberg, an attorney with the National Senior Citizens Law Center. “The position the state has taken is incredible.”

The center filed a class-action lawsuit last year to force the state health department to implement the new federal standards.

“Money has been the primary motivation behind the state’s position,” McGinnis said. “All this boils down to money that the state doesn’t want to pay.

“It angers me because if these new guidelines are adopted and enforced, it would mean a dramatic improvement in care for nursing home residents. . . . They would no longer be able to just tie them up, drug them and let them rot, as they do now.”

The reforms aim to help residents achieve their highest level of mental, physical, psychological and social well-being through increased physical therapy and restorative help. The new rules also strengthen patient rights and give residents more control over their lives, ranging from a say over how furniture is arranged in their room to consultation on medication plans.

In an interview, Wilson said that he supports improved patient care but that the new federal guidelines “mandate minutiae.”

Furthermore, he said the new inspection process required by the federal guidelines would cost the Medicaid program “substantial” money, but provided no exact figure. He said any additional funds should be spent improving patient care rather than on bureaucratic compliance efforts.

Wilensky reponded that the new guidelines are not supposed to raise costs but that if they do, the state should give specific examples and “these will be addressed.”