State Tries to Bar Door to Nursing Home Reforms : Elderly: California lobbies against new regulations, continuing to ignore abuses.

The good news: Nursing homes are getting better. The bad news: Not in California.

The United States is finally making progress in stopping nursing-home abuse and in making nursing homes better places to recover from illness or live out the last days of life. But California is doing everything it can to stand in the way of national improvements--even though in some ways California has one of the worst problems in the nation.

The full story is fairly straightforward: In 1982, the Reagan Administration tried to deregulate nursing homes, in essence to say that federal money would go to any facility, no matter how bad, no questions asked. After meeting bipartisan opposition to this proposal, the Administration withdrew it and a study was commissioned.

The study was done by the Institute of Medicine of the National Academy of Sciences. The expert committee was made up of state officials, nursing-home industry representatives and patient advocates. The study was thorough, thoughtful and balanced. It reached two basic conclusions:

-- The quality of care and the patients’ quality of life in many nursing homes are not satisfactory.

-- Effective federal regulation can improve these quality problems.

The committee said bluntly, “A stronger federal leadership role is essential . . . because not all state governments have been willing to regulate nursing homes adequately unless required to do so by the federal government.” In the case of California, truer words were never spoken.

Hearings were held by my subcommittee on health and environment and public views were heard. Finally, with the support of industry and advocates alike, a bill was passed and signed into law in 1987.

That law gave states three years to comply with the basic requirements. From the day the law was signed by President Reagan, the state of California did nothing to begin nursing-home reform, even as 49 other states reached their goals.

So when the law became effective in October, 1990, no one should have been surprised that California was not in compliance: It never tried. The state had refused to re-examine its quality standards, to respond to its deficiencies or to improve nursing-home care.

Instead of meeting the standards, California sent lobbyists to Washington to get a special exemption from the federal quality controls. Their request was taken seriously. My staff and I reviewed it carefully, looking to see if my home state had found a better way to protect patients and improve their lives.

But there isn’t a case--and it’s not a matter of technicalities.

For example, the federal law gives patients the right to be free of physical or chemical restraints imposed in lieu of treatment. California argues that 75% of its patients are in that category and that the right to be free and treated is expensive because more staff would have to be hired. The state wants to be exempted.

For what? So that three out of four patients can be drugged and tied down instead of treated? So that these facilities can remain understaffed? So that California can continue to ignore these flagrant abuses?

Last fall, the exemption amendment was defeated by more than 2-1 in the health subcommittee. But again California refused to try to comply. This time it sent lawyers to court to defend its refusal and to try to get a judicial exemption. It didn’t take the court much time to say no, and the state was ordered to obey the law.

California has once again refused to address these problems of quality. Ignoring the law, Congress and the courts, this time it has pulled out the big guns: Gov. Pete Wilson called President Bush’s chief of staff, former New Hampshire Gov. John H. Sununu, for an exemption.

There is some irony here. Sununu’s home state has complied with the nursing-home reforms. Using the New Hampshire motto, “Live Free or Die,” it removed chemical and physical restraints from nursing-home patients. The result, says the nursing-home industry itself, is “a profound improvement in the quality of life for these residents,” including improved mobility, increased physical functioning, boosts in staff morale and more frequent family visits.

On March 12, Wilson claimed victory and publicly thanked the White House for interceding on his behalf. Confusingly, the U.S. Health Care and Financing Administration, the agency responsible for administering the law, says it isn’t so. The agency says that it will take comments from California--just as from any other state--and will respond to any legitimate suggestions.

The truth remains to be seen. If Wilson’s claim is correct, the thousands of people in nursing homes in California will be the losers. But if this happens, it won’t be without a fight.

I am ashamed by a state government that will lobby, litigate and wheedle to keep from complying with the law. We have seen the future of nursing-home quality and it works: It improves elderly and disabled people’s lives; it makes patients and their attendants and their families happier. The people of California deserve no less.