Nursing Home Oversight May Be Cut

The Clinton administration is considering a controversial policy shift that would reduce some inspection activities at the nation’s nursing homes.

A draft proposal being circulated among nursing home operators, patient advocates and consumer groups calls for reductions in the scope of federal inspections, as well as a possible cut in the number of patients interviewed. Required reviews of medical records and other documents also would be reduced.

Instead, government inspectors would focus more effort on particular problem areas, such as individual nursing homes with especially troubled reputations, sources said Monday.

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Any final change in policy could draw considerable opposition in Congress and among groups representing senior citizens if it is viewed as weakening federal standards at nursing homes.

“I’m very surprised. This is the first I have heard of any proposed changes,” said Max Richtman, executive vice president of the National Committee to Preserve Social Security and Medicare, which has 5 million members.

“The administration has shown a commitment to maintain quality and standards,” he said. “Conditions are better because of inspections and federal rules.”

Richtman said that his group and other senior organizations would press hard to “maintain high standards.”

Administration officials, sensitive to the potential controversy, were quick to insist that they had not yet made final decisions on a new policy of reduced oversight.

“This is a draft that is being circulated for review,” said Peter Garrett, spokesman for the government’s Health Care Financing Administration, which runs Medicare and Medicaid. “We are seeking feedback to see what ideas might be generated.”

The administration “will be considering all comments,” Garrett said. He added that the “key word” in the proposed policy changes is “would, not will,” meaning that the changes are not yet certain.

Bruce Vladeck, director of the Health Care Financing Administration, has not yet taken a position on the issue.

Repeated scandals led to strengthening of federal laws in the 1980s to improve the quality of care through inspections.

Federal and state inspectors routinely visit nursing homes caring for patients under Medicare, which serves those 65 and over and the disabled, and Medicaid, which serves the poor.

The inspectors consider such issues as staff training, the availability of nurses, the way medicine is administered and the rights of patients.

The nation’s annual bill for nursing home care is about $72 billion, with public funds paying 58% of the cost. The industry’s growth has been heavily dependent on federal dollars from Medicare and the combination of federal and state funds supplied by Medicaid.

The federal government also helps pay the cost of local ombudsmen, who visit nursing homes and talk with patients and family members.

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About 1.1 million people receive nursing home services annually under Medicare and about 1.7 million under Medicaid. There are more than 13,000 nursing facilities.

The Medicare patients who go to nursing homes typically are recuperating from hospital stays and need a higher level of skilled care.

Most of the Medicaid patients, by contrast, are elderly people in custodial nursing homes. Often, they are suffering from Alzheimer’s disease or other incurable dementia.

The federal and state inspectors visit all types of nursing homes but pay particular attention to the custodial-care facilities housing long-term Medicaid patients. Because these patients are typically suffering from both physical and mental deterioration, they are considered vulnerable to exploitation and mistreatment.