Clinton Seeks Improved Nursing Home Oversight

President Clinton on Tuesday called for tough measures to improve the quality of nursing home care, including surprise nighttime and weekend inspections and the creation of a national registry of workers convicted of abusing patients.

The timing of the president’s announcement apparently was designed to preempt some of the political fallout expected from Senate hearings scheduled for next week dealing with allegations of neglect and abuse in California nursing homes.

During its hearings Monday and Tuesday, the Senate Special Committee on Aging will issue a report by the General Accounting Office that is sharply critical of the federal government’s enforcement of nursing home quality regulations in California.

“Many of the most vulnerable and defenseless nursing home residents in California are not receiving an appropriate level of quality of care,” Sen. Charles E. Grassley (R-Iowa), chairman of the committee, said Tuesday.

Grassley received complaints about California last year and asked the GAO for a special investigation in the state. He has indicated that he will decide after the hearings whether to seek a nationwide investigation.

Witnesses at the Senate hearing will talk about seeing California nursing home residents suffering from malnutrition and dehydration, their bodies ravaged by painful bedsores, according to sources familiar with the nine-month investigation. Staff members of the GAO, the investigative arm of Congress, reviewed thousands of pages of records, including numerous death certificates, and visited nursing homes with serious problems.

The most striking problem the GAO uncovered was neglect, with bedridden patients ignored by staff, lying unturned in their beds so that their skin deteriorated into festering bedsores, sometimes requiring major surgery, sources said.

The federal government has a direct and vital interest in nursing homes because it spends $30 billion a year to help pay for the care of many of the 1.6-million people in 17,000 nursing facilities.

State agencies carry out the inspections, but the federal government has ultimate responsibility for enforcing the federal laws and rules that demand quality treatment. The government’s enforcement system is “comatose,” Grassley said.

Most of the nation’s nursing home residents are elderly. The typical resident is an impoverished woman in her mid-80s.

“Choosing to move a parent or a loved one into a nursing home is one of life’s most difficult decisions,” Clinton said Tuesday. “But with these steps we can at least give families a greater sense of security in knowing we are doing everything we possibly can to make our nursing homes safe and secure.”

The Clinton administration announced that federal officials would improve enforcement by requiring states to make their inspections less predictable. Surveys should include some surprise inspections at night or on weekends, according to the policies announced Tuesday.

Nursing homes with “a poor record of compliance with quality standards” will be targeted by federal and state officials for more frequent inspections, according to a White House announcement.

“We will be clearer and quicker in our response to problems that have been identified,” Donna Shalala, secretary of Health and Human Services, told reporters.

Inspection reports on individual nursing homes will be posted on the Internet by the year’s end to help consumers select a facility.

The administration also is sending legislation to Congress asking for laws to require nursing homes to do background checks before hiring employees. A national registry would be created to list workers convicted of abusing residents to ensure that they are not hired by a different facility after moving to another city or state.

The proposed legislation also would expand training for nursing home employees in providing nutrition, including intravenous feedings.

Nursing home officials said their industry has improved its performance and that the drumbeat of negative publicity would discourage nursing home personnel who are trying to do the right thing.

“If the government continues to focus exclusively on enforcement and punishment for the bad actors, the end result will diminish quality in nursing facilities,” said Paul Willging, executive vice president of the American Health Care Assn., an industry trade group. The government instead should work in cooperation with the industry and put the “emphasis on the 90% of the people who want to do a good job,” he said.

In California, “we have been through multiple rounds of reform at the state level and the national level,” said Lori Costa, director of regulatory programs for the California Assn. of Health Facilities, which represents 95% of the 1,400 nursing homes in the state. “More punishment will not bring about the changes we want to see,” she said.

California already requires background checks for nursing home workers, the kind of reform the president is proposing at the national level, she noted.