Clinton Calls on Congress for $1 Billion in Nursing Home Grants to States

Calling for “a new level of quality” in the nation’s nursing homes, President Clinton on Saturday urged Congress to approve $1 billion in grants to states to ease the severe shortage of nursing aides, who provide most of the hands-on care for more than 1.6 million elderly and frail Americans.

There is a 100% annual turnover rate of certified nursing aides, the workers who bathe, feed and exercise patients, and the staffing problem is worsening in the current full-employment economy.

The money, if approved by Congress, would be allocated by the states to private nursing homes, which could use it to train and hire additional workers.

“Of all the obligations we owe to one another, our most sacred duty is to our parents,” Clinton said in his weekly radio address, broadcast from the Washington Home, a nursing facility. “They kept us safe from harm when we were children, and we must do the same for them as they grow older. They shouldn’t go another day without the care they deserve, wherever they live in whatever nursing home facility.”

Clinton also said he is ordering the government to develop within two years minimum staffing levels for nursing homes that participate in Medicare, the program that serves 40 million people age 65 and older and the disabled of all ages. The rules also would apply to Medicaid (called Medi-Cal in California), the major health care program for the poor.

A recent research study by the government suggested that each person in a nursing home should receive at least two hours a day of direct, personal attention from a staff member, whether it is a nurse or a nursing aide. Standards of care now are set by the states and vary considerably.

California’s current standard of 3.2 hours a day of direct attention for each resident is far above the standard suggested by the federal report.

Clinton wants the adoption of a single, uniform standard, and the money he is seeking from Congress would be directed toward improved training, job satisfaction and retention of workers.

The president said that more than half the nation’s nursing homes “don’t have the minimum staffing levels necessary to guarantee quality care, and too often the staff that is there isn’t properly trained.”

Patients in facilities that have too few workers to provide adequate attention “are more likely to lose too much weight, develop bedsores, fall into depression,” the president said. “More than 30% are dehydrated, malnourished; at much higher risk for illness and infection. Older Americans who have worked hard all their lives deserve respect, not neglect.”

As an interim measure, the federal government will order nursing homes to post information about the number of health care workers they have. This information will help families in selecting a nursing home, the president said.

Because of staffing shortages at nursing homes, the Department of Health and Human Services has begun a special effort “to identify residents who are at risk and prevent them from becoming dehydrated or malnourished,” the president said.

The nursing home industry welcomed the president’s remarks.

“We are absolutely excited he has recognized the fact that we have to address staffing issues,” said Rick Abrams, chief operating officer for the American Health Care Assn., which represents the industry. “This is a positive message to people who are being cared for” in nursing homes.

Staff shortages are a persistent problem in California, where Gov. Gray Davis signed a bill Thursday to tighten state oversight of nursing homes. Under the new law, state inspectors must investigate allegations of serious health or treatment problems within 24 hours, and it will be easier for the state to cancel an owner’s license.

The recent state budget provided for additional state payments to nursing homes so they can increase wages by 7.5%. Nursing aides earn an average of $7 an hour.

The number of state inspectors for nursing homes will be doubled, to 400. The federal government sets most of the health and safety rules in nursing homes, while inspection and enforcement are state responsibilities.

California nursing homes have about 250,000 patients cared for by a work force of 120,000 nurses and nurses’ aides. An additional 30,000 workers would be needed to enable all facilities to comply with California’s personal-care standard of 3.2 hours per day per patient.

A 1998 federal study disclosed that one-third of California’s nursing homes had been cited by inspectors for serious violations. Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Aging Committee, which conducted hearings concerning the California problems uncovered in the report, said Friday that he is eager to work with Clinton to improve the quality of nursing homes.

“The suffering of nursing home residents is intolerable,” Grassley said. “Bedsores and malnutrition turn the stomach and hurt the conscience. They beg for a solution; the sooner, the better.”