AAHSA climbs on the deregulatory bandwagon.

"We know we're going to have to deal with less and we're getting to the point now where we have to say, 'Stop! Enough regulation!'"

With such remarks at a recent press briefing, Sheldon L. Goldberg, President of the American Association of Homes and Services for the Aging (AAHSA) signaled that he wants the nursing home industry to be more aggressive in countering regulations - including OBRA '87. AAHSA, which represents the nonprofit long-term care community, has traditionally seemed less strident than the American Health Care Association (AHCA), the for-profit association, in attacking the federal regulatory climate. That appears to be changing.

Part of Goldberg's objections were based on the view that OBRA '87's provisions have been superceded by the rapid pace of change in the nursing home field. Noting that OBRA '87 began its development in 1984, Goldberg said "it was designed for an industry that no longer exists. [The authors] were looking at the nursing home problems of the '70's and early '80's. Those problems, in my opinion, were lack of training, lack of experienced staff and the fact that, at the very start, back in the 1960's, some of the wrong people got into the industry."

Although Goldberg and other AAHSA staff agree that OBRA '87 gave an important boost to some reforms, such as reduction of patient restraints, they believe that improvements in staff quality and the experience nursing homes have acquired in recent years have transformed today's regulations into barriers to genuine quality and efficiency. According to Goldberg, "Quality is not something you regulate. Quality is not rules and regulations - it's an attitude....The key component of quality is the interaction between the staff and patients. When [staff] really respect the environment and recognize that it's their environment too, they produce quality."

AAHSA's initial foray onto the anti-regulation battlefield occurred during the Association's spring Legislative/Management Conference this March, as small groups of conference attendees visited Capitol Hill seeking a delay in the July 1 implementation date for the new Medicaid survey criteria. According to Michael F. Rodgers, AAHSA senior vice president for policy and governmental affairs, the delay actually would make the survey system work more effectively. "The state survey staffs are not going to be trained by the federal staff in some states until June, and the nursing home staffs will not be trained by the states until some time after that."

Rodgers suggested that the survey criteria were rushed into force before HCFA could digest the more than 19,000 comments it received on the draft regulations. He also argued that outcome-based standards in the survey cannot be fully implemented until Minimum Data Sets are available reflecting nursing homes' quality-related achievements of the past several years.

Although AHCA and AAHSA do not appear to be collaborating on this issue, both associations' memberships have been encouraged to pursue parallel strategies on Capitol Hill. An AHCA spokesman told Nursing Homes that "the driving force behind the date for implementation should not be the artificial July 1 deadline. The driving force should be implementing these directives correctly and doing them right." The spokesman added that the effective defeat in the U.S. Senate of a Republican-sponsored moratorium on regulations increases the need to correct problems in the new survey procedures regarding liability and due process.

Another proposed regulation against which AAHSA has decided to take a strong stand is the call for minimum staffing levels by various professional nursing groups. AAHSA members at the Spring meeting described the proposals as "ludicrous" and "another example of regulating process rather than outcome." Goldberg questioned how minimum staffing regulations would provide an incentive for efficiency or improvement of operations, while Rodgers suggested that there was a real possibility for minimum staffing becoming maximum staffing. "We saw this with OBRA," he explained, "when some states already had higher requirements for nurses' aide training than federal regulation mandated. Those states quickly dropped their training regulations down to the less demanding OBRA levels."