Blueprints for reform. (Spotlight On).

Sen. John Breaux (D.-La.) chairs the Senate Special Committee on Aging and serves on the Senate Finance Committee. In 1998, he was selected by the White House and congressional leaders to chair the National Bipartisan Commission on the Future of Medicare. Breaux has led the Special Committee on Aging through several hearings addressing the need for reform in long term care. In June 2002, in conjunction with a hearing entitled "Long Term Care: Blueprints for Reform," the committee's findings were released in a report, which is available at <http://aging.senate.gov>. Following the committee's March 2002 hearing on nursing home abuse, CLTC conducted an interview with Breaux. Here are excerpts from that interview:

How can nursing home operators better protect their residents from abuse?

Breaux: They must hire caring, compassionate, and physically able staff members to serve residents appropriately with varying levels of need. Nursing home operators should also ensure that staff members have access to proper training and resources to assist them in providing the best care possible. Finally, nursing home administration and staff must work with local law enforcement to better recognize, report, and prevent elder abuse.

What changes should be made in the nursing home regulatory system to help prevent resident abuse?

Breaux: Nursing home regulators must develop uniform methods to define both abuse and deficiencies in resident care. On the state level, there needs to be more mandatory coordination among the various agencies tasked with protecting our seniors. Additionally, the administrative investigation and appeals process needs streamlining to ensure timely resolution of abuse complaints.

What steps must lawmakers take to ensure that crimes committed against nursing home residents are reported promptly to law-enforcement officials?

Breaux: Under current federal law, nursing homes are mandated to report crimes to a state-designated agency. In most instances, this is the state health agency and therefore law enforcement is not always immediately notified. By mandating that a law-enforcement agency also be contacted immediately, concerns regarding delayed criminal investigations would be addressed. Furthermore, this would enable law enforcement to conduct more effective and thorough investigations.

What can be done to help offset the severe shortage of geriatric-trained health care professionals?

Breaux: Congress must make sure that more emphasis is placed on geriatrics so that no health care professional receives a degree without obtaining a certain level of education and training in geriatrics. Not only do we need more geriatricians and geriatric specialists, we need all practicing health care professionals to be trained to handle needs specific to the elderly.

Nursing assistants are among the nation's lowest-paid workers, and this makes it difficult for nursing homes to recruit and retain qualified caregivers. What can be done to help attract qualified workers to the front lines of elder care?

Breaux: There is no easy fix to the workforce problem facing nursing homes. The nation's workforce crisis stretches across the entire long term care continuum. Those who care for our nation's elderly are paid low wages for emotionally and physically demanding work. We need to pay better salaries; provide workers with the training, supplies, and other tools needed to do their jobs; and provide decent benefits. We are examining proposals to both recruit and retain nursing home staff. To help nursing homes in this regard, I have supported programs to give state grants for staff recruitment, retention, and training.

The Medicare "givebacks" granted to nursing homes in 1999 and 2000 are set to expire Sept. 30, 2002. Do you support the extension of these givebacks?

Breaux: As a member of the Senate Finance Committee, I have been looking at ways to improve the Medicare program. We cannot continue to rely on provider cuts to restore Medicare's long term solvency since these cuts inevitably will harm beneficiary access to care. To help relieve some of the unintended consequences of the Balanced Budget Act of 1997, I have strongly supported legislation to provide financial relief to beneficiaries, hospitals, nursing homes, home health agencies, and other providers who have been affected adversely.

Congress passed the Medicare, Medic aid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 to address the immediate need for financial relief to providers and beneficiaries. I am pleased to have supported this bill, and I understand that additional relief nay be necessary in the future.

With regard specifically to restoration of nursing home cuts, I expect that the Senate Finance Committee will consider this issue in the context of an overall Medicare package to relieve providers. In the absence of real Medicare reform I understand that such relief will be necessary.