CLINTON PROPOSES PARING NURSING HOME INSPECTIONS.

Byline: Robert Pear The New York Times

The Clinton administration is proposing to scale back inspections of many nursing homes that care for elderly people under Medicaid and Medicare.

The Department of Health and Human Services outlined the proposed changes in documents sent recently to federal and state health officials around the country.

Government data show that more than two-thirds of nursing homes are not fully complying with current federal standards. Federal officials said the proposed changes would allow them to concentrate on homes with serious problems.

The proposed changes would narrow the scope of reviews at many nursing homes and reduce the number of residents who must be interviewed. They also would reduce the number of medical records and other documents that must be examined.

Inspectors would focus on ``areas of concern'' identified in advance, rather than conducting ``comprehensive reviews,'' and they would have fewer opportunities to observe the dispensing of medications.

Anthony Tirone, deputy director of the Health Standards and Quality Bureau at the health department, said in a memorandum that the new procedures would ``increase the effectiveness and efficiency'' of nursing home inspections. In an informal test, Tirone said, ``we saved time, while obtaining better information'' in most cases.

But state officials and consumer groups denounced the proposed changes, saying they would significantly reduce the protection of nursing home residents.

Ellen Reap of Delaware, president of the national organization of state officials who inspect hospitals and nursing homes, said she was shocked to see the proposal.

``These changes will, in effect, authorize drive-by surveys,'' said Reap, who is president of the national Association of Health Facility Survey Agencies. ``Inspectors could walk into a facility, spend a short amount of time, see if it's clean or dirty and if it smells OK. Fewer deficiencies would be cited. The federal government is weakening the inspection program, and it's very dangerous.''

The proposals are the latest twist in a 15-year struggle over the regulation of nursing homes. Efforts by President Reagan to relax the rules for nursing home care died in a storm of bipartisan protest. After a study by the National Academy of Sciences, Congress wrote stringent new standards into federal law in 1987. President Clinton blocked efforts last year by Republicans in Congress to repeal many of the federal standards.

Now, the Clinton administration is not trying to change the standards themselves. But experts in long-term care said the standards would be ineffective if the inspections were not rigorous.

The federal government pays for an ombudsman in each state to investigate the complaints of nursing home residents. Mark Miller, the ombudsman in Virginia, said the proposed changes were ``most definitely'' contrary to the interests of nursing home residents.

``The changes essentially emasculate the survey and enforcement process,'' Miller said.

Under one proposal, inspectors would not have to observe how medications are prepared and given to patients in some nursing homes that score well in the first round of a survey. Robyn Grant, president of the National Association of State Long-Term Care Ombudsman Programs, said this proposal was ``dangerous and irresponsible'' because nursing home residents received many drugs and medication errors and ``may have life-threatening consequences.''

The American Association of Retired Persons, the National Citizens' Coalition for Nursing Home Reform and other consumer groups echoed these concerns.