Not wanted.

Providers fear fallout from HCFA's poster campaign

THE VERDICT IS STILL OUT REGARDING whether HCFA's latest effort to prevent neglect and abuse in nursing homes will be effective. But providers worry that the poster program conveys the wrong message.

Over a dark photograph of a despondent elderly woman is large white type warning: "Sometimes abuse is not so obvious. We need your help to spot abuse in nursing homes and report it." At press time in early July, HCFA planned to send 3,000 posters to facilities in 10 states: Arizona, Colorado, Georgia, Idaho, Louisiana, Massachusetts, Missouri, New Jersey, West Virginia, and Wisconsin. Participation in the program is voluntary.

On the poster is a space for the local phone number for reporting abuse or neglect and a container holding takeaway information cards designed to inform consumers about abuse "warning signs" including scratches, skin tears, depression, and malnutrition.

HCFA announced the initiative this spring, in conjunction with its campaign to reinforce federal and state standards through survey changes and penalties. The posters are intended to help nursing home workers and consumers identify and report signs of neglect and abuse.

Ninety days after HCFA's posters have been distributed to test sites, ombudsmen will evaluate the program, which the agency intends to roll out nationwide late this year.

"Most nursing homes provide quality care to their frail and vulnerable residents and want to make sure their residents don't become victims of abuse or neglect," said HCFA Administrator Nancy-Ann DeParle in a prepared statement about the initiative. "By displaying these posters, nursing homes can send a clear message that residents will get the respect and dignity they deserve."

Former state ombudsman Rick Abrams, president of the New Jersey Association of Health Care Facilities, disagrees. "The poster recycles stereotypes, broad-brushes everybody with the same guilt, scares patients and families, and makes a very negative statement to nursing facility employees," he says. Some providers also fear that the attached information cards may alarm some readers needlessly, since many of the problems listed can have a variety of causes other than abuse or neglect.

Asked about those concerns, one HCFA project insider said, "Providers would only assume it suggests guilt if they have guilty consciences."

According to HCFA, there will be no repercussions to providers who decline to display the posters.

In related moves, HCFA is adding a section on neglect and abuse to its Guide to Choosing a Nursing Home and preparing free consumer videotapes featuring Hugh Downs. Both the printed guide and the video are expected to be available this month. The video will be distributed through surveyors, ombudsmen, and some video stores.

Long term care representatives are launching their own educational campaigns. The American Health Care Association is offering members a training guide and video, Keeping Nursing Facility Residents Safe, to help staff recognize and respond to subtle forms of abuse, neglect, or mistreatment. "We need to teach staff how to safeguard resident dignity while helping residents with the most intimate types of care, such as bathing and toileting," says AHCA Vice President Linda Keegan. "We also need to help staff effectively and sensitively care for residents who exhibit difficult behaviors."

In a similar vein, the American Association of Homes and Services for the Aging is working with the Center for Advocacy for the Rights and Interests of the Elderly in Philadelphia to develop an abuse prevention program, for both members and nonmembers. BY