What's next?

Washington continues campaign to improve care

STAFFING NEEDS AND STATE SURVEY AGENcies were the focus of Congress's most recent hearings on nursing home quality. And behind the scenes, the Department of Health and Human Services (HHS) plans to implement innovative demonstrations designed to improve the quality of care in nursing homes.

In early November, the Senate Special Committee on Aging held one hearing to air a November 4 General Accounting Office report, "Nursing Home Care: Enhanced HCFA Oversight of State Programs Would Better Ensure Quality." The report charges that HCFA's 10 regional offices' monitoring of state survey agencies is "unreliable." The GAO cited one instance where a follow-up federal survey found 24 violations missed by state inspectors, including a patient who had lost 19 percent of his body weight.

The Senate committee also delved into staffing in a two-hour forum titled "Nursing Home Residents: Short-Changed by Staff Shortages." Senator Charles Grassley (R-Iowa) said he wants the GAO to determine how much of the $39 billion the federal government will pay nursing homes goes to staffing.

"Senator Grassley continues to feel there are still a lot of problems in nursing homes," reports one of his staffers. "He's frustrated that it's difficult to get a handle on the extent of the problem because the data recording and survey system aren't up to par." In addition to requesting a GAO study on staffing in nursing homes, the Senator may request a follow-up report on how California nursing homes are faring, the staffer adds.

Advocates for the elderly couldn't agree with Grassley more. "The National Citizens' Coalition for Nursing Home Reform wishes more congressional representatives would join him in being more vocal about the consistently poor conditions in nursing facilities," says Elma Holder, founder of the advocacy group.

HCFA and the Administration on Aging are joining forces to implement projects to improve nursing home quality of care. According to Edwin Walker, director of the AoA's Office of Program Operations and Development, the two agencies will oversee demonstrations designed to improve residents' nutrition and hydration, foster community involvement in nursing homes, and prevent elder abuse in such settings. "We also will be reviewing the adequacy of materials available for consumers to evaluate nursing facilities," says Walker. The projects are funded by $450,000 in HHS grants, effective October 1.

Have providers grown weary of the quality mantra? "The American Association of Homes and Services for the Aging supports the continuing focus on quality of care," says Barbara Gay, AAHSA's director of congressional affairs. "We continue to work very cooperatively on task forces and other initiatives." Still, the group views the idea of a staffing mandate as "somewhat misdirected. It ignores the other innovative things that providers can do to improve the quality of care."