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Big stakes in targeting nursing homes.

Nursing facility operators are feeling the sting of public discontent with nursing home care this summer. One report has followed another, from Time and Newsweek magazines, to CBS's 48 Hours, to the HCFA report on deemed status, and now the General Accounting Office (GAO) has published "Care Problems Persist Despite Federal and State Oversight."

The report opens with the recognition that, "Nursing homes play an important role in the health care system of the United States. Among other services, they provide skilled nursing and supportive care to older individuals who do not need the intensive medical care provided by hospitals, but for whom receiving such care at home is no longer feasible. An estimated 43% of Americans who passed their 65th birthday in 1990 will use a nursing home at some time in their lives. In 1997, there were more than 17,000 nursing homes in the United States with over 1.7 million beds. The federal government, through the Medicare and Medicaid programs, paid these homes nearly $28 billion in 1997."

In response to allegations that 3,113 California nursing home residents had died as a result of "malnutrition, dehydration, and other serious conditions for which they did not receive acceptable care," the GAO investigators were asked to "(1) examine, through a medical record review, whether these allegations had merit and whether serious care problems currently exist; (2) review the adequacy of federal and state efforts in monitoring nursing home care through annual surveys; and (3) assess the effectiveness of federal and state efforts to enforce sustained compliance with federal nursing home requirements."

The report summary states that, "Overall, despite the federal and state oversight infrastructure currently in place, certain California nursing homes have not been and currently are not sufficiently monitored to guarantee the safety and welfare of their residents." The GAO investigators also found that "surveyors can miss problems that affect the safety and health of nursing home residents and that even when such problems are identified, enforcement actions do not ensure that they are corrected and do not recur." The report further specifies that the investigative team "found such care problems as inadequate intervention by the nursing home to prevent dramatic, unplanned weight loss and failure to properly treat pressure sores that became infected and toxic."

I thought long and hard about the commentary I wanted to offer about the GAO report. I don't want to be an apologist for the nursing home industry, nor for state and federal regulators, nor for the Clinton administration, nor for congressional Republicans. What I do want to do is try to understand where a reasonable line can be drawn between accurately pointing out care problems that individual nursing homes clearly must address and recklessly offering up an entire industry for public sacrifice.

My consulting business takes me to thousands of nursing homes across the United States, and I have seen some very poor care practices and some very good care practices. As a former state nursing home regulator, I have also seen some very poor regulatory practices and some very good ones. I have voted for both Democrats and Republicans in state and federal elections, and have seen some very poor laws enacted and some very good laws enacted. Despite these mixed realities, I think that the nursing home industry is an easy target for almost anyone to shoot at. After all, it is hard to grow old and sick and not be able to stay in your home until you die. It is hard for daughters and sons to live far away from their mothers and fathers and know that they cannot provide needed care to their parents. It is hard to be a nursing assistant when there isn't always time to care for each resident and when your wages cannot support a family. It is hard to be a state surveyor and witness the occasional results of poor quality care. It is hard to be a nursing home resident's advocate and realize that you can't help each resident as much as you wish. It is hard to be an owner of a high-quality nursing home when you can't hire enough staff or pay for all the services you wish your residents could enjoy.

And yet, instead of agreeing about the problems that we all know still exist in pockets of the long-term care industry and joining forces to solve them, we have all decided that it is "someone else's fault."

Let us not forget that this is a congressional election year, and that congressional Republicans and the Clinton administration have been at each others' throats all year long. The administration's Office of the Inspector General (OIG) issues reports, Congress holds hearings, the president upstages Congress by holding a press conference, Congress one-ups the president by releasing GAO reports, ad nauseam. Instead of keeping score on "who's winning," I guess I want to know what we, all of us, intend to do about the care problems that arise in these reports.

I don't really know if all California nursing homes look like the homes portrayed in the report, I don't know if all U.S. nursing homes look like California homes, and I don't know anyone else who knows for sure, either. What I do know is that there are some nursing homes delivering really good care, some nursing homes doing a decent job and some nursing homes doing a rotten job. How can we collectively offer the knowledge, education, guidance and support to help every nursing home do at least a decent job? If there are still homes that don't want to improve or just can't seem to do so, then let's "have at them." But while we are at it, let's also "have at" the state and federal regulators and resident advocates who don't want to improve or just can't seem to do so, either.

Maybe we should start by identifying, communicating and reinforcing top-notch care practices within the nursing home industry, such as state-of-the-art pressure sore prevention and treatment protocols, and straight- from-the-heart feeding and dining practices that encourage residents to eat what they like, how much they like and when they like. Then we could build and implement a better national survey system that objectively and frequently evaluates nursing homes' quality performance. Next we could construct a national system of enforcement measures and incentive programs that would simply punish bad acts and reward good deeds. All I know is that if we continue down this path of mutual destruction, we aren't going to have an "estimated 43% of Americans who passed their 65th birthday in 1990" who will use a nursing home at some time in their lives, we won't have any staff that want to work in nursing homes, and we won't have "more than 17,000 nursing homes in the United States with over 1.7 million beds" left to "provide skilled nursing and supportive care to older individuals who do not need the intensive medical care provided by hospitals, but for whom receiving such care at home is no longer feasible."
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Author:Klitch, Beth A.
Publication:Nursing Homes
Date:Oct 1, 1998
Previous Article:Criminal background checks bill advances in Congress.
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