The Advocate:
New Year Begins with Hearings and Reports

Nursing Home Issues Take Center Stage

The New Year began with a flurry of federal and state hearings and reports on various issues relating to nursing home care and consumer information. From an emotional Congressional hearing on abuse in nursing homes, to a California legislative hearing on nursing home closures and liability insurance, 2002 looks to be a busy year for nursing home advocates. Not surprisingly, most of the reports concluded that much more needs to be done to protect residents and more information needs to be made available to the public.

Staffing Study Leaked

Details of a long-delayed study on staffing by the Centers for Medicare and Medicaid Services (CMS) were published in the New York Times in February. The study, which was ordered by Congress in 1990 and has not yet been formally released, found that over 90% of the nation's nursing homes have too few staff to care for residents. Despite the "strong and compelling" evidence of the link between low staff levels and substandard care, the Bush Administration has announced its intent to postpone any further requirements on facilities other than the posting of staffing levels, in the hope that "nurse staffing levels may simply increase due to the market demand by an informed public."

The report noted that over 40% of nursing homes would have to increase staff by 50% or more to meet the minimum recommended staffing standard of 4.1 nursing hours per patient per day, at an additional cost of $7.6 billion. In essence, the report noted that it would cost the government too much money to meet the necessary standards, concluding, "...no action can be taken until there is further analysis of the 'tradeoff' between cost and quality improvement." If we spend more money, will we get better care? Probably not, given the state of the corporate nursing home industry. But if we require more money be spent on staffing, we will certainly have a better chance of meeting the goal.

Nursing Home Closures, Bankruptcies and Liability Insurance

Is there a link? Not according to a study commissioned by California's Senate Health Committee. Researchers with UC San Francisco testified at a joint hearing in Sacramento on March 6, 2002 that poor quality, not financial insolvency, was the primary reason for nursing home closures in California. The study's authors also noted that the state has insufficient information on nursing home finances to provide adequate scrutiny. The study found that of the 32 nursing homes that closed between 1995 and 2001, only 2 were preceded by a bankruptcy.

CANHR's Executive Director testified that both the nursing home industry and the Department of Health Services have failed to protect nursing home residents from the, often fatal, consequences of transfer trauma. Ms. McGinnis noted that there is a crisis in California's nursing homes, but the crisis is in care—not liability insurance. Michel Stimel-Nelson, whose mother was abruptly transferred when Doctors Medical Center-Pinole closed its doors, testified about the trauma suffered by her mother due to the total lack of any relocation services. In addition, two nurses' aides who worked at Sereno Care Center in Vallejo testified about the adverse effects on residents who were moved in July 2001 against their wills to facilities far from families and friends.

The second part of the hearing dealt with the issue of increasing costs of nursing home liability insurance, with the nursing home industry blaming the increased number of elder abuse lawsuits, rather than substandard care, for the increase. Both the for-profit and non-profit representatives called for the prohibition of the admissibility of survey reports in civil litigation actions. The survey information is often used to establish a pattern and practice at a facility. Without this information, any abuse or neglect case can look like an isolated incident.

Russell Balisok, an elder law attorney from Los Angeles and a member of CANHR's Board of Directors, testified that "...there is no legitimate insurance crisis on the table today. This crisis has...been contrived by the nursing home industry, which somehow manages with a straight face to assert that the cost of liability insurance premiums has cut into their profits..."

The hearing concluded with a request for more information from the Department of Health Services and the Insurance Commission.

Two More Reports

On February 21, 2002, Congressmen Henry Waxman (D-LA) and Charles Grassley (R-Iowa), released a study sharply critical of the CMS "nursing home compare" web site, which posts information about annual surveys of nursing homes. Their report noted that the Nursing Home Compare site does not include information on violations documented when surveyors respond to specific complaints, and that nearly 60% of all violations that represent "immediate jeopardy" to patients and nearly 41% of violations that show "actual harm" to patients are not included on the site. On a temporary basis Waxman and Grassley are making this information available to the public in an effort to show CMS how it can be done. www.house.gov/reform/min

Last, but clearly not least, in March 2002, the U. S. General Accounting Office released another report on abuse in nursing homes. Titled, "Nursing Homes: More Can Be Done To Protect Residents," the report concluded that few allegations of abuse are prosecuted, and that protections at both the state and federal level are insufficient to protect residents from abuse. The number of the report is GAO-02-312. A copy can be downloaded from CANHR's web site here.

From the March 2002 Advocate

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