Date: Tuesday, July 21, 1998
FOR IMMEDIATE RELEASE
Contact: HCFA Press Office (202) 690-6145

Clinton Administration Announces New Initiatives To Improve The Quality Of Care In Nursing Homes

The Clinton Administration today announced a new nursing home care initiative to provide enhanced protections for nursing home residents and to target specific needed improvement in nursing home care.

Releasing an independent report that shows progress since strong nursing home enforcement regulations took effect in 1995, HHS Secretary Donna E. Shalala said additional steps will now be taken to address remaining problem areas, including those identified in the report.

The initiative announced today includes tougher enforcement of Medicare and Medicaid rules with strengthened oversight of nursing home quality and safety. Particular efforts will be aimed at preventing instances of bed sores, dehydration and nutrition problems.

"We must ensure that all Americans can rely on quality, compassionate care when they or a loved one requires nursing home care," Secretary Shalala said. "We have seen clear evidence of improvement, but we can and must do more to improve the lives of nursing home residents."

Since 1995, the Clinton Administration has been enforcing the toughest nursing home regulations in the history of Medicare and Medicaid. The new report to Congress notes significant improvements since 1995 in the quality of care delivered in nursing homes, including more appropriate use of physical restraints, anti-psychotic drugs, anti-depressants, urinary catheters and hearing aids. But the report also found a need for further improvements by states, nursing homes and others.

The steps unveiled Tuesday continue the Administration's efforts to improve the quality of life and care for nursing home residents. The Administration's initiative includes a wide range of new approaches to improve care:

• Nursing homes found guilty of a second offense for violations that harm residents will face sanctions without a grace period to allow them to correct problems and avoid penalties.
  
  
• Nursing home inspections will be conducted more frequently for repeat offenders with serious violations without decreasing inspections at other facilities. Inspection times will be staggered, with a set amount done on weekends and evenings.
  
  
• HCFA will instruct states to impose civil monetary penalties for each instance of serious or chronic violation. Until now, penalties have been linked only to the number of days a facility was out of compliance with regulations.
  
  
• Federal and state officials will focus their enforcement efforts on nursing homes within chains that have a record of non-compliance with federal rules.
  
  
• HCFA will provide additional training and other assistance to inspectors in states that are not adequately protecting residents. HCFA will enhance its review of the surveys conducted by the states and implement standard evaluation protocols.
  
  
• States that fail to adequately perform survey would lose federal funding for nursing home surveys. HCFA will contract instead with other entities to conduct survey and certification activities.
  
  
• HCFA will step up its review of nursing homes' ability to prevent bed sores, dehydration, and malnutrition. HCFA also will work with the Administration on Aging, the American Dietetic Association, clinicians, consumers, and nursing homes, to share best practices for residents at risk of weight loss and dehydration.
  
  
• State inspectors will review each nursing home's system to prevent, identify, and stop physical or verbal abuse, neglect, and misappropriation of resident property. A description of each nursing home's abuse prevention plan will be shared with residents and their families.
  
  
• HCFA will work with the HHS Inspector General and the Department of Justice to ensure that state survey agencies and others refer appropriate cases for prosecution under federal civil and criminal statutes, particularly cases that result in harm to patients.
  
  
• Individual nursing home survey results and violation records will be posted on the Internet to increase accountability and make information more accessible.

In addition to these administrative steps, the Administration will ask Congress for new legislative authority to help improve nursing home care and safety. Those requests include a requirement for criminal background checks of nursing home workers; allowing more workers with proper training to perform crucial nutrition and hydration functions; and to reauthorize a strong nursing home ombudsman program through HHS' Administration on Aging.

"We are confident that these actions will further improve the quality of residents' lives and our ability to detect problems with care in the future," HCFA Administrator Nancy-Ann DeParle said. "Nursing home residents will live with the dignity that they and their families deserve and expect." Resources for these efforts are included in the President's fiscal year 1999 budget request now pending in Congress.

About 1.6 million elderly and disabled people receive care in approximately 16,800 nursing homes across the United States. The federal government, through the Medicare and Medicaid programs, provides funding to the states to conduct on-site inspections of nursing homes participating in Medicare and Medicaid and to recommend sanctions against those that are violating health and safety rules.

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