Date: Tuesday, July 21, 1998 FACT SHEET Contact: HCFA Press Office (202) 690-6145
Since 1995, the Administration has been enforcing the toughest nursing home regulations in the history of the Medicare and Medicaid programs. The Health Care Financing Administration has sharply increased the number of penalties levied on poor-quality nursing homes.
In a new report to Congress, HHS notes significant improvements in the quality of care delivered in nursing homes. But the report also finds a need for further improvement by States, nursing homes, and others. States have the primary responsibility for conducting on-site inspections of nursing homes and recommending sanctions on those who are providing poor quality care.
As part of its new initiative, the Administration will work with the States to improve their nursing home inspection systems; crack down on nursing homes that repeatedly violate safety rules; require nursing homes to conduct criminal background checks on all new employees; reduce the incidence of bed sores, dehydration, and malnutrition; and publish nursing home quality ratings on the Internet.
Overview: The Clinton Administration, continuing its strong commitment to ensuring high quality nursing home care for those who need it, announced new steps today to ensure that all nursing home residents are treated with dignity and compassion.
Background
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 home participating in Medicare and Medicaid and to recommend sanctions against those homes that are violating health and safety rules.
Clear Evidence of Improvement, But Problems Persist
According to a new report to Congress, there is clear evidence that current regulations are improving the health and safety of nursing home residents. Specifically:
While there are improvements attributable to the new regulations, the HCFA report makes clear that several areas require greater attention. Among those findings are:
As part of its strategy for continuous quality improvement in nursing homes, the Administration is adding new enforcement tools and strengthening Federal oversight of nursing home quality and safety standards. Resources for these activities are included in the President's fiscal year 1999 budget request currently before the Congress.
Stronger Enforcement Actions. HCFA will take several steps to toughen enforcement of nursing home safety and quality regulations; They are:
Combating Resident Abuse. 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 families. HCFA will also ask states to direct nursing homes to inquire about criminal convictions when interviewing potential personnel.
Prosecution of Egregious Violations. HCFA will work with the HHS Inspector General and the Department of Justice to ensure that state survey agencies and others refer appropriate cases to DOJ for prosecution under federal civil and criminal statutes, particularly cases that result in harm to individual patients. The OIG will also work with HCFA to conduct training for and provide technical assistance to Federal survey and certification staff and HCFA contractors on how to make appropriate referrals to the OIG.
Publishing Survey Results on the Internet. Individual nursing home survey results and violation records will be posted on the Internet to increase accountability and flag repeat offenders for families and the public.
Continuing Development of Minimum Data Sets. In June 1998, HCFA began collecting information on resident care through a national automated data system, known as a Minimum Data Set. This information will be analyzed over time, to identify potential areas of unacceptable care in nursing homes. HCFA will eventually use this data to assess nursing home performance in such areas as avoidable bed sores, loss of mobility, weight loss and use of restraints. This assessment will help HCFA and state surveyors better identify nursing homes for immediate onsite inspections, detect and correct systematic problems early, and ultimately help nursing homes improve quality.
New Legislative Actions
In addition to the administrative steps described above, the Administration will ask Congress to help improve nursing home care and safety in the following ways:
Criminal Background Checks. Ask Congress to establish a national registry of nursing home employees convicted of abusing residents and to require nursing homes to conduct criminal background checks on all potential personnel.
Nutrition and Hydration Therapy. Ask Congress to allow more types of nursing home employees, with proper training, to perform crucial nutrition and hydration functions.
Nursing Home Ombudsman Program. Ask Congress to reauthorize a strong long term ombudsman program through the Older Americans Act, administered by the Administration on Aging. Ombudsmen are an excellent source of information about poor-quality nursing homes and abuse or neglect of patients.
User Fees. In the President's FY 1999 Budget, HCFA requested legislation to collect a fee from Medicare providers and suppliers requesting participation in Medicare both for initial surveys and for recertification surveys. Under this proposal, HCFA would establish fee amounts that reflect the unit cost of a survey and the appropriate and reasonable costs incurred by State survey agencies for fee collection and associated activities. The fee amount would vary by state, since survey costs also vary by state. The user fee amount will include the Federal government's costs as well as those of the States. The fees received from this activity would be credited to HCFA's program management appropriation. The fee for initial surveys will be payable by the entity at the time of the survey. Fees for recertifications shall be deducted from amounts otherwise payable from a Trust fund to such entity.
Public vs. Private Accreditation
Finally, at Congress' request, the HCFA report also evaluated whether private accreditation of nursing homes would be preferable to the current system of public accreditation. HCFA secured an independent evaluation by Abt Associates, to assist in preparation of that portion of the report. The report concludes that the private Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey process was not effective in protecting the health and safety of nursing home residents. According to Abt Associates, granting "deeming" authority to JCAHO would place nursing home residents at serious risk. For example, in more than half of 179 cases where both HCFA and JCAHO conducted inspections of the same nursing homes, JCAHO failed to detect serious problems identified by HCFA.