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Records of the Office of Speechwriting (Clinton Administration)
Joshua Gottheimer's Files
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JOSH GOTTHEIMER BOX #8
Nursing Homes, 9/8/00
National Italian-American Foundation, 10/24/00
Political Events, 10/00
Patients' Bill of Rights, 9/14/00
Radio Address - Patients' Bill of Rights, 5/15/00
Patients' Bill of Rights, 5/11/00
Radio Addresses/Paid Leave, 6/9/00
The Pope
Presidents at Princeton, 9/25/00
Rahal Fundraiser, 6/4/99
Detroit Red Wings Champions, 1/8/99
ENCLOSURES FILED OVERSIZE ATTACHMENTS 18997
NAM /6201
Nursing Homes
Aging/Seniors
Medicare/Prescript. Drugs
September 8, 2000.
Devorah R. Adler
09/14/2000 09:16:56 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: problem statement on nursing homes
MORE MUST BE DONE TO IMPROVE QUALITY OF CARE IN NURSING HOME.
About 1.6 million older Americans and people with disabilities receive care in approximately
17,000 nursing homes. The Clinton-Gore Administration has made the health and safety of
nursing home residents a top priority - putting into effect the toughest nursing home regulations
in the history of the Medicare and Medicaid programs. Most nursing homes provide high quality
care to the frail and vulnerable elderly individuals they serve. However, more must be done.
Over fifty percent of nursing homes do not maintain the minimum staffing levels necessary
to ensure the delivery of quality care. The Health Care Financing Administration recently
released a report demonstrating that patients are significantly more likely to develop pressure
sores, lose weight, and undergo unnecessary hospitalizations once staffing ratios fall below the
level of two hours per resident for nurse aides daily. That amount of time is the minimum
necessary for nursing staff to reposition residents and change wet clothes; assist residents with
toileting; provide feeding assistance; provide morning care; and encourage or assist residents
with exercise as appropriate.
Poor staffing results in many nursing home residents becoming malnourished or
dehydrated, unnecessarily increasing their risk of infection and impaired mental function.
Certified nursing assistants (CNAs) typically help seven to nine residents with their daytime
meals, and as many as 12 to 15 residents with their meals in the evening. Residents are fed
quickly or forcefully, and sometimes not fed at all. A recent study by the Commonwealth Fund
estimates that over 30 percent of nursing home residents are malnourished, placing them at risk
for infections, pressure sores, depression, confusion and impaired cognition, and hip fractures.
Compared with well hydrated and nourished residents, these nursing home patients have a
five-fold increase in mortality in the hospital.
Nursing home staff often need additional training to carry out their assigned duties
adequately. A 93 percent turnover rate in CNAs compounds the problems caused by inadequate
numbers of nursing home staff. A newly hired CNA may not know how to care for a resident
already at risk for malnutrition and dehydration. A shortage of nursing supervisors leaves CNAs
to do the best they can without assistance from professionals.
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Public Papers of the Presidents
Public Papers of the Presidents
July 22, 1999
CITE: 35 Weekly Comp. Pres. Doc. 1495
LENGTH: 2571 words
HEADLINE: Interview With Mike Cuthbert of "Prime Time Radio" in Lansing, Michigan
BODY:
Mr. Cuthbert. Hi. I'm Mike Cuthbert in Lansing, Michigan; welcome back to "Prime Time Radio." As
we promised you, we'll present full and indepth discussion of the proposed changes in our health
care system, with particular focus on Medicare, as the year 2000 campaign begins. But the
discussion of Medicare has not waited for the campaign to start, as you know.
With us here in Lansing, Michigan, is President Clinton, who just finished having a discussion with
folks from Michigan on Medicare. Mr. President, welcome to "Prime Time Radio."
The President. Thank you. I'm glad to be here.
Health Care Reform and Medicare
Mr. Cuthbert. Back in 1992, in a long discussion about health care reform, you stopped the
proceedings and you said, very firmly, "Without wholesale health care reform, we have no hope of a
stabilized, long-term economic recovery." The economic recovery has been long, but health care
reform didn't happen. How does that impact on the Medicare plans?
The President. Well, the one thing that I didn't believe that has happened that was good is that we
had I didn't believe that we could get health care inflation down to the general rate of inflation
without moving to universal coverage. And I think what happened was we got all the benefits of
managed care in the early years and we were very fortunate to do so -- but now we're also living
with the burdens, as you hear all the horror stories that prompted me to push the Patients' Bill of
Rights.
So I think where we are now is where I am, at least, is I'm trying to extend health insurance
coverage to discrete groups that don't have it, to try to improve the way the system works and do
more preventive care, and try to modernize and stabilize the Medicare program. For example, we, 2
years ago, provided for funds to cover 5 million children who don't have health insurance. In this
Medicare reform package, we have a proposal to allow people between the ages of 55 and 65 who
don't have insurance to buy into Medicare.
But the most important thing we can do now is to stabilize Medicare financially by putting some more
cash into it over the next 10 years, by adopting the most modern practices, and by providing more
preventive services free, like testing and screenings for osteoporosis and cancer and other things,
and adding a prescription drug benefit that we can afford.
So I think that this will be a very good, balanced package. It's completely voluntary. It gives seniors
another choice on Medicare. But the most important thing is it stabilizes Medicare for 27 years, and
that's very, very important, because all the baby boomers start retiring in well, they'll start retiring
sooner, but the baby boomers start turning 65 in 2011. The oldest baby boomers are already in the
AARP. That seems impossible to me, but there it is. [Laughter]
So to me, it's very, very important that we not spend too much of this surplus on a tax cut before we
do the first things first, before we stabilize Social Security, stabilize Medicare and reform it. And
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fewer people working and more people getting tax money. But over the 10 year period, the surplus
estimate is almost certainly right.
Nursing Homes
Mr. Cuthbert. Can we turn for a moment to nursing homes? They've been running ads recently in
major papers across the country about the effects of the Balanced Budget Act amendment cuts, some
$ 2.6 billion. My mother is in a nursing home, and I can see the effects on her less exercise
periods, more difficulty getting service, more turnover in staff. How would your Medicare reforms and
stabilization affect that problem, which appears to be growing?
The President. Let me, first of all, describe what the problem was. When we passed the Balanced
Budget Act, we agreed with the Republicans, we would try to achieve a certain level of savings in the
Medicare program, which funds nursing homes and hospitals and home health and all that. We then
produced, from our health care experts who deal with all the providers, the list of changes we
thought were necessary to achieve that level of savings. The congressional budget people said they
thought it would require more changes than that. So under the law, we had to do it. They didn't do
this on purpose. What happened was they cut more than was necessary; they realized much bigger
savings than they estimated. To that extent, our surplus is larger than it otherwise would be.
And we believe that it is mostly because we did too much that some of our nursing homes and
hospitals and other programs are in trouble. And what I have done in extending, in taking the
savings of the Balanced Budget Act for '97 out another 10 years, we have taken out of that some of
the things we put in last time. And we have also set aside a fund of 7.5 billion that can be allocated
by Congress to the hospitals and the nursing homes that have been particularly disadvantaged by
this, to try to alleviate this quite difficult financial situation a lot of them found themselves in.
Prescription Drug Coverage
Mr. Cuthbert. Much of the discussion here in Lansing concerned the prescription program that so
featured part of your Medicare stabilization program. I have not, in all my reading and listening,
been able to discern too much opposition to that. Have you?
The President. Well, I think there's opposition. The only opposition I'm aware of now is there are
some in the Congress who are opposed to it, who say that mostly the Republicans who want to use
the money for the tax cut they basically say, "Well, two-thirds of our seniors already have drug
coverage." But as I pointed out today we produced our report today only about 24 percent have
really good private sector drug coverage related to their former employment. The other coverage --
either they don't have coverage at all, a third of them don't have any coverage; and the rest of them
have coverage that's too expensive and too unreliable and is shrinking every year. Some of them
have coverage that has 1,000 ceiling. And the most rapidly growing drug coverage has a $ 500
ceiling. Well, for people with drug problems, you know, if they have 2,000, 3,000, $ 4,000 worth
of bills every year, that's not much coverage.
So we think that this is a purely voluntary program, but we think that people ought to have
another choice. They ought to have the option to have more adequate drug coverage at a
considerably lower price than you get in the Medigap policy. Medigap is just too expensive. And it
also goes up as people get older. And the older you get, the less able you are to pay, normally, and
the higher the premium is. So I feel that this is quite a good thing to do.
Mr. Cuthbert. Speak to the fears of the people who say, "If this prescription drug program comes in,
my company will cut drug prescription benefits."
The President. Well, we were concerned about that, because the 24 percent that have this drug
coverage already, some of them actually have programs that are more generous than the one we're
bffering, and we don't want to mess that up. So we have offered, as a part of this program, quite
generous subsidies to employers to continue such programs. And I think, actually, it might be that
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THE WHITE HOUSE
Office of the Press Secretary
(Bedford, Massachusetts)
For Immediate Release
April 17, 1999
RADIO ADDRESS OF THE PRESIDENT
TO THE NATION
Roseville Recreation Center
Roseville, Michigan
THE PRESIDENT: Good morning. Of all the duties we owe to one
another, our duty to our parents and grandparents is among the most
sacred. Today I want to talk about what we must do to strength the
safety net for America's seniors, by cracking down on elder crime,
fraud and abuse.
For more than six years, we've worked hard to keep our families
and our communities safe. And we've made remarkable progress, with
violent crime dropping to its lowest levels in 25 years. For elderly
Americans who once locked themselves into their homes in fear, the
falling crime rate is a godsend.
But the greatest threat many older Americans face is not a
criminal armed with a gun, but a telemarketer armed with a deceptive
rap. And our most defenseless seniors, those who are sick or disabled
and living in nursing homes, cannot lock the door against abuse and
neglect by people paid to care for them.
So America's seniors are especially vulnerable to fraud and
abuse. Therefore, we must make special efforts to protect them.
That is why the 21st century crime bill I'll send to Congress
next month includes tough measures to target people who prey on
elderly Americans. First we must fight telemarketing fraud that robs
people of their life savings and endangers their well-being. Every
single year illegal telemarketing operations bilk the American people
of an estimated $40 billion. More than half the victims are over 50.
That's like a fraud tax aimed directly at senior citizens.
Last year we toughened penalties for telemarketing fraud, but we
should stop scam artists before they have a chance to harm America's
seniors. My crime bill will give the Justice Department authority to
terminate telephone service when agents find evidence of an illegal
telemarketing operation or a plan to start one. This new law will send
a message to telemarketers, if you prey on older Americans we will cut
off your phone lines and shut you down.
Second, we must fight nursing home neglect and abuse. Nursing
homes can be a safe haven for senior citizens and families in need.
To make sure they are, we've issued the toughest nursing home rules in
history, and stepped up investigations at facilities suspected of
neglect and abuse. But when one out of four nursing homes in America
does not provide quality care to their residents, and when people
living in substandard nursing homes have as much fear from abuse and
neglect as they do from the diseases of old age, we must do more.
My crime bill gives the Justice Department authority to
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investigate, prosecute and punish nursing home operators who repeatedly
neglect and abuse their residents. With prison sentences of up to 10
years and fines of up to $2 million, these new provisions make clear we
will settle for nothing less than the highest quality care in America's
nursing homes.
Third, we must fight health care fraud. Every year health care
fraud costs American taxpayers billions of dollars, draining resources
from programs that benefit our seniors. As Vice President Gore
announced last month, my crime bill will allow the Justice Department
to take immediate action to stop false claims and illegal kickbacks,
and give federal prosecutors new tools to tackle fraud cases.
Finally, we must fight retirement plan rip-offs. My crime bill
will toughen penalties for people who steal from pension and retirement
funds. To borrow a line from Senator Leahy, who is working closely
with us to strengthen the safety net for our seniors, the only people
who should benefit from pensions are the people who worked for a
lifetime to build them.
I look forward to working with Congress in the coming days to
give our senior citizens the security they deserve. That is
an
important part of our efforts to protect our parents and our
grandparents, to advance our values and build a stronger America for
the 21st century.
Thanks for listening.
END
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THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
March 25, 1999
PRESIDENT CLINTON UNVEILS NEW PROTECTIONS
FOR NURSING HOME RESIDENTS
Signing Ceremony for the Nursing Home Resident
Protection Act of 1999
how much
The Oval Office, The White House
March 25, 1999
propere or \sot year?
Today, President Clinton will sign the Nursing Home Resident Protection
Act of 1999, which prohibits nursing homes that decide to withdraw from
the Medicaid program from expelling or transferring current residents
who are enrolled in Medicaid. He will also urge Congress to pass the
nursing home quality enforcement provisions in his FY 2000 budget, which
provide over $309 million to prevent nursing home resident abuse and
neglect, an unprecedented 31 percent increase ($74 million) over last
year's funding level.
A BIPARTISAN EFFORT TO PROTECT VULNERABLE OLDER AMERICANS The Nursing
Home Resident Protection Act of 1999 provides critical new protections
re'e
to the hundreds of thousands of nursing home patients who rely on
intedued
Medicaid to pay for their care Current law allows nursing homes tomp
reduce or eliminate the portion of their facilities that are available
leplats
to Medicaid patients as long as the residents are given 30 days notice
to
before they will have to leave the facility. This legislation,
sponsored by Congressman Michael Bilirakis (R-FL) and Congressman Jim
Davis (D-FL), together with Senator Bob Graham (D-FL), prohibits nursing
homes that decide to stop accepting Medicaid patients from evicting
those residents who currently depend on the program to pay for their
care. It was approved by an overwhelming margin (398-12) in the House
and by unanimous consent in the Senate. Two-thirds of nursing home
residents depend on Medicaid to pay for their nursing home care, and
with nursing home costs averaging $40,000 a year, about half of the
residents who begin by paying for their care with their own money and
health insurance must turn to Medicaid within three to five years.
AN UNPRECEDENTED INVESTMENT IN QUALITY CARE FOR NURSING HOME RESIDENTS
President Clinton has proposed an unprecedented investment of $309
million for nursing home quality enforcement activities in his FY 2000
budget, an increase of 31 percent ($74 million) over last year's funding
level. In addition to providing an additional $47 million for state
survey and certification activities, an increase of 21.5 percent over
last year's funding level - the proposals in the President's budget will
provide additional assurances that nursing-home residents will receive
the quality care that they deserve and expect, by: 1) requiring nursing
homes to conduct criminal background checks of employees; 2)
establishing a national registry of workers who have been convicted of
abusing residents; and 3) allowing more types of nursing home workers
with proper training to help residents eat and drink during busy
mealtimes. President Clinton's investment in ensuring high quality care
for these vulnerable older Americans stands in stark contrast to the
proposed Republican budget, which cuts funding for nursing home quality
enforcement activities by 10 percent.
BUILDING ON A LONGSTANDING COMMITMENT TO PROVIDING QUALITY HEALTH CARE
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TO NURSING HOME RESIDENTS The Clinton Administration has made ensuring
the health and safety of nursing home residents a top priority and has
issued the toughest nursing home regulations in the history of the
Medicare and Medicaid programs. Since 1993, President Clinton has taken
steps to ensure that all nursing home residents receive good quality
care, including: 1) increasing monitoring of nursing homes to ensure
that they are in compliance; 2) requiring states to crack down on
nursing homes that repeatedly violate health and safety requirements;
and 3) changing the inspection process to increase the focus on
preventing bedsores, malnutrition, and resident abuse. Most recently,
the President has directed HHS to: 1) create higher civil monetary
penalties for quality violations and provide that these penalties will
be more quickly determined and imposed; 2) require states to investigate
resident complaints within 10 days; and 3) begin a national campaign
this spring to educate the public about the risk of malnutrition and
dehydration and preventing abuse and neglect.
###
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nursing homes, with tough, immediate fines for nursing homes that provide inadequate or even
abusive care, a National Registry for nursing home workers known to be abusive, and
unprecedented efforts to prevent poor nutrition and other health concerns that threaten people
in nursing homes.
You and I have fought to improve the health and security of older Americans in many
ways. Today, I ask you to continue to work with me to reauthorize the Older Americans Act,
that has funded Meals on Wheels, and many other programs to help older Americans live
longer, healthier, more independent lives. I ask you to continue to work with me to oppose
the public housing bill currently before the House of Representatives, misguided legislation
that would devastate tens of thousands of our nation's hardest pressed senior citizens, making
it nearly impossible for them to obtain public housing when they need it the most. Finally, I
want to thank NCSC for working with us to deal with the Year 2000 computer problem, by
reaching out to senior citizens to enlist their help in meeting this important challenge.
In all of these ways, working together, putting our nation's progress ahead of
partisanship, putting our people ahead of politics, putting our unity ahead of division, we are
building a better, stronger world for our children, for our grandchildren. I thank you for
everything you are doing to build that brighter future -- and for everything you will do in the
years to come.
###
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Terms: clinton and care for seniors and date(geq (1/1/98) and leq (9/8/00)) (Edit Search)
Chicago Tribune, September 6, 2000
Copyright 2000 Chicago Tribune Company
Chicago Tribune
View Related Topics
September 6, 2000 Wednesday, CHICAGO SPORTS FINAL EDITION
SECTION: News; Pg. 1; ZONE: N
LENGTH: 1428 words
HEADLINE: BUSH SEEKS PRIVATE ROLE IN MEDICARE;
$200 BILLION PLAN INCLUDES STATE-BASED PRESCRIPTION PROGRAM
BYLINE: By Rick Pearson and Jeremy Manier, Tribune Staff Writers. Tribune staff writers Monica
Davey and Ray Long contributed to this report.
DATELINE: ALLENTOWN, Pa.
BODY:
Texas Gov. George W. Bush issued his response to Vice President Al Gore's challenge to provide
prescription drugs and health care for seniors on Tuesday, proposing a $200 billion Medicare plan
that would increase government spending while expanding the role of private insurers.
"Keeping the promise of Medicare and expanding it to include prescription drug coverage will be a
priority of my administration," Bush said while outlining his plan at a senior center.
By earmarking billions of dollars to expand Medicare, Bush followed Gore's tactic of moving toward
the political center on health care. The Republican nominee also hoped to reverse public opinion
polls that indicate voters prefer Gore's policies on senior health care.
But Bush's plan also reflects an essential difference of opinion between the candidates on the
proper role of government in medical care. While the vice president has proposed expanding the
current federally run program to include coverage for prescription drugs, the Texas governor wants
to decrease the government's role by bringing in more private insurers to provide benefits to the
more than 40 million elderly citizens who receive Medicare.
Bush supporters say his plan would unleash market forces that should offer seniors more choices.
Gore's $253 billion proposal emphasizes broad coverage and the security of an established
program.
The Bush plan would pay for prescription drugs for seniors whose income is less than 135 percent
of the federal poverty level, or about $11,300 for single seniors and $15,200 for married couples.
Seniors who make between 135 percent and 175 percent of the poverty level would get partial
subsidies.
Funding would start in 2001, in a four-year, $48 billion direct grant to the states to offset
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prescription drug costs. Bush also would allocate $110 billion over the next 10 years to restructure
Medicare, changing it from a single nationwide insurer to a clearinghouse that would contract with
private insurers and HMOs to provide physician and hospitalization benefits.
Bush believes such a program would increase the choices open to patients while reducing federal
bureaucracy.
"When you need a driver's license, bureaucracy can be frustrating," Bush said. "When you need
medical care, bureaucracy can be a hazard to your health."
Gore said a greater reliance on HMOs would alienate seniors who like the security of traditional
Medicare, which guarantees equal coverage nationwide. HMOs, he noted, provide varying levels of
service.
During a campaign stop Tuesday in Columbus, Ohio, Gore said Bush's plan would "force seniors
into HMOs even if they didn't want to go to them."
"We've seen there are a lot of problems with the way companies, HMOs, have been treating all
Americans," Gore said.
Although the Gore and Bush plans would provide about the same coverage to poor seniors, Gore
officials said their proposal would help the middle class more.
Gore's plan would pay 50 percent of drug expenses for seniors whose income exceeds 150 percent
of the federal poverty level, while Bush's would provide 25 percent of the drug costs for those who
make 175 percent of the poverty level.
Another difference is the two plans' coverage of catastrophic drug costs. Bush's proposal would pay
for any costs above $6,000 a year, while Gore's plan would cover any expenses exceeding $4,000.
The Bush campaign said its plan focuses on the poorest seniors, those who most need relief.
Gore aides and Clinton administration officials said that nearly half of the nation's seniors who
don't have drug coverage make more than 175 percent of the poverty level. The Bush plan, Gore
said Tuesday, "leaves millions of seniors without any prescription coverage--middle-class seniors."
It is also unclear whether private insurers would choose to join Bush's prescription drug plan.
The only way seniors currently can get prescription drugs through Medicare is with HMOs
participating in the Medicare+Choice program. Poor profits in some areas of the country have led
HMOs to drop nearly 1 million seniors from such programs, including thousands in the Chicago
area.
"The nice thing about Medicare is that it's available everywhere, no matter what," said Kenneth
Thorpe, a professor of health policy at Emory University and former Clinton administration
adviser. "I think our experience with Medicare+Choice raises serious concerns about how the
Republicans have designed their plan."
Many of Bush's proposals resemble legislation advanced by Sens. John Breaux (D-La.) and Bill Frist
(R-Tenn.). Aides, for Frist predicted private companies would participate in a prescription drug plan
because they could not pass up the huge potential market of Medicare recipients.
Indeed, one industry group that has given a lukewarm response to other Republican proposals
reacted positively to Bush's plan.
Officials with the Health Insurance Association of America have said they would oppose any plan
that calls for private insurers to cover drugs alone for seniors in the Medicare program. Such a plan
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would not be as profitable as a comprehensive benefits package, and would attract primarily the
sickest--and therefore most expensive--patients.
Yet association spokesman Richard Coorsh said Tuesday that Bush's plan to expand the role of
private insurers could work. It also incorporates the group's proposal of giving block grants to
states as an intermediate step.
"We believe this proposal would give help to the seniors who need it the most, and it would do so
faster than any proposal offered up so far," Coorsh said.
Bush officials said one advantage of their plan is that it would provide immediate relief to seniors
in 2001, unlike the Gore plan, which would not start until 2002 and take until 2008 to phase in
completely.
The Gore campaign said both plans would probably start sometime in 2002, and noted that some
states might choose not to participate during the first four years of Bush's block grants.
Such grants would be a crucial element of the Bush plan, said Mark Pauly, a professor of
health-care systems at the University of Pennsylvania's Wharton School of Business.
"It would be a transition strategy to wean people off the traditional Medicare approach, rather than
a sudden bucket of cold water," said Pauly, a former adviser to Bush's father when he was
president.
Both candidates' proposals rely on continued national economic prosperity to overhaul Medicare.
Gore's prescription drug plan would cost at least $253 billion over 10 years.
Bush's basic Medicare changes would cost $158 billion, plus $40 billion for Medicare providers
whose reimbursement packages were cut as part of the 1997 Balanced Budget Act. Gore also has
proposed to restore those cuts.
Contending that the Clinton-Gore administration has been a "roadblock to reform," Bush on
Tuesday used the Medicare issue as an argument for political change.
"Vice President Gore talks about the 'people' versus the 'powerful.' For eight years, he has been the
powerful and on health care, he has little to show for it," Bush said, eschewing his usual practice of
not referring to his opponent by name.
Donna Shalala, secretary of Health and Human Services, responded that the administration has a
strong record on Medicare, having extended the program's projected life until at least 2025. When
Clinton and Gore took office, projections were that Medicare would be bankrupt by 1999.
Shalala also criticized Bush's approach of giving block grants to the states.
"If you live in a state that opts not to participate, you are left out in the cold," Shalala said
Illinois is among the 22 states that already offer some form of drug benefit. As Texas governor,
Bush has not pushed for a prescription-drug program for seniors.
An underlying weakness of Bush's health plan, according to Gore's campaign, is that the
Republican is counting too heavily on government surpluses. But Bush aides say they have used
the most conservative numbers available from the Congressional Budget Office in putting together
their spending program.
Despite their differences over funding and coverage of seniors, the real gulf between Gore and
Bush on health care is one of philosophy, said Robert Blendon, professor of health policy and
political analysis at Harvard University.
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"The question is whether Medicare does a better job of giving services directly, or if private health
plans would do better," Blendon said. "In both cases, I think seniors would be better off than they
are now."
CAMPAIGN2000.
GRAPHIC: GRAPHICGRAPHIC (color): Comparing Medicare plans; COST; MEDICARE REFORM;
LOW-INCOME SENIORS; PRESCRIPTION DRUG BENEFITS; CATASTROPHIC MEDICARE COSTS; -
See microfilm for complete graphic.
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Los Angeles Times September 6, 2000, Wednesday,
Copyright 2000 / Los Angeles Times
Los Angeles Times
View Related Topics
September 6, 2000, Wednesday, Home Edition
SECTION: Part A; Part 1; Page 1; National Desk
LENGTH: 2158 words
HEADLINE: CAMPAIGN 2000;
BUSH OFFERS PLAN ON HEALTH CARE;
CAMPAIGN: HE PROMISES TO OVERHAUL MEDICARE AND GIVE SENIORS DRUG COVERAGE.
BYLINE: MARIA L. La GANGA and RONALD BROWNSTEIN, TIMES STAFF WRITERS
DATELINE: ALLENTOWN, Pa.
BODY:
Charging that the Clinton administration has reneged on its promise to mend Medicare, Texas
Gov. George W. Bush on Tuesday proposed a $ 198-billion overhaul of health care for seniors
that would provide at least some prescription drug coverage for all elderly Americans.
Bush would spend $ 110 billion over 10 years to "modernize" the 35-year-old Medicare system,
which helps pay for the health care of 39 million elderly and disabled Americans.
Unlike Vice President AI Gore, who would expand the Medicare system, Bush would change the
program by allowing seniors to remain in Medicare or choose annually from a range of private
plans, including those offered by health maintenance organizations. If passed by Congress, it
would amount to the largest structural change in Medicare since its inception.
The Bush plan would subsidize the cost of prescription drug coverage for seniors at all income
levels to some extent, and it would pay all drug costs for the lowest income seniors--individuals
living on less than $ 11,300 a year or couples with a household income of up to $ 15,200.
Bush envisions a four-year transition period in which the federal government would give the states
$ 48 billion in grants to provide what he calls an "immediate" prescription drug benefit for the very
poorest seniors, along with paying all drug costs for seniors above $ 6,000 a year.
In addition, he endorsed congressional efforts to restore cuts to Medicare providers, such as
hospitals and doctors, that were enacted in 1997 as part of the federal Balanced Budget Act. The
cost would be $ 40 billion. Gore also supports such Medicare restoration efforts at the same level.
"Eight years ago, Bill Clinton and Al Gore promised Medicare reform," Bush said as he unveiled his
plan at a senior residence here. "Four years ago, they did the same. This is a patient country, but
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our patience is wearing thin. This is not a time for third chances; this is a time for new beginnings
and new leadership."
In a prosperous, peacetime election year, with the debate driven by the interests of aging baby
boomers and their elderly parents, health care--and particularly Medicare reform--has rapidly
gained momentum as a campaign theme.
Adding to the urgency of Medicare reform efforts is the fact that the number of Americans receiving
benefits is expected to double in the next 30 years as the number of workers paying into the
system drops.
Plan Doesn't Slow Democrats' Attacks
Democrats have spent the last several weeks chastising Bush for making health care reform
promises without particulars. Although Bush has run a campaign ad vowing to offer prescription
drug coverage to seniors, until Tuesday he had given no details about how he would accomplish
the politically tricky feat.
Gore wasted no time Tuesday deriding the Republican presidential nominee's plan, charging that it
would force seniors into bare-bones HMOs if they want prescription drug coverage and would leave
millions of elderly people without coverage for necessary medicines.
Campaigning in Columbus, Ohio, Gore said that "the biggest problem" with Bush's plan is that
"there is no money to pay for it" after the 10-year, $ 1.3-trillion tax cut that Bush also has
proposed.
Gore has rejected the kind of fundamental changes in Medicare touted by Bush. Instead, the
Democratic nominee for president wants to add to the existing program a guaranteed prescription
drug benefit for all seniors at a cost of $ 253 billion over 10 years. That amount does not include
restoration of Medicare cuts to doctors and hospitals.
Today, more than 80% of seniors receive health care in the traditional Medicare "fee for service"
program, under which the government makes payments directly to doctors and hospitals. Most of
the rest enroll in HMOs.
In recent years, HMOs affiliated with Medicare have been terminating their coverage of thousands
of seniors, especially in rural areas, complaining that reimbursements from the government are too
low. An industry survey released in June showed that HMOs planned to cancel coverage next year
for more than 700,000 seniors enrolled in Medicare HMOs.
Under the reforms Bush endorsed Tuesday, Washington would provide a fixed sum of money for
seniors to purchase health insurance from a range of plans, including the existing Medicare
program.
Benefits would vary from plan to plan, with the most expensive plans offering the broadest
coverage, such as prescription drugs and vision and dental care. Less expensive plans would offer
less generous benefits.
If a plan cost more than the sum provided by the government each year, seniors would have to
make up the difference out of their own pockets.
For seniors earning 135% of the poverty rate or less, Bush would provide subsidies sufficient to
cover the full cost of purchasing a plan offering prescription drugs. This would help Americans
avoid what he described as the "cruel choices some seniors face: Heat or medicine. Food or pills."
Those earning more would receive smaller subsidies, on a sliding scale, to purchase plans that
included prescription drugs. The smallest subsidy--given to seniors with household incomes of
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more than $ 19,700 for couples or $ 14,600 for individuals--would pay for 25% of the cost of the
insurance premiums for prescription drug coverage.
Bush and supporters of the plan in Congress--led by Sens. John B. Breaux (D-La.) and Bill Frist
(R-Tenn.)--say this approach will provide seniors more flexibility by allowing them to choose plans
that offer the benefits they need most. And they maintain that the competition between plans to
enroll the elderly will help keep down Medicare's costs in the future.
As Bush pointedly noted in his speech, those arguments have been endorsed by the Democratic
Leadership Council, the centrist organization chaired by Sen. Joseph I. Lieberman (D-Conn.),
Gore's running mate.
Critics Point to Several Flaws
Critics, led by Gore, argue that the plan Bush has embraced is flawed in several respects. Citing
government analyses, they say that under the formulas used in this new approach, premiums
would rise by as much as 47% for seniors who choose to remain in the existing Medicare program.
Those studies--which the Bush campaign disputes--are the basis of Gore's contention that these
reforms would drive seniors into health maintenance organizations, which would likely be cheaper.
Gore also argues that the Bush approach would produce unequal care. Each candidate's plan would
guarantee access to prescription drugs for the poorest seniors. But under the Bush approach,
middle-income seniors would receive only a relatively small subsidy from the government to
purchase prescription drug coverage.
As a result, critics say, many middle-income families may still not be able to afford plans that
provide adequate coverage for prescription drugs, while the affluent would be able to buy such
coverage with their own money.
"The exposure is, if you are middle income, can you afford the high-end, high-option plans that are
going to give you full benefits? Or are you going to have to choose the lower-cost, low-option
plans?" asks Diane Rowland, executive director of the nonpartisan Kaiser Commission on Medicare
and the Uninsured.
But many advocates of the Bush approach say it makes sense to target benefits toward the
neediest seniors. Republicans say Gore's plan squanders government money by providing a
publicly subsidized drug benefit even to affluent seniors who may now have adequate private
coverage.
By rejecting such a universal program, Bush inevitably introduces more uncertainty for the elderly.
Under Bush's approach, seniors would face significant variations in their coverage and
out-of-pocket costs depending on what drug benefits are offered by the private insurance
companies participating in the new system in their areas.
Gore's plan, by contrast, establishes a common set of prescription drug benefits and costs for all
seniors.
Bush's $ 48-billion proposal for state grants to provide seniors with prescription drugs raises
similar questions about uncertainty. Bush calls this proposal the "Immediate Helping Hand"
program and argues that it is the fastest way to get crucial help to those in need, because many
states already have some program in place.
Democrats, like Health and Human Services Secretary Donna Shalala, criticized the idea as a
crapshoot for seniors because states would be entirely free to decide what benefits, if any, to offer.
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According to the National Conference of State Legislatures, 14 states have prescription drug
programs that subsidize drugs for the elderly in place, and another six states have legislation on
the books that will go into effect in the next few years.
The programs vary widely in how many seniors are eligible for the subsidized drug coverage, the
amount of the co-payments and the number of drugs that are covered. In all, only about 1 million
seniors are enrolled in the existing state programs.
Republican congressional leaders said the idea of expanding these state programs tracked largely
with proposals they are pushing in Congress.
*
Times staff writers Alissa J. Rubin, Edwin Chen, Megan Garvey and Matea Gold contributed to
this story.
Comparing Their Plans
Medicare--the federal health care program for the elderly and disabled--does not pay for
prescription drugs. Although 25 million Medicare recipients have prescription drug coverage
through some other medical plan, about 12 million recipients have no drug coverage at all. Here's
how Republican George W. Bush and Democrat Al Gore say they would address the problem.
* MEDICARE REFORM
George W. Bush
Would fundamentally change Medicare. Instead of guaranteeing a specific benefit, the government
would provide seniors a fixed sum of money to purchase health insurance. Seniors could use the
traditional Medicare program or choose from a range of private plans, including those offered by
health maintenance organizations. Benefits would vary from plan to plan.
AI Gore
Would broaden Medicare. He would also allow people from the ages of 55 to 65 to buy into
Medicare--and provide a tax credit toward their premiums. Proposes putting Medicare funding in a
"lock box" so that Medicare payroll taxes could only be used to support Medicare or pay down the
national debt.
*
BASIC DRUG PLAN
George W. Bush
Medicare recipients could choose from several health plans and could select prescription drug
coverage as a benefit. The government would pay for at least 25% of drug-coverage premiums for
all seniors and would shoulder an even larger share for the elderly poor.
Al Gore
A prescription drug benefit would be available to all Medicare recipients. Those people enrolled in
the plan would pay half of their drug costs; the government would pay the other half. During the
first year, the government would pay a maximum of $ 1,000. That would rise to $ 2,500 in 10
years.
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*
BENEFITS FOR THE POOR
George W. Bush
Low-income seniors would pay nothing. Free coverage would be offered to individuals earning up
to $ 11,300 and couples earning up to $ 15,200. For seniors on the edge of poverty--those
individuals earning $ 11,300 to $ 14,600 a year and couples up to $ 19,200--the government
would pay a portion of their premiums.
AI Gore
If the plan was offered this year, individuals who earn $ 11,200 or less annually would pay
nothing. Prescription drugs for seniors with incomes between $ 11,200 and $ 12,450 would be
partially subsidized.
*
PREMIUMS
George W. Bush
No cost to poor seniors. For everyone else, the government would cover at least 25% of their
premiums. Costs would vary depending on the health plan chosen.
Al Gore
The elderly poor would pay nothing. For everyone else, premiums would be about $ 25 a month in
the first year, rising over 10 years to more than $ 40 a month.
*
CATASTROPHIC COVERAGE
George W. Bush
The most anyone in the program would pay out of pocket for drugs would be $ 6,000 a year. The
government would pay any drug costs over that amount, picking up all other health care costs over
$ 6,000 after Bush's plan has been in effect for four years.
AI Gore
The government would pay any drug costs over $ 4,000 a year. This provision is designed to cover
"catastrophic" illness.
*
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OVERALL COSTS
George W. Bush
An estimated $ 198 billion over 10 years. This figure includes $ 48 billion to go to the states
immediately to cover drugs for the poor and the catastrophically ill over four years. Then $ 110
billion would go toward overhauling Medicare and partially covering all seniors' drug costs. Would
also restore $ 40 billion in cuts to Medicare providers.
Al Gore
An estimated $ 253 billion over 10 years. Also favors restoring $ 40 billion in Medicare cuts,
although that is not part of his drug plan.
GRAPHIC: PHOTO: (A2) SENIORS--George W. Bush proposed a $198-billion overhaul of health
care that would provide some prescription drug coverage for all seniors. At right, Bush gets kiss
from Doris Nonnemaker in Allentown, Pa. A1 PHOTOGRAPHER: Reuters PHOTO: George W. Bush
PHOTO: AI Gore
LANGUAGE: English
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The New York Times, September 2, 2000
Copyright 2000 The New York Times Company
The New York Times
View Related Topics
September 2, 2000, Saturday, Late Edition - Final
SECTION: Section A; Page 18; Column 1; Editorial Desk
LENGTH: 774 words
HEADLINE: Editorial Observer;
The Crisis in Providing Care for the Elderly Ill
BYLINE: By DUDLEY CLENDINEN
BODY:
In Florida, where retirees have been flocking since the 1920's and where 25 percent of the
state's population is expected to be over 65 by the year 2010, there are growing feelings of strain
and exhaustion among the managers, the nurses and nurses' aides who care for the old and frail.
The word most often heard in conversations with elder-care professionals these days is "crisis."
With a population calculated to be aging at a rate 20 years ahead of the nation as a whole, the
Sunshine State has become a harbinger for a nation growing old and facing problems with
long-term care for the aged.
As the average life span lengthens, people seem healthier in old age than ever before. The
question is how to serve those who become infirm or ill. In Florida and in the nation, most of that
burden falls, as it always has, on families, usually on a woman caring for an older one. In Florida, a
study four years ago found that almost 80 percent of the frail elderly were cared for at home.
African-American and Hispanic families are more likely to care for their own, says Larry Polivka,
director of the Center on Aging at the University of South Florida, whereas more whites seek
professional help. But there is no way to know what quality of care the people at home actually
get, or what sacrifices their care-givers have to make to give it.
What is known, Professor Polivka says, is that more than 88 percent of the public money spent to
support long-term care in Florida now goes to nursing homes, where the remaining 20 percent of
the frail elderly reside. Nationally, in the last fiscal year about $39 billion in public money for
long-term care went to nursing homes, where the average age of the residents is 85, where 42
percent are demented, and 72 percent are women.
Virtually no one seems happy about the current state of affairs. The federal government has found
substantial evidence of fraud and mismanagement in nursing home chains, as well as consistent
patterns of neglect and abuse. The nursing homes feel over-regulated, under-compensated, unable
to hire and keep employees, and over-sued. The nursing home employees, who are called on to do
difficult work with compassion, feel underpaid and unfairly maligned. The families of the residents
increasingly sue on charges of mistreatment. And a growing body of consumer advocates accuse
the state and federal governments of having no sensible policy of long-term care.
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It is, in a word, a mess.
Although four-fifths of Florida's nursing homes are in business to make a profit, and tax dollars pay
for 90 percent of their charges, 23 percent of the beds are now managed by companies gone
bankrupt. In 11 other states, the percentage is even higher.
But Florida, which allows residents to sue for violation of their patient rights under state law -- and
allows attorneys to collect fees separate from the damages -- leads in another national trend, the
soaring rate of lawsuits against nursing homes. It began 11 years ago, when a Tampa attorney,
Jim Wilkes, filed his first suit in behalf of a resident. He won. He has since expanded to seven other
states, helped persuade Arkansas to pass a similar law, put up billboards on highways to solicit
cases, and says he currently has 800 to 1,000 lawsuits in process, seeking a total of about $1
billion.
He is out, Mr. Wilkes says, to destroy the industry. "There are no good nursing homes," he says.
He is wrong. There are bad ones. There are also many good and caring homes, particularly the
nonprofit ones. But Mr. Wilkes and the other lawyers who have followed his lead have had an
effect. A study conducted this year for the Florida Health Care Association of for-profit homes found
that the annual liability cost per occupied nursing home bed has now reached $6,283 -- eight
times the national average.
Liability insurance premiums have ballooned. Mary Ellen Early, director of the state's group of
nonprofit homes, cited two cases: a central Florida retirement community with its own nursing
home, whose premium has gone in a year from $33,000 to $545,000; and a group of three homes,
whose premium just jumped from $159,000 to $1.7 million. Some insurers are canceling. A dozen
or more nursing homes in Florida now operate with no liability insurance at all.
A 17-member task force headed by Lt. Gov. Frank Brogan, who called the situation "frightening," is
expected to recommend some changes to the state legislature by the end of this year. As Ruben
King-Shaw, head of the state Health Care Administration, has said, "We are witnessing the
disintegration of the long-term-care system before our very eyes."
http://www.nytimes.com
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The San Francisco Chronicle AUGUST 29, 2000, TUESDAY,
Copyright 2000 The Chronicle Publishing Co.
The San Francisco Chronicle
AUGUST 29, 2000, TUESDAY, FINAL EDITION
SECTION: EDITORIAL; Pg. A16; EDITORIALS
LENGTH: 327 words
HEADLINE: A Plan to Curb Elder Abuse
BODY:
ALTHOUGH WEAKER than it needs to be, a bill increasing scrutiny and fines for abusive or
negligent California nursing homes is long overdue. The bill, AB 1731, watered down to win
approval from Gov. Gray Davis who is now expected to sign it, adds bite to what had been
toothless oversight of the state's 1,400 elder care facilities.
The measure is the product of a 20-year effort to exert greater control over senior care
homes where the most vulnerable of patients often suffer the most inhumane treatment from
ill-tempered and badly-trained employees. "The horror stories you hear about people being
strapped down in wheelchairs, festering for hours in their urine, those are all true," said the
bill's author, Assemblyman Kevin Shelley, D-San Francisco. "Hopefully, this bill will have a
chilling effect on facilities to make them be more careful."
Aside from tougher care standards, the bill raises employees' pay and mandates stiff fines
for abuse $20,000 for incidents that result in serious harm and up to $100,000 if death
occurs. The law would also:
-- Strip licenses for two serious complaints within two years.
-- Temporarily replace managers if facilities are found to be unsafe.
-- Require response to serious complaints within 24 hours.
-- Mandate an additional 10 hours of employee training focusing on elder abuse and
Alzheimer's disease.
But the best way to improve care by increasing the level of staffing was nixed to
appease Davis, who called it too expensive when he vetoed a similar bill last year. Still,
considering that 30 percent of the facilities had a deadly or serious harm violation in 1998,
and that last year nearly 300 nursing home citations were issued for serious harm or
deaths, this bill comes none too soon. While the measure fails to end all mistreatment, and
the Legislature should pursue even greater safeguards, nursing homes should beware that
abuses will no longer be tolerated.
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The Denver Post, August 10, 2000 Thursday
Copyright 2000 The Denver Post Corporation
The Denver Post
August 10, 2000 Thursday 2D EDITION
SECTION: DENVER & THE WEST; Pg. B-02
LENGTH: 478 words
HEADLINE: Udall: Care homes must improve Lawmaker backs federal fines to enforce
standards
BYLINE: By Karen Auge, Denver Post Medical Writer,
BODY:
Standing before a roomful of elderly women, some in wheelchairs, some gripping metal
walkers, U.S. Rep. Mark Udall said Wednesday he was 'shocked and disturbed' by the
findings of an audit of nursing-home conditions in his district.
And the Boulder Democrat has signed on to federal legislation he said will help fix the
problem.
A congressional committee reviewed the findings from 1999's annual state inspections of
nursing homes in Udall's 2nd Congressional District and found that of 27 facilities, 19 had
at least one violation 'with the potential to cause more than minimal harm to residents.'
Inspectors found no violations of federal care standards in eight of the homes.
The report didn't divulge specific violations, and Udall said pointing fingers at individual
nursing homes was not his intent.
But he said many of the violations were serious. 'These aren't just bad food,' he said. 'They
range from failing to prevent falls and accidents to improper use of restraints.'
One nursing home, he said, had only one staff member caring for 40 patients when
inspectors visited.
To help fix the problem, Udall has pledged to co-sponsor a bill that would create a system of
automatic fines of $ 2,000 to $ 25,000 for violations. Money collected would be put into a
grant program designed to help nursing homes hire and keep qualified staff. The bill also
would require that inspection information be posted on the Internet.
The bill, sponsored by fellow Democrat Henry Waxman of California, also would restore
reimbursements to nursing homes that provide quality care. Those reimbursements,
primarily through Medicaid and Medicare, were gutted in 1997 by Congress.
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But if Udall had much to tell the group of residents and nursing-home industry
representatives at Crossroads of Northglenn assisted-living center Wednesday, they had a lot
to say to the congressman as well.
Several described the challenge of hiring people willing to do the physically and emotionally
demanding work of caring for nursing-home residents.
And several bristled at the prospect of more federal mandates.
Colorado already sanctions nursing homes - either through fines, intense monitoring or
other methods - that aren't operating up to snuff, and the state already posts the findings of
nursing home inspections on the Internet, said Jay Moskowitz, who operates five Colorado
nursing homes.
'I urge you to look at Colorado, to visit those facilities in your district before enacting more
federal mandates,' Moskowitz said.
He also urged Udall to examine why so many of the state's nursing homes are in financial
trouble. Fifty-seven of Colorado's 226 nursing homes have filed for bankruptcy, according
to Colorado Health Care Association figures.
GRAPHIC: PHOTO: The Denver Post/Helen H. Davis Rep. Mark Udall, D-Colo., talks to
residents at Crossroads of Northglenn assisted-living center Wednesday, telling them that 19
of 27 nursing homes in his district had violations in 1999 state inspections.
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The Christian Science Monitor, July 19, 2000
Copyright 2000 The Christian Science Publishing Society
The Christian Science Monitor
July 19, 2000, Wednesday
SECTION: FEATURES; HOMEFRONT; Pg. 15
LENGTH: 1511 words
HEADLINE: Nursing homes reach out
BYLINE: Cathryn J. Prince, Special to The Christian Science Monitor
DATELINE: LAWRENCE, MASS.
HIGHLIGHT:
Hispanics and Asians traditionally care for their elders at home. Increasingly, they look to facilities
to provide multicultural support.
BODY:
Puerto Rican immigrant Juan Suarez raised seven children in this Northeast industrial city, and it
was understood that his children would care for him when he got older.
So the fact that Mr. Suarez now spends his days in a nursing home will never sit right with family
members, who felt they had no choice when a medical condition made it difficult for Suarez to be
cared for at home.
The retired fisherman and his family symbolize slowly changing attitudes about nursing-home care
within minority communities. But while the situation is becoming more common, it still meets a
great deal of resistance. Many cultures, such as Hispanic and Southeast Asian, consider it a breach
of familial responsibility to place someone in a home.
"We were raised to believe we must care for the elderly," says Helen Suarez, Suarez's daughter.
"We'd like to have him here at home but he needs extra care," she says. "We cried a lot when the
social worker told us he needed a nursing home. I still cry a lot, but I couldn't maintain the care."
Ms. Suarez says she tried as long as she could to care for her father. Each day she placed freshly
laundered and pressed clothing on his bed, just like her parents did for her grandparents in Puerto
Rico. She bathed him and cooked all his special meals.
However, Juan Suarez needed medical care and couldn't be left alone for any length of time.
Piatas at Christmas
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"Latinos really believe in the extended family, in keeping the families together. But right now there
is need for [both] husbands and wives to work, so they must bring their parents or grandparents to
the nursing homes," says Isabelle Melendez, director of the community center in Lawrence, Mass.
"I come from Puerto Rico. My grandmother lived to 105 and never was in a nursing home.
Everyone took care of her, the grandkids, the nephews, and the nieces. Here life is different."
Because of these lifestyle differences, many nursing homes across the country have begun to reach
out to minority communities. It is becoming more common to find nursing homes that offer
everything from traditional meals to piatas at Christmas.
"This will be reflected in the rest of the country. The baby-boomer population is aging. All over the
country [we] need to understand how different cultures treat their aged," says Ray D'Aiuto,
administrator of the Wood Mills nursing home facility, in Lawrence, Mass.
Lawrence, a working-class town north of Boston, is an example of what is happening in small
towns and sprawling cities from coast to coast. Here the number of Hispanic residents over 65
increased 31 percent from 1990 to 1995, according to the Massachusetts Institute for Social and
Economic Research.
Meanwhile, the number of Hispanics between 20 and 39 years of age has increased by just 6
percent over the same five-year period. In other words, in coming years there will be more elderly
Hispanics than there will be young family members to care for them.
No one at home all day
The Hispanic population has long opposed the idea of placing a relative in a nursing home. Indeed,
20 years ago there were hardly any Latinos in nursing homes, says Betty Mills, a nursing-home
administrator in Blen, N.M. Extended families were the norm, and each generation cared for its
elderly.
However, these days most family members are working or in school. There is no one at home to
care for their aged and infirm relatives.
Even so, as with families of whatever background, placing a relative in a nursing facility is a
decision that can be fraught with guilt.
"We see a lot of fear and confusion on their faces when they arrive, so gaining their trust is a big
thing," says Pat Kidder, administrator of the Heritage Nursing Home in Lowell, Mass. "The children
don't often come out and say they feel guilty, but it is obvious."
To help alleviate anxiety, nursing-home staffs encourage family members to attend support groups
and learn that they are not alone in their choice.
In addition to support groups, or access to social workers, many nursing homes strive to create a
more welcoming atmosphere for residents of different ethnic backgrounds.
At Wood Mills, 75 per cent of the staff is bilingual and, with the aid of Microsoft's translation
software, all memorandums are issued in Spanish and English.
Religious services are held in Spanish, and residents are provided with Spanish-language books
and newspapers. Residents attend Spanish education groups, and listen to music and weather on
the local Spanish radio station. They also worked with the facility's dietitian to create Spanish
meals, consisting largely of rice, beans, and chicken, which are served three times a week. Having
familiar meal choices helps prevent weight loss, sometimes a problem for the elderly.
"We needed to redefine what we do because of the area we are in," says D'Aiuto, who came to
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Wood Mills two years ago. "We are a provider in a community which is Spanish-speaking, and we
need to give our residentsa greater sense of respect and dignity."
They speak the language
A common goal for nursing homes with non-English-speaking residents is finding staff who can
communicate.
In Pico Rivera, Calif., a predominantly Hispanic community outside of Los Angeles, 90 percent of
the residents are Hispanic, says Jean Doerfler.
She, like other administrators, encourages staff members to learn another language because, while
many residents are in fact bilingual themselves, "as they get older they revert to their roots and
like to speak only Spanish."
It's the same in Lowell, which has a large concentration of Southeast Asians, says Ms. Kidder.
"Out of 142 beds, perhaps six are occupied by Vietnamese, Thai, or Cambodians," Kidder says.
"That may be a small number, but one person's needs can be great, especially if they are not
understanding you."
Aside from overcoming any language barriers, Kidder says nursing home staffs must learn that
cultures have different attitudes toward medical care, and a failure to understand these viewpoints
will only add to the residents' and families' stress.
Despite these many steps to reach different cultures, "I truly believe that certain ethnic groups
only care for their relatives at home," says Rose McGary, nursing home ombudsman for the
Massachusetts Department of Elder Services.
"They cannot fathom [why] the care is not exactly the same as it as at home. They want the
one-on-one care. I can't tell you how many complaints I get that say the homes aren't doing a
good job," and then they pull relatives out of care against our advice, she says.
These situations arise from a deep-seated abhorrence of nursing homes in cultures where extended
families still live in close proximity, if not under a single roof.
"When my grandmother was ill, the idea of a nursing home never came up," says Martha Velez of
the Lawrence Council on Aging. "She had three daughters living in Lawrence, and we all took care
of her."
No substitute for family
Ms. Velez, who grew up in a three-family home in town, says that when families don't consider the
option of placing a relative in a nursing home, it's because they think: "No one loves you more
than your family, there is a big language barrier, and the food isn't good."
And while nursing homes are trying to be more accommodating, in many people's minds they can
never replace home or the responsibility of children to care for their parents.
"Elderly care is like child care. You have a child, you work your schedule around its care," Velez
says. "I think the same respect is due to your parent."
However, there are cases where that is not enough, says Linea McQuade, administrator of a
nursing home in Fall River, Mass. Ms. McQuade has lived and worked in the largely Portuguese
community for the past decade.
"You'll hear a resident's daughter say, 'My mother took care of me her whole life, and now I take
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care of her.' But sometimes that is no longer possible," says Ms. McQuade. "The mother or relative
needs more attention than can be given at home. They need 24-hour care."
Nursing-home administrators say that families who come from minority backgrounds are more
likely to visit on a daily basis than are those in the Caucasian population.
Indeed, Helen Suarez visits with her father each evening after she finishes English classes at the
local college. Her daughter, too, visits often, as do her brothers.
"To a certain extent there is much more involvement with the Hispanic community versus the
Anglo population," says Doerfler, the administrator in Pico Rivera, Calif.
"Daughters and sons routinely come during mealtimes to help out, they participate in the
activities. There is a strong bond with the elderly."
(c) Copyright 2000. The Christian Science Publishing Society
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The San Francisco Chronicle JUNE 9, 2000, FRIDAY,
Copyright 2000 The Chronicle Publishing Co.
The San Francisco Chronicle
JUNE 9, 2000, FRIDAY, FINAL; CONTRA COSTA EDITION
SECTION: NEWS; Pg. A21
LENGTH: 1795 words
HEADLINE: Nursing Homes Skewered;
House report details violations in 119 Bay Area facilities
BYLINE: Sabin Russell, Carolyn Lochhead, Chronicle Staff Writers
DATELINE: Regional
BODY:
More than one-third of all Bay Area nursing homes have been cited for violations in which
residents were harmed or placed at risk of death or serious injury, according to a study
released yesterday by House Democrats.
Among the problems most frequently cited in annual inspections at 119 homes were failure to
treat and prevent bed sores an affliction that can lead to serious infection -- and a "failure
to provide supervision or assistance devices to prevent accidents."
The study by the Democratic staff of the House Government Reform Committee examined the
records of 288 nursing homes over a two-year period ending in January. It was based on
citations that were considered the most serious violations of federal quality-of-care
standards.
Rep. Pete Stark, D-Hayward, who ordered the study, was joined at a Washington press
conference by four of the eight other Bay Area House Democrats who also requested the
report.
Stark called for more federal financing to improve salaries and training of nursing home
staff and for greater enforcement and oversight.
"It's like speeding on the freeways," said Stark. "If the cops aren't out there, you are going to
start driving at 75 instead of 65
We've gotten sloppy. We need more surprise
inspections."
Going to a nursing home "is in many ways the ultimate nightmare that we either secretly
think about ourselves or pray that we will not face with our families," said Rep. Anna Eshoo,
D-Palo Alto. "The system does not have enough money in it."
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Together, the 119 Bay Area nursing homes with serious citations collect $141 million in
federal and state funds through the Medi-Cal and Medicare programs each year, the
lawmakers said.
Nationwide, nursing homes will consume a projected $58.1 billion in government funds this
year. Medicare, the federal health insurance program for the elderly and disabled, accounts
for $11.2 billion, while the Medicaid program, which covers long-term care for the poor, will
pay $44.9 billion $17.2 billion of which comes from the states.
Critics of the industry said that with so much tax money going to nursing homes, the failure
to meet federal standards was inexcusable. Of 288 Bay Area nursing homes, only 18 -- or
6.3 percent were found to be in "full or substantial" compliance.
Nursing home operators said the citation reports on which the study is based are often
overblown and unreliable, but they agreed with the critics in Congress that the state's
nursing home system is understaffed and underfunded.
"The nursing home industry has been plummeting down in a financial crisis for many years.
California ranks 46th in the nation in Medicaid spending on long-term care," said Betsy Hite,
spokeswoman for the California Association of Health Facilities, the Sacramento trade group
for the state's 1,500 nursing homes.
Hite said nursing home operators in the Bay Area can afford to pay an average of only
$7.50 to $8 an hour for nursing assistants, which makes it difficult to compete in a tight labor
market.
A spate of California nursing home bankruptcies has boosted prospects for a 10 percent
increase in Medi-Cal spending for nursing homes, which is part of Gov. Gray Davis'
proposed budget. The plan would boost combined federal and state spending by $322 million.
In addition, the Legislature has proposed a 10 percent increase in wages to be paid nursing
home workers. Davis has proposed a 5 percent increase.
Hite said studies that rely on state inspection reports are notoriously subjective. She
described a Fresno facility that allegedly received a citation for causing "harm" for a series of
incidents in which ketchup spilled on a resident at lunchtime, the lunch was delayed and then
a second resident was not served relish.
"They've gone absolutely over the edge with this zero tolerance," Hite said. "Not serving
relish should not be a federal crime."
The report's authors challenged the industry's assertions that citations are often insignificant.
Audits of the serious violations turned up ghastly incidents. Seventy-four Bay Area nursing
homes were cited for not preventing or treating bed sores, an affliction that can lead to
serious infections, amputation of limbs and death.
The study found 44 incidents of "failure to provide supervision or assistance devices to
prevent accidents."
Of the 119 homes cited for serious violations, 76 incurred more than one during the 28-
month survey period, and 29 had more than five such citations.
Pat McGinnis, executive director of California Advocates for Nursing Home Reform, said the
figures are shocking, but not surprising. "I've been studying this stuff for years," she said. "If
the Bay Area is this bad, God help the rest of the state."
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McGinnis said the Bay Area receives the highest daily reimbursement rate for Medi-Cal, pays
nursing home workers the highest wages and has the lowest turnover of any region in
California. She said more money for nursing homes will help, but only if it is accompanied
by requirements for accountability.
"They say, Give us more money,' and we do. But they don't give us better care. The problem
is poor business practices. If we give them $300 million, they use it to buy another
corporation," McGinnis said.
Rep. George Miller, D-Martinez, said the report was a wake-up call.
"This is a problem that is coming at us like an avalanche," Miller said. "Those of us in the
leading edge of the baby boom are very much aware that our parents are living longer.
They're encountering more complex medical problems, and yet we want the best of care for
them and in fact in this country we have a very limited system of care."
The Bay Area report covered 13,419 nursing home residents. The worst of five metropolitan
areas within the region was Vallejo-Fairfield-Napa, where 17 of 29 homes had been cited for
multiple violations.
Nationwide, 1.6 million people live in nursing homes, a number projected to balloon to 6.6
million by 2020.
Debby Friedman, administrator for Vintage Estates, a family-owned business in Richmond
that runs six nursing homes, said reports like this are "demoralizing to a staff that works
extremely hard for a pittance."
Two of her Bay Area homes received "actual harm" citations during the study period, but both
of those were instances of "unavoidable harm" related to the condition of frail patients, she
said.
Friedman said that lost in such reports is the real compassion that people who work in
nursing homes show for their residents. "We're portrayed as callous individuals. You can't
be callous providing the level of care we do," she said.
But relatives of nursing home residents who believe they were victimized by poor care said
filing complaints can be a nightmare. "I had to fight like hell to get a citation issued," said Jill
Lerner, who said her 95-year-old grandmother died in a Marin nursing home because the
staff failed to treat her with ulcer medication after surgery.
San Jose resident Kathy Case, accompanied by her sister, Mary Black, broke into tears at
yesterday's press conference while recounting the death of their healthy and active 78-year-
old mother, Josephine Case, after a stay in the Guardian nursing home in San Jose, where
she was sent to recover from back surgery.
Case said she had a good first impression of the facility, but "things started going bad"
almost immediately when her mother did not receive proper pain medication and was not
eating or drinking. Case said she repeatedly questioned her mother's care but was told that
she was overreacting. Finally Case said she was told to call 911 if she wanted a doctor.
When the ambulance came, the elder Case was admitted to intensive care, suffering from
malnutrition, severe dehydration, pneumonia, a staphylococcus infection and a large bed
sore. She died two weeks later.
The Santa Clara County district attorney filed charges against Guardian, which pleaded no
contest two weeks ago to six counts of abuse of the elderly and was ordered to close its San
Jose and Los Gatos facilities.
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Randy Hey, the Santa Clara County assistant district attorney who prosecuted Guardian, said
he discovered "every kind of neglect you normally find in a nursing home. There was just
simply no management whatsoever."
CHART:
NURSING HOME VIOLATIONS BY METROPOLITAN AREA
San Francisco Metro Area
(San Francisco, Marin and San Mateo counties)
Number of homes
62
Homes with actual harm violations
26
(42%)
Homes with immediate jeopardy violations
(percent of total homes)
1
(2%)
Santa Rosa Metro Area
(Sonoma County)
Number of homes
25
Homes with actual harm violations
8
(32%)
Homes with immediate jeopardy violations
2
(percent of total homes)
(8%)
San Jose Metro Area
(Santa Clara County)
Number of homes
60
Homes with actual harm violations
13
(22%)
Homes with immediate jeopardy violations
1
(percent of total homes)
(1%)
Oakland Metro Area
(Alameda and Contra Costa counties)
Number of homes
112
Homes with actual harm violations
49
(44%)
Homes with immediate jeopardy violations
1
(percent of total homes)
(1%)
Vallejo-Fairfield-Napa Metro Area
(Solano and Napa counties)
29
Number of homes
16
Homes with actual harm violations
(55%)
Homes with immediate jeopardy violations
2
(percent of total homes)
(7%)
GRAPHIC: CHART: SEE END OF TEXT
LOAD-DATE: June 12, 2000
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The Denver Post, May 14, 2000 Sunday
Copyright 2000 The Denver Post Corporation
The Denver Post
May 14, 2000 Sunday 2D EDITION
SECTION: A SECTION; Pg. A-01
LENGTH: 1309 words
HEADLINE: Care center's funds in peril State inspectors find numerous violations at
Briarwood
BYLINE: By Michael Booth, Denver Post Staff Writer,
BODY:
Nursing-home regulators have recommended cutting off vital Medicare and Medicaid
payments to the Briarwood Health Care Center for repeated violations of care standards,
prompting patient advocates to call the home their biggest concern in the metro area.
The east Denver home must now fix the problems or face a June 14 cutoff of state and
federal aid, the seldom-used death sentence for nursing homes that usually requires them
to shut their doors and transfer patients. Briarwood has approximately 140 patients.
A surprise inspection in February and March by the Colorado Health Facilities Division found
numerous cases of medical harm to patients due to staff mistakes or oversights, including
neglecting to monitor a diabetic patient for nearly 12 hours at a time and failing to call a
doctor during an entire night in February when the patient was 'unable to wake up.' She died
days later in the hospital.
'Briarwood is our No. 1 most concerning facility right now,' said Jayla Sanchez-Warren, an
ombudsman, or patient advocate, for nursing homes in the Denver area. Her office
contracts with the state to oversee 103 homes; it currently counts nine facilities on its
internal warning list, and Briarwood is at the top.
Briarwood's executive director, John Milewski, responded to questions in a brief written
statement saying the survey results 'were not only unacceptable to the state, but they fall
short of our standards as well.' He said the home was working to correct the problems but
would not discuss specific issues.
Other patients reviewed in the survey had charts on which vital daily monitoring of liquid
intake and output, or of tube-feeding schedules, were left blank for dozens of entries in
a month. Surveyors repeatedly found patients known to be prone to sores in exactly the
position staff had been ordered not to leave them in, and one patient lay in urine-soaked
sheets for four hours.
Left without glasses
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One patient, whose need for eyeglasses was documented on her chart, was left without the
glasses for nearly two months until the surveyors came. When the surveyors intervened, a
nurse admitted she had known the glasses were missing for some time. Asked to look, she
found them in the back of a desk drawer at the nurse station.
The patient told surveyors: 'It's nice to be able to see. I'm nearsighted, and I've had to get
along blind for two months.'
The state this month imposed an independent monitor to oversee the efforts of Briarwood's
owner, the national chain Life Care Centers of America in Cleveland, Tenn., to bring the
home back into compliance. But the efforts of management, spurred by now-weekly visits
from the ombudsman's office, have not yet improved life for the patients, Sanchez-Warren
said.
'Progress? I haven't seen it yet, to be honest,' she said.
Briarwood management last week filed a 225-page plan to correct the problems, which the
state accepted. But the threat of a funding cutoff cannot be lifted until the state conducts
another surprise inspection and finds that the written plans are making a difference, said
Jeanne-Marie Ragan of the state Health Facilities Division.
One other Colorado nursing home, Integrated Health Services at Cheyenne Mountain, is
under threat of losing its crucial public funding. Since Medicare and Medicaid payments make
up the majority of revenue at most nursing homes, losing that source usually prompts
closure.
Two nursing homes were shut down by the state health department in the 1980s, but none
was closed in the 1990s.
In the surprise Briarwood survey, residents were found with caked food on wheelchairs, in
their seats and on their tables, and with chairs 'stained and smelling.' Broken recliners
dumped patients onto the floor, causing head injuries.
Investigators routinely found patients on locked-down floors or in restraints with no evidence
that they needed to be. State law requires the nursing home to justify the restraints and
to have a written plan for reducing the restrictions.
But Briarwood administrators told them such plans 'don't exist.'
And throughout the understaffed halls of Briarwood, investigators found patients left in
wheelchairs or darkened bedrooms for days with no activities planned or offered.
Nursing aids turned patient radios to rap music while in the room, then left the immobile
patients to listen to it for the rest of the day.
Surveyors found one patient sitting in a wheelchair next to a friend in the corner of an empty
hall at 9:05 in the morning. The residents told the surveyor they sat there because 'there
ain't nothing else to do.' The resident 'was observed in the same corner of the hall with the
fellow resident at 1:05 p.m., 1:25, 3:47 and 4:20.'
The facility is tagged numerous times in the report for failing to plan activities, as required
by state regulations, or failing to carry out scheduled activities. On 'Pet Therapy'
day, surveyors observed that the staff did not even bother to take Briarwood's 'facility
bunny' to visit all floors.
Another patient interviewed had a documented need for glasses, but her family noted that
piles of magazines were left unread because her glasses were broken for months. A staff
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member queried in February said she had no idea the patient needed glasses to read, but
notations on the patient's vision problems were found in charts dating to April 1999.
In the meantime, investigators observed the woman alone in her room watching TV at
'10:10 a.m., 10:35, 2:25 p.m., 3:40, and 4:30.'
Neglect, mistakes
Both neglect and medical mistakes were a factor in the poor treatment and subsequent
death of 73-year-old Lucia Kirk in February, according to a relative and the state records.
Kirk was released from University Hospital to Briarwood with a host of problems including
diabetes and heart failure, said her third cousin and caretaker, Steve Boyle.
'They stuck her in a single room for days, with a light above her bed that didn't work and a
stark wall to stare at' until he convinced the management to move her to a double room for
company. Frustrated with a 'revolving door' of staff and no attention to Kirk unless he
demanded it, Boyle arrived one day to have her moved to another nursing home only to
find paramedics taking her to a hospital.
She died in the hospital from a urinary tract infection and sepsis, Boyle said. Though state
records are anonymous, Kirk's case matches in dates and details the one documented in
the deficiency report, in which Briarwood is accused of failing to monitor her diabetes and
failing to call a doctor when she could not be awakened over the course of a night.
'It was obvious to me her lack of care contributed to her death,' Boyle said. 'They need to
monitor something like that.'
'The findings revealed that the facility failed to adequately monitor, document and
communicate the resident's condition,' the state deficiency report said.
Boyle had decided not to sue Briarwood, but a letter from the home made him reconsider.
Kirk left Briarwood on Feb. 22 and died the next day in the hospital.
In March, the home sent him a letter saying it was time for Kirk's regular health evaluation
meeting.
Questions about metro-area nursing homes can be answered by the Division of Aging
Services at the Denver Regional Council of Governments, 303-480-6735. The state World
Wide Web site, www.cdphe.state.co.us/hf/hfd.asp, documents complaints and
surveys regarding all Colorado nursing homes. Michael Booth can be reached at
[email protected]
GRAPHIC: PHOTO: The Denver Post/Dave Buresh Regulators have recommended that
Medicare and Medicaid payments to Briarwood Health Care Center, 1440 Vine St., in Denver,
be cut off because of repeated violations of care standards.
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The Denver Post, February 24, 2000 Thursday
Copyright 2000 The Denver Post Corporation
The Denver Post
February 24, 2000 Thursday 2D EDITION
SECTION: DENVER & THE WEST; Pg. B-06
LENGTH: 538 words
HEADLINE: Nursing home could face loss of funding
BYLINE: By Ann Schrader, Denver Post Medical/Science Writer,
BODY:
A Colorado Springs nursing home with a recent history of substandard patient care has
been placed under state monitoring and faces possible loss of Medicaid and Medicare
payments.
Integrated Health Services at Cheyenne Mountain, 835 Tenderfoot Hill Road, also has been
ordered to develop a plan to correct 15 deficient-care practices.
Uncovered in an unannounced visit on Jan. 28 were ongoing problems with residents'
bedsores, nutrition and incontinence care. Similar problems were found in July 1999 at the
148-bed facility, which has a number of residents with dementia.
'The range of the deficiencies is from fairly low in scope of severity to those that pose actual
harm but not immediate harm,' said Jeanne-Marie Ragan of the Colorado Department of
Public Health and Environment.
Residents left in feces, urine
The 168-page list of deficient care included:
Residents left in their feces and urine for hours, and sometimes all night, resulting in skin
damage and emotional distress.
Failure to perform simple grooming tasks such as shaving.
Inadequate nutrition for some residents who weren't given much assistance in eating.
Failure to provide several residents with cushions to prevent bedsores.
Failure to ensure staff followed safe procedures in filling portable oxygen tanks.
Insufficient nursing staff on each shift.
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One resident complained about the inattention to incontinence care: 'This is not right. It
makes me feel like a dog.'
The state has recommended that the federal Health Care Financing Administration deny
payment for new patients until the daily needs of current patients are met and terminate the
nursing home's certification to receive Medicaid and Medicare money if current problems
aren't corrected within 90 days.
Facility officials could not be reached for comment.
Penalty of $ 700 a day
Health Care Financing Administration officials in Denver imposed a civil penalty of about $
700 a day on the facility on Nov. 24, 1999, when the nursing home was found to have
fallen out of compliance with corrections promised after the July 1999 visit.
At the end of December 1999, the facility was once again deemed to be in compliance with
care standards. But a complaint in January brought investigators back.
The nursing home is one of four in Colorado Springs, Pueblo and Grand Junction operated
by Integrated Health Services Inc. of Lester. The parent company, Integrated Health
Services Inc., is based in Maryland and operates other long-term-care facilities in Colorado
and elsewhere.
In a letter dated Feb. 2 to the state, Integrated Health Services noted that it and its
subsidiaries had filed a petition for reorganization under Chapter II of the Bankruptcy Code.
The corporation's legal counsel, Marshall Elkins, assured state health officials that patient
care would not be compromised and that the corporation had secured a $ 300 million loan
with Citibank to operate during the reorganization.
Ragan said two consultants have been hired by the state to monitor the nursing home as
needed. Monitoring will be done for at least 90 days.
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The Washington Post, December 2, 1999
Copyright 1999 The Washington Post
The Washington Post
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December 2, 1999, Thursday, Final Edition
SECTION: METRO; Pg. B04
LENGTH: 1028 words
HEADLINE: Shady Grove's Owner Cited for Deficiencies at Nursing Homes
BYLINE: Avram Goldstein, Washington Post Staff Writer
BODY:
The church-affiliated company that owns troubled Shady Grove Adventist Hospital in Rockville
has been battling state and federal regulators over deficiencies in the quality of care at five of
its seven nursing homes in Maryland, state health officials say.
One of the facilities run by Adventist HealthCare Inc., Sligo Creek Nursing and Rehabilitation
Center in Takoma Park, was dropped from the Medicare and Medicaid programs in April after
failing three consecutive inspections over six months. In each visit, regulators found a
different patient suffering from bedsores--cases of "actual harm" that represent a red flag for
federal and state inspectors.
After six weeks and a series of changes in patient care procedures, 102-bed Sligo Creek was
recertified by state officials to receive Medicaid funds. Money from the state-administered
federal insurance program for the poor and disabled represents about 65 percent of the
facility's income.
Four other area nursing homes run by Adventist HealthCare Inc., which is controlled by the
Seventh-day Adventist Church, also have been cited in the past year for deficiencies that
regulators said could have led to expulsion from Medicare and Medicaid. However, those
facilities righted themselves before enforcement efforts reached that point, officials said.
Of Maryland's 261 nursing homes, only Sligo Creek and nine others persistently failed
inspections to the point that officials cut off their Medicare and Medicaid funding in the past
year. Among the 10, two facilities closed and relocated all their residents.
After Sligo Creek had its Medicare and Medicaid payments suspended in the spring, Adventist
HealthCare hired Ellen Reap, Delaware's former chief nursing home inspector and a frequent
adviser to federal officials who oversee Medicare, the federal insurance program for the
elderly. As vice president of senior living services, she oversees nursing homes, assisted-
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living facilities and adult day-care operations.
Reap declined to comment on the problems at Adventist nursing homes, saying she
preferred to discuss improvements in care and standards she is planning for the 1,200
employees she supervises.
"People know that I represent quality," she said. "My goal is to be the leader in the state and
the nation.
I believe that our nursing home residents can receive that kind of care."
About six weeks after cutting taxpayer support for Sligo Creek's residents, state regulators
reinspected the nursing home and found that the facility had begun a program to prevent
bedsores by having nurses regularly turn over patients and perform more thorough skin
assessments. The state resumed Medicaid funding on May 20.
Federal officials at Medicare's regional office in Philadelphia have not decided whether to
reopen that program to Sligo Creek. Adventist HealthCare officials say they are still waiting
for a requested reinspection by Medicare officials.
"You can argue that it's a single incident and that from time to time something like this will
happen for any nursing home operator," said Carol Benner, who heads Maryland's office of
health care quality. "On the other hand, you certainly would not want this to happen to
someone that you knew."
Georges C. Benjamin, Maryland's health secretary, said nursing home enforcement in the
state is more stringent than ever.
"I think it says we're serious," he said of the payment suspensions. "The industry has been
working with us to improve
There has been nationwide concern about the quality of care
in nursing homes."
Adventist HealthCare operates a total of 838 beds at six nursing and rehabilitation centers in
the region in addition to Sligo Creek. They are Bradford Oaks in Clinton; Fairland in Silver
Spring; Glade Valley in Walkersville, Frederick County; Shady Grove in Rockville;
Springbrook in Silver Spring; and Shore in Denton, Md.
Maryland cited Shore for patient falls, Glade Valley for falls and management problems,
Fairland for management problems and Bradford Oaks for patient bedsores, officials said.
The problems at Adventist nursing homes were identified by Maryland health officials long
before the medical staff's executive committee at Shady Grove Adventist Hospital complained
in October to administrators that staff cuts and other changes at the Rockville facility had
damaged patient care.
State officials had not made regular inspections of the hospital as long as it held the highest
ranking granted by the Joint Commission on the Accreditation of Healthcare Organizations, a
national group that rates hospitals.
But after The Washington Post reported the medical staff's complaints and the death of a
patient from the intensive care unit who had been left unattended in a hallway at Shady
Grove, the joint commission reversed itself. On Nov. 15, the commission moved to revoke the
accreditation of Shady Grove after concluding that patient care at the 263-bed facility had
suffered.
A day later, state health officials issued their own report on Shady Grove, citing mistakes in
patient care that included medication errors, several patient falls, a chronic failure among
staff members to note mistakes and adverse incidents in hospital records, an operation
performed on the wrong hip of one woman, and the death of the intensive care patient.
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State officials reported that a review of the minutes of hospital board meetings going back a
year lacked any "substantive discussion of quality issues or any oversight of the quality of
care."
Hospital officials dispute many of the state report's findings and say they will vigorously fight
the move to lift its accreditation. Minus accreditation, Shady Grove could lose contracts with
health plans and see its bond rating damaged.
Adventist HealthCare spokesman Robert Jepson said the company is committed to providing
quality care as part of its Christian mission, adding that the problems reflect the harsh
environment facing the nation's nursing home industry. Financial pressures have driven a
growing list of nursing home companies into financial trouble as governments heighten their
scrutiny of care.
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The New York Times, December 6, 1999
Copyright 1999 The New York Times Company
The New York Times
View Related Topics
December 6, 1999, Monday, Late Edition - Final
SECTION: Section A; Page 1; Column 5; National Desk
LENGTH: 1687 words
HEADLINE: Health Industry Sees Wish List Made Into Law
BYLINE: By ROBERT PEAR
DATELINE: WASHINGTON, Dec. 5
BODY:
The budget bill signed last week by President Clinton is packed with provisions sought by lobbyists
for drug companies, hospitals, health maintenance organizations and nursing homes.
Congress backed away from any broad overhaul of Medicare and rebuffed older patients' pleas for
coverage of prescription drugs, but it tinkered with details of the program -- details that determine
how billions of dollars are spent each year. Many provisions follow the lobbyists' recommendations
word for word.
Even as the drug industry attacked Mr. Clinton's plan to offer comprehensive drug benefits under
Medicare, individual drug companies lobbied frantically to secure or retain coverage of specific
products they make. And to a significant degree, they succeeded.
"This is not a good way to legislate," said Representative Pete Stark of California, the senior
Democrat on the Ways and Means Subcommittee on Health.
Gordon B. Schatz, a Washington lawyer who represents medical technology companies, agreed. "This
is no way to run a Congress," he said. "But there's a compelling need for product-specific legislation
because Medicare officials, in their rush to regulate, have ignored the real complexity of new medical
technology."
Health care lobbyists argue that with more federal money they can better serve their Medicare
patients, the elderly and the disabled. Their success underlines several hard truths about the politics
of health care in Washington. Lobbyists can block big schemes to which they object, and rarely agree
on any big schemes of their own. But they can score victories when they pursue narrowly defined
objectives.
One example illustrates the pattern. In 1997, in an effort to save money, Congress instructed the
secretary of health and human services to devise a way of paying for the thousands of diagnostic
tests and procedures performed in hospital outpatient departments everything from breast
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biopsies to cataract surgery.
Makers of drugs and medical devices complained that they would be grossly underpaid if the Clinton
administration carried out its plan for hospital outpatient services. And they proposed a solution:
certain high-cost prescription drugs should be excluded from the new system, and Medicare should
pay separately for them. That is exactly what Congress decided to do.
Medicare generally does not pay for outpatient prescription drugs, but there are some limited
exceptions. For example, Medicare covers some drugs provided by injection or infusion in the
outpatient department of a hospital or in a doctor's office.
The new Medicare law instructs the health secretary to make "an additional payment" to cover such
drugs and medical devices.
This provision was sought by three big trade associations: the Pharmaceutical Research and
Manufacturers of America, which represents drug companies; the Biotechnology Industry
Organization, which represents biotech companies, and the Health Industry Manufacturers
Association, which represents more than 800 makers of medical devices and diagnostic products.
Several companies were particularly eager to ensure that Medicare would pay for their products. At
their urging, Congress guaranteed extra payments for any "device of brachytherapy" and for
"radiopharmaceutical drugs."
And what is brachytherapy? It is an innovative treatment for prostate cancer, often performed as an
outpatient procedure. Radioactive "seeds" are implanted directly into the prostate, in the hope that
they will destroy cancer cells. The seeds, an alternative to radical surgery, are sold by Indigo
Medical, a unit of Johnson & Johnson.
John McKeegan, a spokesman for Johnson & Johnson, said the payment system devised by the
Clinton administration would have cut reimbursement for this treatment by more than 80 percent,
to $1,500 from the current level of $9,000 to $10,000. "With that kind of reimbursement," he said,
"doctors would have stopped doing the procedure."
A provision of the new law continues the higher payments. That provision was added at the
insistence of Representative Rob Portman, a Republican from Cincinnati. Indigo Medical is based in
his district.
The new law also requires extra payments for radiopharmaceutical drugs used in outpatient hospital
procedures to diagnose or treat illnesses. Such drugs include small amounts of radioactive material.
Doctors inject the drugs and can then visualize organs inside the body with the help of a special
camera that detects the radiation.
The most popular product of this type, Cardiolite, is used to detect heart problems and to predict a
patient's risk of heart attack. Cardiolite is sold by DuPont, the chemical company based in
Wilmington, Del. This provision of the Medicare bill was inserted by the senior senator from
Delaware, William V. Roth Jr., a Republican who is chairman of the Finance Committee.
Amgen, the nation's biggest biotechnology company, was another big winner. Amgen lobbyists
persuaded Congress to overturn a Clinton policy that could have eliminated Medicare payment for a
company.
The product, Neupogen, is often given to cancer patients because it counters the adverse effects of
chemotherapy. Medicare officials recently threatened to cut off payment for Neupogen because, they
said, even though patients usually receive such drugs from a doctor, they can theoretically give
injections to themselves.
The campaign to protect Neupogen was led by Peter B. Teeley, a well-connected Republican who is
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head of Amgen's Washington office. He flooded Congress with letters from cancer patients and
doctors saying the Clinton policy was misguided and dangerous, because elderly patients could not
safely administer the drug to themselves.
The new law prohibits Medicare officials from imposing any new "restriction on the coverage of
injectable drugs."
Lobbying reports filed with Congress show that Amgen's Washington office spent $3.6 million on
lobbying in the last year. It formed a coalition with five other companies to work on this one issue,
deploying more than 15 lawyers and lobbyists.
Medicare uses more than a dozen formulas and fee schedules to pay for different types of goods and
services. But the secretary of health and human services, Donna E. Shalala, can unilaterally reduce
payments that she finds to be inherently unreasonable or "grossly excessive."
Dr. Shalala tried to use this authority to cut Medicare payments for blood glucose test strips, used by
diabetics to monitor their blood sugar levels. And she was considering similar cuts in payments for
many other products -- an alarming prospect to the health care industry.
The new law says the secretary may not use this authority again until Congressional investigators
have reviewed her prior actions and she issues new criteria to identify excessive payments.
Congress ladled out money to a few favored hospitals by reclassifying the counties in which they are
situated. Hospitals in large urban areas get higher Medicare payments than other hospitals.
The new law says that, for the purpose of Medicare reimbursement, Lee County, III., is deemed to be
in the Chicago metropolitan area. That seemingly minor change will provide $750,000 a year in extra
Medicare money to the county's only hospital, the Katherine Shaw Bethea Hospital in Dixon, III., a
small rural town 100 miles west of Chicago.
The county is represented in Congress by J. Dennis Hastert, the speaker of the House. Darryl L.
Vandervort, president of the hospital, said, "Mr. Hastert has been working with us on this for three
years."
But Mr. Vandervort insisted: "This is not pork-barrel spending. It was the right thing to do."
Likewise, under the new law, Brazoria County, Tex., is deemed to be part of the Houston area. Tom
DeLay, the House Republican whip, represents most of the county. This provision is worth $380,000
a year to Angleton Danbury Medical Center in Angleton, 45 miles south of Houston. Patti E. Worfe, a
spokeswoman for the hospital, said: "Tom DeLay really made it happen."
Sometimes Congress earmarked money for specific hospitals by name. Mississippi, the home of the
Senate majority leader, Trent Lott, appears to have received more such grants than any other state.
The new law provides $3 million for environmental medicine and toxicology at the University of
Mississippi Medical Center at Jackson; $2 million to help the university find plants with medicinal
value; $2 million for health care programs at the University of Southern Mississippi; $2.5 million for
a rural health institute at Mississippi State University, and unspecified amounts for a new cancer
research institute.
"When you invest in health care, you could never ever call it pork- barrel spending," said Barbara
Austin, a spokeswoman for the University of Mississippi Medical Center.
Members of Congress continually rail against H.M.O.'s as heartless and bureaucratic. But the new
Medicare law increases payments to them, over objections by the White House, which contended that
they were already overpaid by Medicare.
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Karen M. Ignagni, president of the American Association of Health Plans, observed that H.M.O.'s
participating in Medicare would get $4.8 billion of the $16 billion in additional money spent over the
next five years as a result of the new law.
"That's a real vote of confidence in the importance of managed care for senior citizens," Ms.
Ignagni said.
The industry detested one particular provision of the 1997 budget law: H.M.O.'s had to pay $95
million a year for a government-run education campaign to advise Medicare beneficiaries of
insurance options.
Lobbyists persuaded Congress to slash the fees charged to H.M.O.'s. for the education campaign.
Instead of paying the full $95 million, they will pay only a small fraction of the total, reflecting their
share of the Medicare population, now 16 percent. The Medicare trust fund will pay the remainder,
subject to approval by Congress each year.
"We lobbied very strongly for that change," Ms. Ignagni said. "We don't mind paying our fair share.
But we didn't want to bear the entire cost."
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THE INDIANAPOLIS STAR December 5, 1999 Sunday
Copyright 1999 The Indianapolis Newspapers, Inc.
THE INDIANAPOLIS STAR
December 5, 1999 Sunday CITY FINAL EDITION
SECTION: LIFE/STYLE; Pg. J06
LENGTH: 190 words
HEADLINE: Fast facts about caregiving
BODY:
Remember the old TV commercial that said, "You're not getting
older. You're getting better. "
Yeah, right.
The fact is, you are getting older; your parents are getting
older; America is getting older.
About 33 million Americans are older than 65 today; more than
31/2 million are 85 or older.
Life expectancy at birth for all Americans is about 76, but
life expectancy for those already at the age 65 plateau is 16
additional years for men and 21 years more for women. That's a long
time to be "old. "
In the United States, there are nearly 2 million nursing home
beds. Medicare, the federal insurance plan, and Medicaid, the
mandated states' welfare program, pay three-fourths of the total
costs.
The profile of a typical caregiver for an elderly person is a
46-year-old woman who is employed and spends about 18 hours a week
helping her mother, who lives nearby.
Nearly one in four households in this country is involved in
some way in providing care for an elderly friend or relative.
Sources: Census Bureau; www.retireweb.com; American Health Care
Association; National Alliance for Caregiving.
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USA TODAY, July 28, 1998
Copyright 1998 Gannett Company, Inc.
USA TODAY
July 28, 1998, Tuesday, FINAL EDITION
SECTION: NEWS; Pg. 10A
LENGTH: 1689 words
HEADLINE: Nursing homes must serve their residents' interests
BODY:
Donna Kelly, of Lexington, Ky., remembers the morning her uncle,
Albert, died.
She was asked by the hospital to inspect his body. Donna said
the nurse told her she had never seen someone "in such poor
condition."
Albert Hogan was an unassuming man. "He used to work at the
local Kroger's sweeping the floors; he gave day-old bread from
the store to people in need. In time, though, his own needs were
neglected," Donna explained.
Her displeasure is not unique. Donna is one among millions of
baby boomers who have helped care for aging loved ones in a nursing
home. It is an effort often characterized by stress and frustration,
judging from the growing number of complaints that advocacy groups
such as mine have been getting, and, indeed, from the growing
number of nursing-home advocacy groups themselves.
In 1993, after an illness that required hospitalization and a
family effort to care for him at home, Hogan entered a nursing
home to get more constant care.
Soon after, problems began. In a lawsuit, Albert Hogan's estate
alleges that the home, Heartland Health Care Center, owned by
Complete Care Inc., was responsible for Hogan's gross malnutrition,
dehydration, the tightening of his joints from the lack of motion,
infections, impacted bowels, serious pressure sores and rib fractures.
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The suit also alleges that Hogan was illegally restrained, denied
prescribed medications and improperly given psychotropic medications
all in violation of federal and state standards.
In a five-page answer to the allegations, the nursing-home company
denies any wrongdoing. The suit is before the court.
As Albert deteriorated, Donna fought to get the nursing home to
respond to the problems. With the help of the long-term care ombudsman,
a meeting with the home's administrators was arranged. "Things
got better for maybe a day or two," Donna claims.
Each resident of a nursing home is entitled to care that allows
him to function in his day-to-day life at the highest possible
level. Such is the protection afforded by the Nursing Home Reform
Act of 1987, for which the National Citizens' Coalition for Nursing
Home Reform lobbied.
But despite the quality of the legislation, government enforcement
of quality care standards is abysmal. President Clinton has recently
ordered tougher enforcement of nursing-home regulations. He joins
Sen. Charles Grassley, R-Iowa, in efforts to bring attention to
all of these problems.
Taxpayers pay billions of dollars to nursing-home operators through
the Medicaid program. In turn, the operators fund lobbyists in
Washington to protect their interests. The baby boom generation
of nursing-home consumers must pressure our leaders to ensure
that the enforcement system for nursing homes looks out for the
residents' interests rather than special interests.
Sarah Greene Burger, exec. director
National Citizens' Coalition for
Nursing Home Reform
Washington, D.C.
Even our most revered national sites aren't safe from violence
anymore
What a sad affair our nation endured once again, when violence
erupted in yet another once-sacred locale the U.S. Capitol ("Slain
guards to lie in state at Capitol," News, Monday).
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Schools, office buildings, even the U.S. Capitol none is exempt
when a nation forgets its roots, embraces and
encourages moral relativism and ignores the fact that violence
in the media will ultimately mirror itself in our everyday lives.
Each day, thousands of times, we are exposed to gross acts of
violence on TV and in the movies. While these acts may reflect
"reality," they also deaden our senses to the true cost
and impact they have when they leave the screen and occur in in
our workplaces, institutions of learning and centers of government.
I'm saddened, as all Americans should be, by the tragedy which
took place in Washington, but I believe it is not an isolated
incident. It is merely indicative of a nation that appears to
have forgotten how truly blessed it is.
In fact, I believe it should be viewed in the same tragic light
as the recent incidents in Arkansas, Kentucky, Oregon, Oklahoma,
Mississippi and other places where tragedy seems to be becoming
more and more a part of our everyday lives.
The real tragedy will be if we don't learn from these terrible
acts. God has truly blessed our nation, and I wonder if the seemingly
exponential increase in violence in our workplaces may be a sign
that we have forgotten how to be a thankful, blessed people.
Mark Fogas
Bossier City, La.
Which offense is worse?
I do not understand why a person can rant and rave at the CIA
headquarters and threaten to kill President Clinton and this is
not considered a federal offense.
But if someone is heard even mentioning the word "bomb"
at a U.S. airport, the person is arrested on the spot and charged
with having committed a federal offense.
I really wonder which is worse:
To threaten to kill our president or say "bomb" in an
airport?
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Charles Gunn
Hattiesburg, Miss.
Security never enough
The killing of two guards and wounding of other innocent people
certainly warrant everyone's deepest sympathy and regards to the
victims and families.
However, before the hue and cry go out to weld the doors of the
Capitol, there needs to be a weighing of the existing measures
to secure such public facilities, specifically Washington, D.C.,
structures.
It has been 15 years since such an incident has happened, with
the Capitol, America's heartbeat, having more than seven million
visitors a year.
Two points can be made here:
One, no other event or facility can possibly have as good a record.
Two, no possible measure can be taken anywhere to isolate a crazy,
no matter what precautions are taken.
Donald L. Keefe
Columbus, Ohio
Capital punishment
The recent shootings at the Capitol are another unfortunate situation
and act of violence. Other major crimes that occurred this decade
were the Los Angeles riots, the World Trade Center bombing, the
Oklahoma City bombing, the Long Island railroad massacre and the
Unabomber's acts of terror.
One thing all of these situations had in common were people. It's
people who are responsible for their actions and should be held
accountable for them. Sadly, none of the suspects has received
the ultimate punishment, capital punishment. Although Timothy
McVeigh was sentenced to death, it could be at least 10 years
until justice will be served because of the lengthy appeals process
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of our current system.
In order to combat crime and terrorism, our nation needs a justice
system that will enforce the laws and set tough examples.
In the case of capital punishment, using it more would teach criminals
that crime does not pay and would also serve as a deterrent. This
would make people think more than twice about committing a felony,
thus serving to protect the innocent.
Randell Hansen
Rockville Centre, N.Y.
Montreal Expos neglect their most important investment: their
fans
I read with deep interest the article "Stadium seen as cure-all"
about the pathetic plight of the National League's Montreal Expos
averaging around 10,000 fans per game (Sports, July 21).
Expos president Claude Brochu claims a $ 250 million ballpark is
the panacea for all that ails his club.
In my opinion, he is wrong and his view of life is extremely myopic.
Fan base is a major factor. The clubs mentioned as having big
successes with new stadiums Baltimore, Cleveland and Atlanta already
have a solid fan following. Colorado is a new franchise hungry
for a team and willing to support a team that has already made
the playoffs.
The Expos have always had a dearth of loyal fans. Yes, a new stadium
will break all attendance records on opening day, but only out
of curiosity. By game two, attendance will fall to under 20,000.
The ballpark in Montreal is not a user-friendly place. I have
attended more than 25 games there since 1975, but I won't do so
again. The first problem is the ticket department.
Ticketron has been fine, but when I have to call Montreal for
tickets, once they are aware I'm an American, rudeness sets in,
and I ultimately end up in the nosebleed section, wondering about
the 40 or more vacant rows in front of me. The few times I've
had decent seats, my family and I have been threatened and have
had beer and other sundry items thrown at us because we dared
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to cheer for the visiting team. And I emphasize we never have
booed the Expos.
Marketing is a major problem for that organization. Either that
department was downsized to zero or there are some authentic charlatans
on the payroll. One part of marketing is promotion. The top money-making
operations know that to make money you have to spend money, and
giveaways, such as umbrellas, gym bags, hats and baseball cards,
are common. The Expos give you nothing but an unfriendly, condescending
attitude, threats and a general bad feeling.
A potential market exists throughout northern New York State,
Vermont and New Hampshire, which have a multitude of young baseball
players who could all become potential Expo fans. Discount tickets
once or twice a year for each league throughout that region would
bring fans and create loyalty.
There are many empty seats at every game. This is lost revenue.
Fans in the seats paying half price or even less would be better
than nothing.
When customers save money on the admission, they are more likely
to spend more at the concession stands, where you make the most
profits anyway.
The Expos need to learn that "location, location, location"
are the three most important factors to success.
Montreal is not the right location. The organization is destined
to fail. It is too worried about losing money instead of making
it.
"Build it, and they will come" does not hold true for
this winter hockey town. A more realistic view would be to say:
"Sell it, and all will work out."
William J. McLaughlin
Saranac Lake, N.Y.
GRAPHIC: PHOTO, b/w, Ron Edmonds, AP
LANGUAGE: ENGLISH
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Daily News (New York) July 25, 2000, Tuesday
Copyright 2000 Daily News, L.P.
Daily News (New York)
July 25, 2000, Tuesday SPORTS FINAL EDITION
SECTION: EDITORIAL; Pg. 32
LENGTH: 807 words
HEADLINE: AMERICA'S ELDERS DESERVE BETTER
BODY:
LAST WEEK, the Daily News reported on a Health Care Financing Administration survey that was
sharply critical of nursing home oversight in the State of New York. This week, another federal
study emerged. It censures the nursing home industry nationwide. Elder care, it appears, is on the
front burner these days. But how long it remains there, and with what results, is, sadly, still a
matter for speculation.
The latest study, conducted by the Department of Health and Human Services, took an astounding
eight years to complete. It certainly cannot be faulted for lack of thoroughness. Prime among its
findings is that nursing homes are critically and consistently understaffed. More than half fail to
meet minimum staffing guidelines.
That translates into inadequate daily care, which, in turn, results in patients developing
life-threatening conditions requiring hospitalization. It also can translate into daily humiliations.
Example: Aides at one home forcing "huge spoonfuls of food" into the patients' mouths in an effort
to get them to eat faster.
If someone uncovered a day-care center where children were virtually force-fed and ended up
choking on their food, the public would be outraged. But here the victims are "only" the elderly, so
outrage appears to be in short supply.
The report recommends new federal guidelines to ensure that patients receive an average of two
hours' care per day from nurses' aides. That would be the minimum standard. Currently, 54% of
homes fail to meet it. Also proposed: at least 12 minutes' care per day per patient from registered
nurses. Thirty-one percent of the homes could not guarantee that.
The number of this nation's senior citizens is growing by leaps and bounds as Baby Boomers age
and medical advances prolong life. The longer America waits to correct the problems, the more dire
the situation will become. Already, the nationwide nursing home population is more than 1.6
million. It is served by some 17,000 facilities, 95% of which are subject to federal standards. But
those standards, the report notes, are "too vague."
The government - federal, state and local - ought to be addressing funding, staffing, salaries,
employee training, adequate inspections, etc. It must clarify rules and regulations - and ensure
that higher standards are not only monitored but enforced. Right now.
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Every generalized criticism of nursing home care translates into specific individual suffering - being
endured right now by a human being who is bedridden, frail, sick and/or mentally incapacitated.
Some patients may have families to plead their cases. Many do not. They are alone and forgotten.
If society does not speak up for them, who will? Or have we deteriorated so much as a society that
some people count less than others?
Bye-bye bullies
You might find this difficult to believe, but until now, teachers could not remove violent students
from classes without approval from an administrator. That's being changed. Measures signed into
law yesterday by Gov. Pataki demand zero tolerance for violent students - or for dangerous
teachers.
Now, each school must set up a code of conduct, covering everything from appropriate dress and
language to discipline. Break the code, and you're in detention. Or on suspension. Or just plain
out.
The punishment for assaults - kid against teacher or vice versa - is increased from a misdemeanor
to a Class D felony. That could lead to seven years in prison.
And there's no more sweeping bad behavior under the rug. Every incident of school violence must
now be reported to the state Education Department and the Division of Criminal Justice Services.
And family and criminal courts must notify schools about students' juvenile delinquency records.
The new legislation requires fingerprinting of prospective school employees, including teachers,
statewide. The city already demands prints and background checks of teachers, but before the new
legislation, school authorities could simply allow dangerous staffers to resign without disclosing
allegations of child abuse. No more.
Schools also must develop safety plans with the local police, including strategies for responding to
emergencies. There will have to be a crisis response plan for every building.
Unruly students deny other students the chance to learn, and their disruptive presence has long
been cited as a major factor in the abysmal academic performance of the city's youngsters. At last,
the troublemakers will not be tolerated and learning can begin.
Surferbird
From the wires: CAMBRIDGE, Mass. (AP) - A professor at the Massachusetts Institute of
Technology and a handful of students are spending their days training a gray parrot to surf the
Internet - hoping to keep boredom at bay for their feathered friend.
Wait until it starts ordering crackers online.
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The Atlanta Journal and Constitution June 15, 2000, Thursday,
Copyright 2000 The Atlanta Constitution
The Atlanta Journal and Constitution
June 15, 2000, Thursday, Final Edition
SECTION: Editorial; Pg. 22A
LENGTH: 491 words
HEADLINE: Senior citizens don't need to lean more on government
BYLINE: Staff
SOURCE: JOURNAL
BODY:
YES, IT'S AN ELECTION year, and this time lawmakers are buying the vital vote of seniors through
various congressional efforts to adopt a Medicare prescription drug plan.
President Clinton proposed his plan last year; House Republicans offered their nearly complete
version this week. Some misguided Senate Republicans are even proposing price controls on
drugs, a sure way to constrain competition and stifle research and development among
pharmaceutical firms.
In a nutshell:
The Republican plan, sponsored by Rep. Bill Thomas (R-Calif.), would cover costs for low-income
seniors or those with especially high expenses --- about $ 5,000 to $ 6,000. All others enrolled in
Medicare would be able to buy government-subsidized private insurance; the government would be
the insurer of last resort. Private insurance companies would get a 30-35 percent subsidy.
Premiums would be $ 35 to $ 40 a month.
Clinton's plan would have the government pay half the cost of prescription drugs, up to $ 5,000
annually; all for those earning less than 135 percent of the poverty level. The premium would be $
24 a month.
The GOP says its plan is expected to cost $ 40 billion over five years; the Clinton plan, $ 150
billion to $ 160 billion over 10 years. Based on our politicians' penchant for understating the cost of
their initiatives, we're betting it'll be a lot higher.
As expected, each side is denouncing the other's plans, but as we started out saying, this is an
election year. The ubiquitous polls have identified this as an issue with strong voter interest, so
despite the heated partisanship in Washington, there's actually a possibility of agreement on a plan
this session.
That's unfortunate. What Republicans and Democrats are formulating is a new entitlement under
the program for those 65 and older and the disabled. And that's tantamount to a competition over
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the perfect deck chair arrangement on the Titanic. We don't need to expand entitlements. Like
Social Security, Medicare in its present form is unsustainable amid the "graying of America."
We have no doubt it's high time that seniors get private-sector coverage for prescription drugs. But
even more important, it's time to quit the Band- Aid approach to health care for our seniors and
to rethink the entire Medicare program. There is a role for government in catastrophic illness and
among the needy, but we need to wean Americans off the expectation that government will take
responsibility for their health care.
What's needed for seniors and the disabled is a program that offers participants a choice of health
care options from the private sector, encourages competition and quality and contains costs. And
for that, lawmakers need not look far. A model for such a program is already on the steps of the
U.S. Capitol: the Federal Employee Health Benefits Program, covering 9 million federal employees
and
surprise
our members of Congress.
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USA TODAY, October 12, 1998
Copyright 1998 Gannett Company, Inc.
USA TODAY
October 12, 1998, Monday, FINAL EDITION
SECTION: MONEY; Pg. 1B
LENGTH: 2848 words
HEADLINE: Unheeded cries for help Problems at Florida home reveal gaping holes in legal
safety net
BYLINE: Elliot Blair Smith
DATELINE: TAMPA
BODY:
TAMPA "Suitcase City" is named for the transients
who drift through north Tampa like the surf on a dirty beach.
But it is the final destination for many elderly and disabled
Americans who no longer can take care of themselves and come to
live at the oak-shaded nursing home known as the Brian Center.
Flanked by pawnshops, a check-cashing store and an abandoned housing
project, the 266-bed Brian Center Health and Rehabilitation had
a prosperous history before it was sold to new owners in July.
Most residents' room and board was paid for by federal Medicare
and state Medicaid insurance programs available to all Americans.
Behind warped doors that hung crookedly on loose hinges, however,
some Brian Center residents were left bruised and bloodied and
their gums black from neglect, according to state regulatory records
and lawsuits filed by family members who seek more than $ 100 million
from the nursing home's owners.
For those residents - sometimes barefoot, dressed in thread-bar
gowns and unattended in urine-soaked hallways, according to state
records the home came to symbolize universal fears of growing
old.
More broadly, Brian Center was emblematic of gaping holes in state
and federal efforts to police the nursing home industry, notwithstanding
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repeated warnings and fines by Florida authorities.
Eventually, some Brian Center residents and their families turned
for relief to contingency-fee lawyers, joining a litigious trend
in the nursing home industry that can reward the victorious with
tens of millions of dollars but also embodies excesses.
More than a dozen "residents" rights" lawsuits, including
a class-action claim, are pending against Brian Center and a succession
of owners and management companies of systematic fraud, abuse
and neglect orchestrated to inflate profits at the expense of
people.
Defense lawyer Kirsten Ullman, who represents Brian Center and
its owners says: "We've done our investigation and we feel
we have evidence that is strong to defend these cases." She
declines to discuss individual allegations.
Among the defendants is Unifour of Florida, 100% owned by millionaire
Don Beaver, who founded and named a chain of nursing homes after
his deceased son Brian.
Beaver, who declined to comment for this story, made his fortune
operating 49 Brian Center homes and other nursing facilities throughout
the Southeast. In 1995, he merged Unifour of Florida into the
publicly held Living Centers of America nursing home chain --
also a defendant in the lawsuits -- receiving $ 185.7 million in
stock and a board seat.
In July, a successor company controlled by money manager Apollo
Advisors merged with Mariner Health Network to form Mariner Post-Acute
network. This organization sold Brian Center of Tampa to the unrelated
and privately held Delta Health Group, which renamed it Delta
Health Care Center of Tampa.
Florida regulators say they could not keep up with the Tampa retirement
home's frequent changes in owners and care standards, expressing
a chronic complaint among state and federal authorities.
State nursing home chief Doug Cook, director of the Agency for
Health Care Administration, says enforcement lawsuits against
nursing home owners take up to four months to be heard in court
and an additional month to be decided. Fines are limited to $ 5,000
per violation.
"There's very little incentive to quickly corrected problems
that our surveyors discover," Cooks says. "They need
only [prove they've improved the conditions of the home by the
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time of the hearing."
Federal regulators say they are even more constrained. The Justice
Department's Civil Rights Division prosecutes physical abuse cases
at government-owned and operated nursing homes, which number fewer
than 1,000 of the 17,168 nursing homes nationwide.
But federal prosecutors say they have no statute under which to
litigate human-rights abuses of private nursing homes. Rather,
they are limited to pursuing money fraud cases under the Federal
False Claims Act. The law recoups money lost to Medicare. It does
not repair damaged lives.
That helps explain why Florida is lined with billboards paid for
by private lawyers who specialize in suing nursing home operators.
"We found there was a complete government abdication of responsibility
for nursing homes," says Tampa lawyer James Wilkes, who has
10 lawsuits against Brian Center, including a class action, and
settled six prior claims for undisclosed cash sums. "Not
only does the government not protect nursing home patients. It
protects nursing home operators."
'Wandering around in the dimmed light'
Over a decade's time, Florida nursing home regulators repeatedly
deemed Brian Center's care deficient but let the facility off
with small fines and promises of corrective action, state records
show.
Authorities rarely varied their annual inspections by more than
a week. Even then, inspectors said they found Brian Center residents
unbathed, inappropriately dressed, spotted with bed sores and
housed in unsafe and unsanitary conditions.
Many Brian Center residents' medical records were inaccurate,
incomplete or missing altogether, and some patients were misdiagnosed,
the state records say.
An though Florida law prohibits nursing homes from employing violent
felons in jobs that involved contact with residents, state inspectors
repeatedly found that Brian Center failed to screen employees
for criminal backgrounds.
In a review of law-enforcement records, Wilkes' law firm found
that 46 Brian Center workers employed between 1989 and 1997 had
been convicted of felonies. Some were convicted of such offenses
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as aggravated assault, battery, kidnapping and murder.
Alone in the twilight of their lives, Brian Center residents received
"no stimulation or distraction" and sat "for long
periods of time with no meaningful activity or interactions,"
state inspectors reported.
"Call lights were not answered in a timely manner, resulting
in soiled linens," an inspector wrote in one report. For
a time, "overtly violent" residents were place in a
locked unit with patients who Alzheimer's disease; one such person
"had injured several staff (members) and several residents,"
the records say.
"Quiet time," an inspector said in another report, "consisted
of gathering 20-25 residents in the dining room and announcing
in a loud voice, 'It's quiet time now.' (the employee) then turned
off the light and left the residents. During this quiet time,
residents were yelling at each other and residents were wandering
around in the dimmed light."
Brian Center owners and managers dutifully corrected state-identified
problems. And the nursing home remained eligible to collect Medicare
and Medicaid payments despite state threats to cut off Medicaid
in 1989, 1992 and 1997.
But the deficiencies recurred year after year.
"Brian is a classic yo-yo facility," says Florida nursing
home chief Cook. "In a typical yo-yo facility, the owner
is starving the home or putting them on short rations."
Brian Center was "up" for state inspections -- fully
staffed and stocked with fresh linens -- and "down"
much of the rest of the year, according to the testimony of nurse's
assistants in state regulatory reports and plaintiffs' lawsuits.
Without meaningful intervention by state or federal authorities,
private lawyers and civil lawsuits came to substitute for regulatory
enforcement. Or, as Cook says: "We're left with Mr. Wilkes'
actions."
Lounge lizard or legal legend?
Wilkes' pale blue eyes and tousled hair favor his first choice
of profession as country balladeer. His monogrammed shirts and
private jet bespeak the second as legal eagle. With 300 lawsuits
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Page 5 of 9
pending against most of the USA's major nursing home chains, Wilkes
tugs at heartstrings. But for much larger stakes than he crooned
for in cocktail lounges.
This year, the 18-lawyer Wilkes and McHugh law firm has won $ 35
million in nursing home settlements. Next year, Wilkes expects
to bring home $ 100 million, 20% of the jury verdicts and legal
settlements he predicts for the nursing home industry as a whole.
The firm keeps 40% of its winnings a contingency fee and tacks
on expenses. But Wilkes says the recoveries include more than
$ 3 million that nursing home operators had to repay Medicare and
Medicaid for improper billings.
"Nobody does it on the scale we do," says Wilkes, 47.
"It isn't just the money. It's personal on my part. One of
his grandmothers died in a nursing home.
Wilkes' success has engendered a growth industry of private lawyers
who take on big-chain nursing homes. And his promotional style
has spawned a new performance art of lawyers employing billboards,
direct mail, newspaper and television advertisements. Detractors
point out that Florida lawyers need win only $ 1 damages to be
entitled to recover their expenses. "There's no incentive,
really, to stop after a point," says Mary Ellen Early, director
of policy at the Florida Association of Homes for the Aging, a
trade group that represents nonprofit nursing homes.
"It's a no lose deal for those guys," agrees Ed Towey,
spokesman for the Florida Healthcare Association, the state's
largest nursing home trade group. Towey says lawsuits cost the
Florida industry about $ 30 million a year, prompting nursing home
insurers to increase premiums and deductibles and scale back coverage.
A decade ago, the specialty that vaulted Wilkes to prominence
-- and made the Brian Center lawsuits possible -- hardly existed.
Under Florida law, if a nursing home resident died of abuse, his
or her legal rights also ceased. In 1986, the state nursing home
residents' Bill of Rights law was amended so heirs could bring
action against an abusive home.
This March, in a tacit admission that private lawyers had been
more successful than regulators at punishing rogue nursing home
operators, the state attorney general appointed Wilkes as outside
counsel.
Wilkes quit amid strong industry protest. "They said me with
a badge would be the end of the industry," he says.
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Page 6 of 9
Others picked up the torch.
At a White House briefing in July, the official who administers
Medicare, Nancy-Ann Dearle, said the federal government will get
tougher with nursing homes that repeatedly violate safety rules,
in part by requiring states to more frequently inspect homes with
serious or repeat violations.
The Health Care Financing Administration, which DeParle heads,
endorses criminal background checks on nursing home employees
-- a measure already required in some states, including Florida
-- and state regulatory records for nursing homes nationwide.
The Internet-based resource will be introduced this month.
Private efforts also are under way. This month, the American Nurses
Association plans to roll out a ratings system that will assess
the quality of care at nursing homes that agree to be inspected.
Association President Beverly Malone says: "We believe the
public deserves to know which nursing homes are there to meet
their expectations about quality of care."
Wilkes sees no barrier to expanding his brand of justice-for-hire,
however. He holds law credentials in Florida, Alabama and Texas
and recently passed the bar exam in Arkansas.
"I don't think there's anybody but me who knows how to do
it. I eat it, I drink it, I live it every day," Wilkes says.
"But having said that, I think I must exercise restraint.
I have not wanted to destroy the industry and not leave an alternative
to the elderly who need them."
They're not meat, they're humans'
When Emma Louise Butler of Tampa grew too old to care for her
adult son John a retired barber and Army veteran disabled after
a beating and robbery he was institutionalized at Brian Center.
It was August 1989. He was 60 years old. The Veterans Administration
paid his bill.
Former Brian Center nurse's assistants describe John Butler with
fondness and dismay. He was talkative -- always trying to borrow
a cigarette and complaining about the food but he also snuck
into elderly female residents' rooms, and Brian Center employees
treated him roughly for misbehavior, former employees say in dispositions.
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Page 7 of 9
By the time Butler was 65, an age when many Americans consider
retirement, he was incontinent, had lost his ability to walk and
developed infected be sores. Butler's mother, vigorous at age
84, said in a deposition in November that she often found her
son in his nursing home bed "wet from head to foot"
in urine.
In the last 15 months of his life, Butler lost 41 pounds. His
death certificate, dated Nov. 23, 1994, cites emaciation. Wilkes
seeks $ 30 million on behalf of Butler's heirs.
Another of Wilkes' lawsuits tracks the decline of Mamie Beasley,
who entered Brian Center in June 1992 as a 97-year-old widow.
Less than a year later, Beasley fell, fractured her hip and never
walked again. According to court records, Beasley developed a
sore on her big toe that turned to gangrene and resulted in the
amputation of her leg above the knee. She died in December 1997.
In this lawsuit, filed on behalf of Beasley's grandniece, Wilkes
seeks $ 25 million, arguing that "numerous entries of fraudulent
documentation were instrumental in the development of Mrs. Beasley's
pressure sores, which resulted in the amputation of her left leg."
Defense lawyer Ullman facing more than $ 100 million in such
claims from Wilkes and others -- says: "I think it's fair
to say we were open to discuss their position and our position.
Then the demand(s) came in, which (were) unreasonable. That ended
the negotiations at that point in time."
In April 1997, management of Brian Center of Tampa was taken over
by Delta Health Group. And in July, Delta exercised an option
to acquire the home from its most recent owner, Mariner Post-Acute
Network, which judged the center nonstrategic to its interests.
"It was a problem-plagued facility," says Delta President
Scott Bell, whose company invested more than $ 1 million to upgrade
the renamed Delta Health Care Center of Tampa. Delta rid the home
of pervasive urine odors with a new ventilation system. It also
replaced rusted furniture and rotting doors and raised workers'
pay.
Delta administrator Kay Maley says: "We are not the Taj Mahal
or a 'Pink Palace' of nursing homes. But I will put my care that
I give in this home up against any home in Tampa as outstanding."
Even top nursing homes have trouble maintaining regulatory compliance,
however. In December, state inspectors confronted Delta with allegations
that ranged from inappropriate care of elderly residents to mishandling
their funds. The family of an allegedly abused resident threatened
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Page 8 of 9
to sue. Delta fixed the regulatory deficiencies, some of which
it ascribes to "holdovers" from former owners. And in
February it was awarded the state nursing home regulator's top
rating of "superior,."
Nevertheless, Lillian DuBois, 64, says the health of her husband,
John, 79, deteriorated dramatically after he was institutionalized
at Delta Health Care Center in June 1997. Within five months,
the strapping former builder lost 60 pounds -- 30% of his body
weight and was heavily medicated, medical records show.
Lillian DuBois' brother, Danny Eldridge, says that in his opinion.
"They took him from a walking, functioning human being to
a zombie. He didn't know where he was, who he was or anything."
In September 1997, DuBois says, she discovered her husband glassy-eyed
and unattended n a nursing home hallway. After escorting him back
to his bedroom, she says, "I picked up the sheet and there
was blood all over the bed. And there were gashes down his arm.
And his mouth was so black inside where they had not been brushing
his teeth."
Nearly two weeks later, a Delta Health Care nurse recorded for
the first time a "skin tear to (John DuBois') right upper
arm." By then, it had scabbed over. The nurse identified
the elderly man as "lethargic, (his) face flushed,"
and said officials dispatched him by ambulance to a local hospital
for evaluation.
Nursing home administrator Maley says: "I personally believe
we were giving good care to John DuBois at the time."
While declining to elaborate on the complaint, Maley adds: "This
is a tough business we're in. We're dealing with human lives that
are frail, elderly. It's always -- a constant -- vigilance, daily.
I never find it easy to give excellent care. I find it rewarding."
Lillian DuBois transferred her husband to another nursing home,
where, she says, he is doing well. And she hired Wilkes to sue
Delta.
"If they're treating one other person like that, and I can
get them to stop, that's what I want them to do," DuBois
says. "Because they're not a piece of meat. They're human
beings. And they need help."
GRAPHIC: GRAPHIC, color, Suzy Parker, USA TODAY(IIIUSTration); PHOTO, b/w, David
Carson for USA TODAY; PHOTO, b/w, Jeffrey Camp for USA TODAY; PHOTO, b/w
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The Columbus Dispatch, March 21, 1998
Copyright 1998 The Columbus Dispatch
The Columbus Dispatch
View Related Topics
March 21, 1998, Saturday
SECTION: NEWS, Pg. 1D
LENGTH: 721 words
HEADLINE: PATIENT DEATH PROMPTS PROBE, FIRINGS AT NURSING HOME
BYLINE: Alice Thomas, Dispatch Staff Reporter
BODY:
An East Side nursing home has been investigated and two nurses fired - because of a
patient's death.
A complaint that six other deaths were suspicious has been investigated - but not
substantiated - at Isabelle Ridgway Nursing Center, 1520 Hawthorne Ave., state health
officials said.
"This facility has had a significant number of complaints, higher than the average. And many
of the allegations were very serious in nature," said Kurt Haas, chief of the bureau of health-
care standards and quality at the Ohio Department of Health.
The patient linked to the firings was a diabetic man who died before he reached a hospital on
Oct. 7, 1997, department records show.
The man was found unresponsive at 6 a.m. that day. Despite doctor's orders that he should
be given an injection of glucose, the unconscious man was fed glucose in what is described as
a "health shake," state records show.
The nurse stayed in the patient's room for 30 minutes, without calling his doctor or taking
additional steps, while he remained unconscious, the report shows.
After another half hour, a doctor was called. He said the man should be taken to a hospital. A
nursing home employee called an ambulance at 7:25 a.m. It arrived at 7:40 a.m.,
according to records, and the man died at 7:45 a.m.
State investigators said staff at Isabelle Ridgway told them the two nurses were fired "for
their nursing judgments" about the patient's condition.
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The report also notes that the nursing home didn't have an incident report of the man's
death.
The state views the patient's death as an isolated incident, which the nursing home took
actions to correct, officials said. The investigation also examined the treatment of two other
diabetic patients and found it adequate.
"It's not a punitive system. It's a system we use to get them to comply quicker. And in this
case, it had already happened," said Randy Hertzer, Ohio Department of Health spokesman,
referring to the firing of the nurses.
"They corrected the problem almost as quickly as they figured out what was going on."
The investigation of the six other deaths has ended, but the report hasn't been written and
details are not available, Haas said.
Other investigations at Isabelle Ridgway in 1996 found a resident who was subjected to
physical and verbal abuse by staff members, another who developed bed sores, roach
infestations and documentation problems with patients' weight and doctor notification.
The home had four complaints last year, six each in 1996 and 1995, five in 1994 and 10 in
1993. But that doesn't add up to "poor performer" status, which the state reserves for its
most severe cases.
"They have been cited for having quality-of-care problems, but they did not meet that
particular threshold of substandard of care," said Roy Croy, assistant chief of the bureau of
health-care standards and quality at the department.
Haas said care at the center has shown improvement over the years.
Larry James, Isabelle Ridgway's attorney, also views the death as an isolated incident.
Asked why he thinks it happened, James said, "Any time you have allegations and you're
looking back on a situation, you can't say with specificity what happened.
"I wasn't there, and I haven't talked to the individuals" who were fired, he said.
State officials acknowledged it can be difficult to prove the most severe allegations, such as
patient abuse, because of the legal burden of proving intent.
"It literally is to the point that you have to prove what was in a person's mind at the time.
And that, as you can imagine, is nearly impossible," Haas said.
Other examples of the most serious acts are improper use of restraints that result in
strangulation or allowing residents to walk away from a facility, Haas said.
In general, he said, the due-process requirement means "our belief about what happened
might not be supported by the evidence we find."
As for Isabelle Ridgway, "the facility does have a history that is certainly less than stellar. But
the fact is, to impose fines, we have to go with the information available when we go on
site," Haas said.
Last year, the state health department wrote 6,134 deficiencies statewide. The average
number of citations, per nursing home, in Columbus is 6.38.
LOAD-DATE: March 22, 1998
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The New York Times, October 18, 1995
Copyright 1995 The New York Times Company
The New York Times
October 18, 1995, Wednesday, Late Edition Final
SECTION: Section A; Page 22; Column 1; Editorial Desk
LENGTH: 436 words
HEADLINE: Keep Nursing Home Standards
BODY:
In its ongoing effort to give more power to the states, Congress wants to scrap Federal
standards for quality of care in nursing homes. Given past abuses that the standards were
designed to guard against, and the future need for even more nursing homes, this is an
invitation to trouble. There may well be room to revise the Federal standards to make them
simpler and less costly. But with vast changes occurring in the health-care system, the need
for Federal standards to insure minimal quality is greater than ever.
It was only about 20 years ago that a series of media exposes, state government reports and
legislative hearings revealed widespread abuses in nursing homes, from unsanitary
conditions and malnutrition to overmedication, neglect and sexual and physical abuse. In
1987 Congress passed the Nursing Home Reform Act, which set national standards for staff
training, individual assessments of patients and protection of basic patient rights, including
the right not to be physically restrained, the right to voice grievances and the right to be
notified before transfer or discharge.
The law has begun to make a difference. In the mid-1980's, about 40 percent of nursing
home patients were physically restrained; now, less than 20 percent are. Improved care has
also led to savings on medications and unnecessary hospitalizations.
Now Congress is trying to reshape the health-care system by sharply cutting Medicaid, which
provides about 60 percent of nursing home funding, and shifting the money to state control
through block grants. Congress wants to cut $182 billion out of Medicaid over seven years,
which would likely lead to reduced reimbursement rates for nursing home services and
facilities.
Many states are insisting that, if they are to assume control of a reduced pot of money, they
must have the power to set their own nursing home standards to eliminate needless costs.
House and Senate committees have separately passed bills that would give states primary
responsibility for setting quality-of-care standards for nursing homes, with Washington
offering only general categories to be covered. Nursing home providers could lean on states
to cut back on standards that they will not be able to live up to for lack of funds.
Nearly two million people now reside in nursing homes. But with an estimated 43 percent of
people over 65 years of age likely to spend some time in a nursing home, and an aging
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baby-boomer population, the demand for these facilities will only grow. To abandon national
standards now may invite a return to the nursing home disasters of the past.
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Times Newspapers Limited, September 8, 1993
Copyright 1993 Times Newspapers Limited
The Times
September 8, 1993, Wednesday
SECTION: Home news
LENGTH: 517 words
HEADLINE: Eased rules on homes for elderly 'could lower care standards'
BYLINE: By Michael Horsnell
BODY:
GOVERNMENT plans to relax regulations governing private residential and nursing homes
for the elderly could create a "free for all" in standards, critics said yesterday.
John Bowis, a junior health minister, said the initiative was aimed at reducing the burden of
"unnecessary and excessive" regulations by simplifying the registration and inspection of
homes.
But Sally Greengross, director of Age Concern, said the charity was gravely disturbed that the
protection of vulnerable older people could be reduced if inspection and registration
requirements were eased. She called for people to be put before cost analysis and for binding
contracts defining the responsibilities of private residential and nursing homes in a business
now worth an estimated Pounds 3.3 billion.
The Royal College of Nursing (RCN) gave a warning of a "free for all" over care standards
unless a close watch was kept by an independent inspectorate. It said deregulation could
easily become a cynical cost-cutting exercise. Christine Hancock, general secretary, said:
"The RCN is totally opposed to giving nursing and residential homes a free rein. This could
seriously jeopardise the quality of care."
The government's initiative coincides with the launch by Mr Bowis tomorrow of a new
protective agency, Action on Elder Abuse, being set up after growing evidence of an increase
in abuse. The group, to be established at the Age Concern headquarters in London under the
auspices of the National Council on Ageing, is expected to call for a tightening of regulations
and a rise in staffing levels at homes.
The government has yet to spell out its proposals, which are part of its initiative to reduce
red tape for all businesses. But Mr Bowis denied any assault on fire and environmental health
standards, and said: "Raising standards is our task. Maintaining red tape is not." David
Blunkett, shadow health secretary, said that the scheme, disclosed in a health department
letter to home proprietors, could reduce the homes to "firetraps and centres of food
poisoning".
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"No one in their right mind would consider the safeguarding and protection of elderly and frail
people to be anything but vital. If we have deregulation in this area it will inevitably spell
disaster. The better home-owners want regulations, otherwise they will be put out of
business by the fly-by-nights," he said.
Phillip Hunt, director of the National Association of Health Authorities and Trusts, said:
"Health authorities are now required on a regular basis to inspect these homes and ensure
standards are acceptable. Relatives depend on these inspections to ensure that everything is
okay in these homes. It is one thing to simplify regulations but you will still need inspections
to ensure standards are kept up."
In a burgeoning industry, places in private nursing homes went up from 18,000 in 1982 to
109,000 in 1991, and in private residential homes from 39,300 to 155,000. Under present
regulations, only a home with more than four residents needs to be registered with the local
authority.
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Editorial Reviews
Amazon.com
Nonzero, from New Republic writer Robert Wright, is a difficult and important
pook--well worth reading--addressing the controversial question of purpose in
I of 9
9/14/2000 4:17 PM
Joshua S. Gottheimer
09/14/2000 04:13:32 PM
Record Type:
Record
To:
Mara A. Silver/WHO/EOP
CC:
Subject:
Towards the end the remarks, Clinton also cited the book "Non Zero" by Robert Wright as his
favorite recent read.
Patients in these homes are more likely to lose too much
weight, develop bed sores, and fall into depression. More
than 30 percent of them are dehydrated, malnourished,
and at a much higher risk for illness and infection.
Older Americans who have worked hard all their
lives deserve respect, not neglect. That's why, for more
than seven years now, Vice President Gore and I have
acted to improve the quality of care in our nation's
nursing homes.
In 1995, we put in place tough regulations to crack
down on abuse and neglect, by stepping up on-site
inspections of nursing homes.
3
THE WHITE HOUSE
WASHINGTON
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Devorah R. Adler
09/15/2000 06:03:44 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: edits from devorah; cj will review soon
call with questions
Forwarded by Devorah R. Adler/OPD/EOP on 09/15/2000 05:49 PM
Joshua S. Gottheimer
09/15/2000 04:40:55 PM
Record Type:
Record
To:
See the distribution list at the bottom of this message
CC:
Subject: DRAFT--Nursing Homes Radio Address. Comments pls to Gottheimer ASAP 62554.
1
Draft 9/15/00 4:30pm
Josh Gottheimer
PRESIDENT WILLIAM J. CLINTON
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
Good morning. I'm joining you today from the Washington Home, a nursing home in
our nation's Capitol, that's been delivering quality care to older Americans for more than a
hundred years. The seniors here with me receive top-quality assistance, from a dedicated and
attentive staff.
Every one of the 1.6 million Americans living in nursing homes all across our country
deserve the same quality care. And, as the baby boomers retire, the demand for quality care
will continue to rise even higher. By 2030, the number of Americans over the age of 85 will
double - making compassionate, quality nursing home care even more important.
But while the majority of nursing homes today provide excellent care, too many of our
seniors, in too many homes, aren't getting the proper attention they deserve. And, according
to current research, the number one culprit is chronic understaffing. When there are too few
caregivers for the number of patients, the quality of care goes down.
A recent study from the Department of Health and Human Services reports that more
than half of America's nursing homes don't have the minimum staffing levels necessary to
guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
these homes are more likely to lose too much weight, develop bed sores, and fall into
depression. More than 30 percent of them are dehydrated, malnourished, and at a much higher
risk for illness and infection.
so
Older Americans who have worked hard all their lives deserve respect, not neglect.
That's why, for more than seven years now, our Administration has acted to improve 3 the
in
quality of care in our nation's nursing homes.
look
clm
taken)
In 1995, we put in place tough regulations to crack down on abuse and neglect, by
street
is
stepping up on-site inspections of nursing homes. That/same year, when Congress tried to
eliminate federal assurances of nursing home quality, said no. Then, in 1998, I issued an
executive order requiring all states to increase investigations of nursing homes fining those
that failed to provide its residents with adequate care.
warly The
Thanks to the leadership of Senator Grassley, and Congressman Waxman, Stark,
and Gephardt, Phave developed a bipartisan legislative proposal to improve nursing home
quality. Next week, I'll be sending legislation births to the Hill that takes four new steps to that
Improve conditions in nursing I'M homes across America. Not
Asc
Aerica.
in
*
d)rt.
,a ve jet accurney This yer:
before
First, I'm announc a $1 billion investment over five years in new grants to boost
staffing levels in poorly-performing nursing homes, improve recruitment and retention, and
give more training to caregivers. We will also reward the best-performing nursing homes.
will leak
Second, I'm directing the Health Care Financing Administration to establish, within
two years, minimum staffing requirements for all nursing homes participating in Medicare and
Medicaid.
slow effort to evtable stall
Third, as part^of the establishment of minimum staffing requirements, we are
reviewing Federal reimbursement rates for nursing homes to ensure that they receive the
right level of funding for the number of patients they serve.
50
Fourth, we are taking new steps to educate providers families about critical
quality issues. My proposal requires mursing homes to post detailed information on their
staffing levels in each facility to ensure In addition, just this week, we launched a
new campaign to educate nursing home personnel on ways to prevent weight loss and
dehydration in patients.
on M bot upp to provide qualing core to New Intact,
Slend AT te put Joe the thile improved way to improe runn has 1 up
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Ldnr
Of all the obligations we owe to one another, our most sacred duty is to our parents.
They kept us safe from harm when we were children. We must do the same for them, as they
grow older.
President Kennedy once said, "It is not enough for a great nation merely to have added
new years to life - our objective must also be to add new life to those years." The steps we're
taking today will help bring new life to our nation's seniors, by brining a new level of quality
to America's nursing homes.
Message Sent To:
Draft 9/15/00 1:30pm
Josh Gottheimer
PRESIDENT WILLIAM J. CLINTON
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Capitol,that's been delivering quality care to older Americans for more than a hundred
years The seniors here with me receive top-quality assistance, from what is clearly nn attentive
and
caring
staff
instrution has
Stall embas who are
Eng we of 4
#2 twey in
Today, more than 1.6 million Americans on nearly nursing homes all across
went America. \When the baby boom generation moves into retirement age, that number will rise even
higher. By 2030, the number of Americans over the age of 85 will double making
compassionate, nursing home care even more important.
quality baw deserve M Save sudes car care it ml N bas book retires)
At their best, nursing homes can be a godsend for older Americans and their families - + M
providing safe haven in times of great need. But at their worst, nursing homes can actually
# of
endanger their residents, subjecting them to the worst kinds of neglect.
mains
But
tody
over
While the majority of nursing homes provide excellent care, too many of our seniors, in
85
too many homes, aren't getting the proper care they deserve. And, according to current research,
set to
the number one culprit is chronic understaffing. There is a direct correlation between the number
double
of caregivers per patient and the quality of care a patient receives.
to
1-30
70
A recent study from the Department of Health and Human Services reports that more
denad for
than fifty percent of America's nursing homes don't have the minimum staffing levels necessary
to guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
rualy
these homes are more likely to lose weight, develop pressure sores, and experience depression.
care
And it' estimated that more than 30 percent of them are dehydrated and malnourished, putting
will
to them at & much higher risk for illness and infection.
sloyacked
People living in nursing homes shouldn't have to worry about poor staffing and poor
nutrition. Families shouldn't have to worry as much about a loved one living in a nursing home
as one living alone. That's why, for more than seven years now, our Administration has worked
to improve the of care in our nation's nursing
quality old Amount we have roled homes. hard all Neir closene let 1.es I sech not nglet
In 1995, we put in place tough regulations to crack down on abuse and neglect in our
nation's nursing homes, by stepping up on-site inspections. That same year, when Congress
tried to eliminate federal assurances of nursing home quality, I said no. Then, in 1998, I issued
an executive order requiring all states to step up investigations of nursing homes fining those
that failed to provide its residents with adequate care.
un me ae too few caelson, the fucks 7 care for
down + ratien sutter
1
Today, with the help of Congressmen Grassley, Waxman, and Gephardt, we're taking
three newsteps to improve conditions in nursing homes across America.
First, I'm announcing a $1 billion grant program to help increase boot staffing levels in powy -potory potorny
just)
nursing homes, improve staff recruitment and retention, and provide increased training for
caregivers. This program will seward the best hursing homes, as well as those that need the most
help We're also introducing new, immediate financial pendities for nursing homes that are
currently endangering the health and sufety of our most vulnerable population
provide persons bauses herde 1 protonal
Second, we are taking new steps 10 make sure that all nursing homes provide the
bomon
government with accurate information on their staffing levels so that they receive proper
funding for their facilities. This will help keep our nursing homes accountable, and eliminate
much of the wasteful spending that's getting in the way of good care.
stat
participate 1- redice rediad,
result
Third, I'm directing the Health Care Financing Administration to establish, within two
years, minimum staffing requirements for all nursing homes. This will help ensure that nursing
home participants ind Medicare and Medicaid programs have adequate affing levels and well-
trained caregivers. Additionally, this week, we launched a new campaign to educate nursing
home personnel on ways to prevent weight loss and dehydration in patiets.
Of all the duties lolljahns we owe to one another, our duty to our parents is the most sacred. When
most screddats 15 to our pack tn
slay
kept
ut
we are children, our parents do their best to keep us safe from harm; when our parents begin to
need us, we must do no less. When that time comes, we need to know that our parents will be
sele ham from renue well cared we for. childr. we must do he same tor rem, on They the srow (00, older. for
As President Kennedy once said, "It is not enough for a great nation merely to have
added new years to life - our objective must also be to add new life to those years." The steps
we're taking today will help bring new life to our nation's seniors - and a new sense of security
to America's nursing homes.
2
Affluence
18
With breathtaking rapidity, we are destroying all that was lovely to look at and
in a vein of joc
turning America into a prison house of the spirit. The affluent society, with relentless
good time that
single-minded energy, is turning our cities, most of suburbia and most of our roadways into
oured, and dis
the most affluent slum on earth.
DON MA
Attributed to ERIC SEVAREID. Unverified.
25
Growir
Aged
ANDRÉ
(1940).
19
Yet somehow our society must make it right and possible for old people not to fear
the young or be deserted by them, for the test of a civilization is in the way that it cares for
26
To hold
its helpless members.
score of years,
PEARL S. BUCK, My Several Worlds, p. 337 (1954).
none the wiser
ROBERT
20
Old age isn't so bad when you consider the alternative.
Later Essays,
Attributed to MAURICE CHEVALIER.-James B. Simpson, Contemporary Quotations,
p. 295 (1964), citing The New York Times, Sunday, October 9, 1960. Unverified.
21
As I give thought to the matter, I find four causes for the apparent misery of old
27
Burn d
age; first, it withdraws us from active accomplishments; second, it renders the body less
by magic; but
powerful; third, it deprives us of almost all forms of enjoyment; fourth, it stands not far
country.
from death.
not press down
upon a cross of
MARCUS TULLIUS CICERO, De Senectute (Of Old Age), book 5, section 15.-Herbert N.
Couch, Cicero on the Art of Growing Old, p. 21 (1959).
WILLIAM
Illinois, July 8,
22
This increase in the life span and in the number of our senior citizens presents this
Often r
Nation with increased opportunities: the opportunity to draw upon their skill and sagac-
cluding senten
ity-and the opportunity to provide the respect and recognition they have earned. It is not
enough for a great nation merely to have added new years to life-our objective must also
28
For of a
be to add new life to those years.
delightful, noth
President JOHN F. KENNEDY, special message to the Congress on the needs of the
MARCUS
nation's senior citizens, February 21, 1963.-Public Papers of the Presidents of the United
Offices, or Mor
States: John F. Kennedy, 1963, p. 189.
29
Cultiva
23
As one grows older, one becomes wiser and more foolish.
the most indep
it's liberty and
FRANÇOIS DE LA ROCHEFOUCAULD. The maxim, "En vieillissant, on devient plus fou
emploiment in
et plus sage," was first published in his Réflexions ou Sentences et Maximes Morales, 1655.
But our citizer
There are various English translations, including that above from his Selected Maxims and
productions, be
Reflections, trans. Edward M. Stack, p. 26 (1956).
THOMAS
24
Between the years of ninety-two and a hundred and two, however, we shall be the
Jefferson, ed. J
ribald, useless, drunken, outcast person we have always wished to be. We shall have a long
white beard and long white hair; we shall not walk at all, but recline in a wheel chair and
30
And, he
bellow for alcoholic beverages; in the winter we shall sit before the fire with our feet in a
Blades of Grass
bucket of hot water, a decanter of corn whiskey near at hand, and write ribald songs against
better of Mank
organized society; strapped to one arm of our chair will be a forty-five calibre revolver, and
Politicians put
we shall shoot out the lights when we want to go to sleep, instead of turning them off; when
JONATH
we want air we shall throw a silver candlestick through the front window and be damned to
in The Prose W
it; we shall address public meetings (to which we have been invited because of our wisdom)
6
7
This week, I am proposing comprehensive legislation
to protect older Americans with a national registry to
track nursing home employees known to abuse nursing
home residents, and criminal background checks to keep
potentially abusive employees from being hired in the
first place. I ask the Congress to put progress ahead of
partisanship, and pass legislation to improve our nation's
nursing homes this year.
Choosing to move a parent or a loved one to a
nursing home is one of life's most difficult decisions. But
with these steps, we are giving families the security of
knowing that we are doing everything we can to make our
nation's nursing homes safe and secure. Thank you very
much.
- 7 -
Devorah R. Adler
09/14/2000 10:15:54 PM
Record Type:
Record
To:
Joshua S. Gottheimer/W O/EOP@EOP
CC:
Subject: members to praise
PRAISES A BIPARTISAN CONTINGENT OF MEMBERS FOR THEIR LEADERSHIP IN
IMPROVING NURSING HOME QUALITY. In his radio address, President Clinton will praise
Senators Grassley, Breaux, Reid, and Kohl, as well as Congressmen Gephardt, Waxman, and Stark, for
their leadership on this issue and their efforts to improve nursing home quality nationwide
Devorah R. Adler
09/14/2000 10:15:54 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: members to praise
PRAISES A BIPARTISAN CONTINGENT OF MEMBERS FOR THEIR LEADERSHIP IN
IMPROVING NURSING HOME QUALITY. In his radio address, President Clinton will praise
Senators Grassley, Breaux, Reid, and Kohl, as well as Congressmen Gephardt, Waxman, and Stark, for
their leadership on this issue and their efforts to improve nursing home quality nationwide.
the should Buth
I TNC. net 1
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Captiol that's been delivering quality care to older Americans for more than a hundred
years. The seniors here with me receive top-quality assistance, from what is clearly an attentive
and caring staff.
Of all the duties we owe to one another, our duty to our parents is the most sacred. When we are
children, our parents do their best to keep us safe from harm; when our parents begin to need us,
we must do no less. When that time comes, we need to know that our parents will be well cared
for.
Today, more than 1.6 million Americans live in nearly 17,000 nursing homes all across America.
When the baby boom generation moves into retirement age, that number will rise even higher.
In fact, by 2030, the number of Americans over the age of 85 will double - making
compassionate, quality nursing home care even more important.
At their best, nursing homes can be a godsend for older Americans and their families -
providing a safe haven in times of great need. But at their worst, nursing homes can actually
endanger their residents, subjecting them to the worst kinds of neglect.
But [while we've made progress] too many of our seniors, in too many nursing homes,
still aren't getting the proper care they deserve. [expand on this
malnourished, etc.
ratio
FACTS] Today, I'm announcing several new steps to
For more than seven years now, we have worked hard to improve the quality of care in
our nation's nursing homes.
We've learned that one of the best indicators -- having trained health care professionals in
adequate numbers.
Too many patients are served by too few nurses and personnel. Demonstrable correlation
between ratio nurses and other health care personnel. Ratio between patient quality and nubmer
of personnel.
In aftermath of recent report, consensus has developed - no question about it. Number one
means of quality is adequate staff.
[REFER TO REPORT]
Most nursing homes, like the Washington Home, are quite good - they deliver high quaility care.
They have good people who are committed to high level care.
We have to ensure that all nursing homes are held accountable.
1. $1 bilion. More money for better trained staff to provide adquate care. We need to reward
nursing homes who meet/ deliver high standards and deliver quality care. Rewarding nursing
) 6rant program eg skiping staff
Devorah R. Adler
09/14/2000 10:08:28 PM
Record Type:
Record
3) Financial
To:
Joshua S. Gottheimer/WHO/EOP@EOP
alto my I fiass inseluls
CC:
Subject: summary of initiative
Create a new, $1 billion grant program to improve quality of care in nursing homes. Today, the
1
President announced a new investment of $1 billion over 5 years in a competitive grant program to
increase staffing levels in nursing homes nationwide by providing financial and technical assistance to
nursing facilities, unions, non-profit organizations, or community colleges. States applying for funds
would be required to develop, through an open public process a proposal to chnance staff recruitment
and retention efforts: establish career ladders for CNAS; provide increased training for staff; or conduct
$14
other staffing initiatives. States wishing to reward nursing facilities with exemplary quality of care
records or staffing levels above the minimum levels proposed in the recent HCFA report on nursing
home staffing can use up to 25 percent of their grant funds for bonus payments to these facilities. States
receiving funds must demonstrate how the funds they receive increased staffing in nursing facilities
within one year. This your will used recurd. mayber Not Doe Love (lie reun me)
cratdultele'ry
Thereday / out sever-
Ensure appropriate reimbursement for nursing facilities and provide the public with accurate
1
information on staffing levels. Similar to legislation introduced by Representative Pete Stark (D-CA),
aled
nursing homes participating in the Medicaid and Medicare programs will be required to provide HCFA
with detailed information on their current staffing levels, including the total number of hours; coverage
levels per shift; identifying staff as CNAs, LPNs or RNs; and the average wage rate for each class of
employees. This information will be used to ensure that Medicare is providing appropriate
best here
rent N
reimbursement to nursing facilities, and will be posted for the public to review on HCFA's Nursing
Home Compare website
0.5 well 120st
Establish national requirements within two years. Today, the President will direct needay
3rd minimum d in staffing reg
upal
2
2
the Health Care Financing Administration to complete its comprehensive study on staffing ratios within
mut
12 months and develop and publish Federal regulations establishing minimum staffing levels based on
this report no later than September 1, 2002. As part of this process, HCFA will concurrently evaluate
whether any changes in Federal reimbursement are necessary to implement the new staffing standards
established by the report.
New tray studus for argini
2
Determine the feasibility and advisability of increasing training requirements for CNAs. HCFA
will include a recommendation on the feasibility and advisability of increasing training requirements for
CNAs to 160 hours. Currently, CNAs complete just two weeks of training - less than beauticians,
manicurists, and dog groomers.
not
Impose immediate financial penalties on nursing homes endangering patients. Currently, if a
3
nursing home appeals the imposition of a fine for a quality violation, the Federal government does not
collect the fine until after the appeal is settled, allowing many facilities to avoid paying fines for years
Nex will swest enone
get X nun hon fort 1- refer
we
to
PAX
ruder!
for
our
+ reduce premi bee adjust Stay
r'r.
after the violation was committed. This initiative would require CMPs to be immediately withheld from
future payments to the nursing home. If a nursing home appealed the imposition of the fine and won, the
Federal government would return the funds with interest. In addition, under this initiative, civil money
penalties will be invested in the new incentive grants to States, rather than returned to the Medicare Trust
Fund.
Launch a new campaign to prevent unintended weight loss and dehydration among nursing home
2
residents. This week, HCFA sent every nursing home in the country a new set of training materials to
prevent malnutrition and dehydration. These materials will help certified nursing assistants and other
caregivers identify residents at risk for unintended weight loss and dehydration and then take the
necessary action to prevent it.
fuct pac
Devorah R. Adler
09/14/2000 09:16:56 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: problem statement on nursing homes
MORE MUST BE DONE TO IMPROVE QUALITY OF CARE IN NURSING HOME.
About 1.6 million older Americans and people with disabilities receive care in approximately
17,000 nursing homes. The Clinton-Gore Administration has made the health and safety of
nursing home residents a top priority - putting into effect the toughest nursing home regulations
in the history of the Medicare and Medicaid programs. Most nursing homes provide high quality
care to the frail and vulnerable elderly individuals they serve. However, more must be done.
&tu ree patats
Accordy.
were
and
Over fifty percent of nursing homes do not maintain the minimum staffing levels necessary
to ensure the delivery of quality care. The Health Care Financing Administration recently
HCVA
released a report demonstrating that patients are significantly more likely to develop pressure
sores, lose weight, and undergo unnecessary hospitalizations once staffing ratios fall below the
level of two hours per resident for nurse aides daily. That amount of time is the minimum
necessary for nursing staff to reposition residents and change wet clothes; assist residents with
toileting; provide feeding assistance; provide morning care; and encourage or assist residents
with exercise as appropriate.
Poor staffing results in many nursing home residents becoming malnourished or
dehydrated, unnecessarily increasing their risk of infection and impaired mental function.
Certified nursing assistants (CNAs) typically help seven to nine residents with their daytime
meals, and as many as 12 to 15 residents with their meals in the evening. Residents are fed
quickly or forcefully, and sometimes not fed at all. A recent study by the Commonwealth Fund
estimates that over 30 percent of nursing home residents are malnourished, placing them at risk
for infections, pressure sores, depression, confusion and impaired cognition, and hip fractures
Compared with well hydrated and nourished residents, these nursing home patients have a
five-fold increase in mortality in the hospital.
Nursing home staff often need additional training to carry out their assigned duties
adequately. A 93 percent turnover rate in CNAs compounds the problems caused by inadequate
numbers of nursing home staff. A newly hired CNA may not know how to care for a resident
already at risk for malnutrition and dehydration. A shortage of nursing supervisors leaves CNAs
to do the best they can without assistance from professionals.
Devorah R. Adler
09/14/2000 10:08:28 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: summary of initiative
Create a new, $1 billion grant program to improve quality of care in nursing homes. Today, the
President announced a new investment of $1 billion over 5 years in a competitive grant program to
increase staffing levels in nursing homes nationwide by providing financial and technical assistance to
nursing facilities, unions, non-profit organizations, or community colleges. States applying for funds
would be required to develop, through an open public process, a proposal to enhance staff recruitment
and retention efforts; establish career ladders for CNAs; provide increased training for staff; or conduct
other staffing initiatives. States wishing to reward nursing facilities with exemplary quality of care
records or staffing levels above the minimum levels proposed in the recent HCFA report on nursing
home staffing can use up to 25 percent of their grant funds for bonus payments to these facilities. States
receiving funds must demonstrate how the funds they receive increased staffing in nursing facilities
within one year.
Ensure appropriate reimbursement for nursing facilities and provide the public with accurate
information on staffing levels. Similar to legislation introduced by Representative Pete Stark (D-CA),
nursing homes participating in the Medicaid and Medicare programs will be required to provide HCFA
with detailed information on their current staffing levels, including the total number of hours; coverage
levels per shift; identifying staff as CNAs, LPNs or RNs; and the average wage rate for each class of
employees. This information will be used to ensure that Medicare is providing appropriate
reimbursement to nursing facilities, and will be posted for the public to review on HCFA's Nursing
Home Compare website.
Establish national minimum staffing requirements within two years. Today, the President will direct
the Health Care Financing Administration to complete its comprehensive study on staffing ratios within
12 months and develop and publish Federal regulations establishing minimum staffing levels based on
this report no later than September 1, 2002. As part of this process, HCFA will concurrently evaluate
whether any changes in Federal reimbursement are necessary to implement the new staffing standards
established by the report.
Determine the feasibility and advisability of increasing training requirements for CNAs. HCFA
will include a recommendation on the feasibility and advisability of increasing training requirements for
CNAs to 160 hours. Currently, CNAs complete just two weeks of training - less than beauticians,
manicurists, and dog groomers.
Impose immediate financial penalties on nursing homes endangering patients. Currently, if a
nursing home appeals the imposition of a fine for a quality violation, the Federal government does not
collect the fine until after the appeal is settled, allowing many facilities to avoid paying fines for years
after the violation was committed. This initiative would require CMPs to be immediately withheld from
future payments to the nursing home. If a nursing home appealed the imposition of the fine and won, the
Federal government would return the funds with interest. In addition, under this initiative, civil money
penalties will be invested in the new incentive grants to States, rather than returned to the Medicare Trust
Fund.
Launch a new campaign to prevent unintended weight loss and dehydration among nursing home
residents. This week, HCFA sent every nursing home in the country a new set of training materials to
prevent malnutrition and dehydration. These materials will help certified nursing assistants and other
caregivers identify residents at risk for unintended weight loss and dehydration and then take the
necessary action to prevent it.
kn A A
Cooly (M
21.0 labore R
6 5 has 35209
H
N
\
Devorah R. Adler
09/14/2000 05:38:10 PM
Record Type:
Record
To:
Joshua S. Gottheimer/WHO/EOP@EOP
CC:
Subject: The Washington Home
Here's some information for you:
The Washington Home is a non-profit nursing home, which was founded in 1888 and was the first inhouse
hospice establishment in Washington, D.C. (President Clinton is the first President that has not visited the
home thus far.) It originated as a facility to help "incurable cases" or who people who needed assistance
caring for themselves, but had no money or family. Most residents are over 65 years old, but they will
accept adults 18 years or older -- admission is based on medical need, not age, race, sex, or national
origin. The Board of Directors set a precedent in 1896 when it admitted their first cancer patient -- a time
when cancer was believed to be a contagious disease.
The Home provides a range of services including Long-Term Care, a 39-bed Special Care Unit for
individuals with Alzheimer's disease and related conditions, hospice home care services and sub-acute
services, and most recently it has added a new Health and Rehablitation Care Program for residents who
need more specialized medical attention such as occupational, speech, and physical therapies. They also
provide innovative programs such as pet therapy, music therapy, alternative medicine therapies, babies
day, and theme days. This home is a 198 bed facility that operates 24 hours/day, seven days a week and
is accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The
residents are a racially diverse group and approximately 68 percent are Medicaid patients. The Home also
has staffing affiliations with Georgetown University and George Washington University to provide medical
services for the residents.
homes that have record of good quality care. Not just punitive, but provide rewards to do the
job well.
2. Training and placement programs and/or incentives; rewards for nurising homes.
Helping those homes that need help - but rewarding those who are doing well by their residents/
patients.
II.
medicare. Some nursing homes compensate for more staff than they have. Reduce
payment rates in not staffing adequately. We're going to take more steps to cean up the
system to ensure that nursing homes receive the right medicare payments for personnel
that are taking care of the patients.
III.
Today I'm instructing/ directing HHS to report back to the White House within 1 year.
Lastly, just this week, as part of our nursing home initaitive, we sent out
now that we recognize that issue - we shouldn't delay any longer; address shortcomings in the
system.
We need more and better trained nurses.
CONCLUSION
Today Americans are living longer and healthier lives than ever before. But as President John
Kennedy once said, "It is " [see JT conclusion]
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Captiol that's been delivering quality care to older Americans for more than a hundred
years. The seniors here with me receive top-quality assistance, from what is clearly an attentive
and caring staff.
Of all the duties we owe to one another, our duty to our parents is the most sacred. When we are
children, our parents do their best to keep us safe from harm; when our parents begin to need us,
we must do no less. When that time comes, we need to know that our parents will be well cared
for.
Today, more than 1.6 million Americans live in nearly 17,000 nursing homes all across
America. When the baby boom generation moves into retirement age, that number will rise even
higher. In fact, by 2030, the number of Americans over the age of 85 will double - making
compassionaté, quality nursing home care even more important.
At their best, nursing homes can be a godsend for older Americans and their families -
providing a safe haven in times of great need. But at their worst, nursing homes can actually
endanger their residents, subjecting them to the worst kinds of neglect.
[Most nursing homes have capable staff and provide quality care.] But too many of our
seniors, in too many nursing homes, simply aren't getting the proper care they deserve. And the
number one culprit the number one culprit is there's just not enough staff to meet the needs of
simply not enough well-traine
According to a recent study from the Department of Health and Human Services,
[expand on this
malnourished, etc.
ratio
FACTS]
poor staffing results in
malnourishment
in fact
30 percent
[SOUNDBITE: a nursing home should be a
not a
should be a blanket
place
where you're X by attention
not fighting for attention
overwhelmed by attention
not
swimming in attention - not W.. blanket of protection/ care not left out to place where
you're warmed by attention/ care
not
the steps we're taking today will do that
should
provide a shelter of safety should provide shelter and safety/ security - not
]
For more than seven years now, we have worked hard to improve the quality of care in
our nation's nursing homes. In 1995, we did
in '98, I issued e.o. We simply must do more
Today, I'm announcing several new steps to Today I'm announcing X new steps
We've learned that one of the best indicators having trained health care professionals in
adequate numbers.
Too many patients are served by too few nurses and personnel. Demonstrable correlation
between ratio nurses and other health care personnel. Ratio between patient quality and nubmer
of personnel.
In aftermath of recent report, consensus has developed - no question about it. Number one
means of quality is adequate staff.
[REFER TO REPORT]
Most nursing homes, like the Washington Home, are quite good - they deliver high quaility care.
They have good people who are committed to high level care.
We have to ensure that all nursing homes are held accountable.
1. $1 bilion. More money for better trained staff to provide adquate care. We need to reward
nursing homes who meet/ deliver high standards and deliver quality care. Rewarding nursing
homes that have record of good quality care. Not just punitive, but provide rewards to do the
job well.
2. Training and placement programs and/or incentives; rewards for nurising homes.
Helping those homes that need help - but rewarding those who are doing well by their residents/
patients.
П.
medicare. Some nursing homes compensate for more staff than they have. Reduce
payment rates in not staffing adequately. We're going to take more steps to cean up the
system to ensure that nursing homes receive the right medicare payments for personnel
that are taking care of the patients.
III.
Today I'm instructing/ directing HHS to report back to the White House within 1 year.
Lastly, just this week, as part of our nursing home initaitive, we sent out
now that we recognize that issue - we shouldn't delay any longer; address shortcomings in the
system.
We need more and better trained nurses.
CONCLUSION
Today Americans are living longer and healthier lives than ever before. But as President John
Kennedy once said, "It is " [see JT conclusion]
Joshua S. Gottheimer/WHO/EOP@EOP
James R. Kvaal/OPD/EOP@EOP
Elliot J. Diringer/WHO/EOP@EOP
[email protected] @ inet
Terry Edmonds/WHO/EOP@EOP
Jeffrey A. Shesol/WHO/EOP@EOP
Michele Ballantyne/WHO/EOP@EOP
Fern Mechlowitz/WHO/EOP@EOP
Rachael F. Goldfarb/WHO/EOP@EOP
John Podesta/WHO/EOP@EOP
Karen Tramontano/WHO/EOP@EOP
Carolyn T. Wu/WHO/EOP@EOP
Irene Bueno/WHO/EOP@EOP
Maria Echaveste/WHO/EOP@EOP
Rochelle G. Thompson/WHO/EOP@EOP
Christine M. Glunz/WHO/EOP@EOP
Linda Ricci/OMB/EOP@EOP
Patrick M. Dorton/OPD/EOP@EOP
Jason Furman/OPD/EOP@EOP
Loretta M. Ucelli/WHO/EOP@EOP
Melissa G. Green/OPD/EOP@EOP
Joseph N. Crisci/OPD/EOP@EOP
Joseph P. Lockhart/WHO/EOP@EOP
Jenni R. Engebretsen/WHO/EOP@EOP
Bruce N. Reed/OPD/EOP@EOP
Cathy R. Mays/OPD/EOP@EOP
Thomas L. Freedman/WHO/EOP@EOP
Emil J. Barth/WHO/EOP@EOP
Christopher C. Jennings/OPD/EOP@EOP
Jennifer E. McGee/OPD/EOP@EOP
Karin Kullman/OPD/EOP@EOP
Steve Ricchetti/WHO/EOP@EOP
Jennifer L. Dewitt/WHO/EOP@EOP
Mara A. Silver/WHO/EOP@EOP
Richard L. Siewert/WHO/EOP@EOP
Devorah R. Adler/OPD/EOP@EOP
Stephanie A. Cutter/WHO/EOP@EOP
Christopher M. Wanken/OPD/EOP@EOP
Cheri L. Stockham/WHO/EOP@EOP
Drew T. Gardiner/WHO/EOP@EOP
Valerie J. Owens/WHO/EOP@EOP
Barbara Chow/OMB/EOP@EOP
[email protected] @ inet
[email protected] @ inet
Joel Johnson/WHO/EOP@EOP
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In 1995, we put in place tough regulations to crack down on abuse and neglect, by
stepping up on-site inspections of nursing homes. That same year, when Congress tried to
eliminate federal assurances of nursing home quality, I said no. Then, in 1998, I issued an
executive order requiring all states to increase investigations of nursing homes -- fining those that
failed to provide its residents with adequate care.
Today, with the help of Congressmen Grassley, Waxman, and Gephardt, we're taking
four new steps to improve conditions in nursing homes across America.
First, I'm announcing a $1 billion in new grants to boost staffing levels in
poorly-performing nursing homes, improve recruitment and retention, and give more training to
caregivers. We will also reward the best-performing nursing homes.
Second, we are improving Sedral the way we measure staffing levels at nursing homes so that
theyreceive the right level offunding for the number of patients they have - and we get a better
picture of the problems the have. This will help keep our nursing homes accountable, and
or
eliminate much of the wasteful spending that's getting in the way of good care.
Third, I'm directing the Health Care Financing Administration to establish, within two
years, minimum staffing requirements for all nursing homes participating in Medicare and
Medicaid.
Fourth, this week, we are launching a new campaign to educate nursing home personnel
on ways to prevent weight loss and dehydration in patients.
Of all the obligations we owe to one another, our most sacred duty is to our parents.
They kept us safe from harm when we were children. We must do the same for them, as they
grow older.
President Kennedy once said, "It is not enough for a great nation merely to have added
new years to life - our objective must also be to add new life to those years." The steps we're
taking today will help bring new life to our nation's seniors, by brining a new level of quality to
America's nursing homes.
Message Sent To:
are improvy The us we measure receive starly lads at may home
Second, we introducing new measures to make sure that all nursing homes provide the
government with accurate information on their staffing levels -- so that they receive proper right lest
r funding for their facilities This will help keep our nursing homes accountable, and eliminate
much of the wasteful spending that's getting in the way of good care.
we
gut or M
45 the # of parto Mar her have.
Third I'm directing the Health Care Financing Administration to establish, within two
1t
years, minimum staffing requirements for all nursing homes participating in Medicare and
publect
Medicaid. Additional this week, we, launched a new campaign to educate nursing home
personnel on ways to prevent weight loss and dehydration in patients.
any have.
Of all the obligations we owe to one another, our most sacred duty is to our parents.
They kept us safe from harm when we were children. We must do the same for them, as they
grow older. np Per state
President Kennedy once said, "It is not enough for a great nation merely to have added
new years to life - our objective must also be to add new life to those years." The steps we're
taking today will help bring new life to our nation's seniors - and a new sense of security to
America's nursing homes.
d reu level quar, of
to 15th X
X
2
most, improve recruitment and retention, give more training to caregivers, and reward the best-
performing nursing homes.
But while working to improve nursing home care, we have to act swiftly to keep nursing
homes safe. That's why this legislation will impose immediate financial penalties on nursing
homes that are endangering the safety of their residents. And it will use those funds to improve
patient care.
Second, I'm directing the Health Care Financing Administration to establish, within two
years, minimum staffing requirements for all nursing homes participating in Medicare and
Medicaid. The agency will also develop recommendations to ensure that nursing homes receive
the necessary payments for high-quality care.
Third, we are taking new measures to educate caregivers at nursing homes. In fact, just
this week, we launched a new campaign in America's 17,000 nursing homes to identify residents
who are at-risk, and prevent them from becoming dehydrated or malnourished.
Finally, to help families select the right nursing home, we will require all facilities to post
the number of health care personnel serving their patients.
Of all the obligations we owe to one another, our most sacred duty is to our parents.
They kept us safe from harm when we were children. We must do the same for them, as they
grow older. Our parents shouldn't go one more day without the care they deserve.
President Kennedy once said, "It is not enough for a great nation merely to have added
new years to life - our objective must also be to add new life to those years." The steps we're
taking today will help bring new life to our nation's seniors, by bringing a new level of quality to
America's nursing homes.
Draft 9/15/00 1:30pm
Josh Gottheimer
PRESIDENT WILLIAM J. CLINTON
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
nets been
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Capitol. For more than a hundred years, this institution has been delivering quality care
to older Americans The seniors here with me receive top-quality assistance, from caring and
attentive staff members
a dedicted
For rere na a hided year
Every one of the 1.6 million Americans living in nursing homes all across our country
deserve the same quality care. And with the baby boomers retiring, and the number of
Americans over the age of 85 doubling in 30 years the demand for quality care will skyrocket. a
Dull date our me next 30 year
But while the majority of nursing homes today provide excellent care, too many of our
seniors, in too many homes, aren't getting the proper attention they deserve. And, according to
current research, the number one culprit is chronic understaffing. When there are too few
caregivers, the quality of care goes down and patients suffer
Fir the # of patents
A recent study from the Department of Health and Human Services reports that more
than fifty percent half of America's nursing homes don have to the minimum staf levels necessary
to guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
these homes are more likely to lose ,Weight, develop pressure sores, and experience depression.
tall
More than 30 percent of them are dehydrated, malnourished, and at a much higher risk for illness
to
and infection.
Older Americans who have worked hard all their lives deserve respect, not neglect.
That's why, for more than seven years now, our Administration has acted worked to improve the
quality of care in our nation's nursing homes.
of non
In 1995, we put in place tough regulations to crack down on abuse and neglect in our
nation's nursing homes, by stepping up ncreasing on-site inspections. That same year, when
Congress tried to eliminate federal assurances of nursing home quality, I said no. Then, in 1998,
I issued an executive order requiring all states to increase investigations of nursing homes
fining those that failed to provide its residents with adequate care.
three y new steps to improve conditions in nursing homes across America.
Today, with the help of Congressmen Grassley, Waxman, and Gephardt, we're taking
Stet
First, I'm announcing a $1 billion in new grants to boost staffing levels in poorly-
performing nursang homes, improve staff recruitment and retention, and provide increased fie nne
training for caregivers. We will also reward the best-performing nursing homes
terry
7
w/
1
Today, with the help of Congressmen Grassley, Waxman, and Gephardt, we're taking
three new steps to improve conditions in nursing homes across America.
First, I'm announcing a $1 billion grant program to help increase staffing levels in
nursing homes, improve staff recruitment and retention, and provide increased training for
caregivers. This program will reward the best nursing homes, as well as those that need the most
help. We're also introducing new, immediate financial penalties for nursing homes that are
currently endangering the health and safety of our most vulnerable population.
Second, we are taking new steps to make sure that all nursing homes provide the
government with accurate information on their staffing levels -- so that they receive proper
funding for their facilities. This will help keep our nursing homes accountable, and eliminate
much of the wasteful spending that's getting in the way of good care.
Third, I'm directing the Health Care Financing Administration to establish, within two
years, minimum staffing requirements for all nursing homes. This will help ensure that nursing
home participants in Medicare and Medicaid programs have adequate staffing levels and well-
trained caregivers. Additionally, this week, we launched a new campaign to educate nursing
home personnel on ways to prevent weight loss and dehydration.
Of all the duties we owe to one another, our duty to our parents is the most sacred. When
we are children, our parents do their best to keep us safe from harm; when our parents begin to
need us, we must do no less. When that time comes, we need to know that our parents will be
well cared for.
As President Kennedy once said, "It is not enough for a great nation merely to have
added new years to life - our objective must also be to add new life to those years." The steps
we're taking today will help bring new life to our nation's seniors - and a new sense of security
to America's nursing homes.
2
Draft 9/15/00 1:30pm
Josh Gottheimer
PRESIDENT WILLIAM J. CLINTON
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Capitol, that's been delivering quality care to older Americans for more than a hundred
years. The seniors here with me receive top-quality assistance, from what is clearly an attentive
and caring staff.
Today, more than 1.6 million Americans live in nearly 17,000 nursing homes all across
America. When the baby boom generation moves into retirement age, that number will rise even
higher. By 2030, the number of Americans over the age of 85 will double - making
compassionate, quality nursing home care even more important.
At their best, nursing homes can be a godsend for older Americans and their families -
providing a safe haven in times of great need. But at their worst, nursing homes can actually
endanger their residents, subjecting them to the worst kinds of neglect.
While the majority of nursing homes provide excellent care, too many of our seniors, in
too many homes, aren't getting the proper care they deserve. And, according to current research,
the number one culprit is chronic understaffing. There is a direct correlation between the number
of caregivers per patient and the quality of care a patient receives.
A recent study from the Department of Health and Human Services reports that more
than fifty percent of America's nursing homes don't have the minimum staffing levels necessary
to guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
these homes are more likely to lose weight, develop pressure sores, and experience depression.
And it's estimated that more than 30 percent of them are dehydrated and malnourished, putting
them at a much higher risk for illness and infection.
worry about?
People living in nursing homes shouldn't have to fear poor staffing and poor nutrition.
Families shouldn't have to worry as much about a loved one living in a nursing home as one
living alone. That's why, for more than seven years now, our Administration has worked to
improve the quality of care in our nation's nursing homes.
In 1995, we put in place tough regulations to crack down on abuse and neglect in our
nation's nursing homes, by stepping up on-site inspections. That same year, when Congress
tried to eliminate federal assurances of nursing home quality, I said no. Then, in 1998, I issued
an executive order requiring all states to step up investigations of nursing homes, and x fining
those that failed to provide its residents with adequate care.
1
Draft 9/15/00 9:30pm
Josh Gottheimer
PRESIDENT WILLIAM J. CLINTON
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Capitol, that's been delivering quality care to older Americans for more than a hundred
years. The seniors here with me receive top-quality assistance, from a dedicated and attentive
staff.
Every one of the 1.6 million Americans living in nursing homes all across our country
deserve the same quality care. And, as the baby boomers retire, the demand for quality care will
continue to rise even higher. By 2030, the number of Americans over the age of 85 will double -
making compassionate, quality nursing home care even more important.
But while the majority of nursing homes today provide excellent care, too many of our
seniors, in too many homes, aren't getting the proper attention they deserve. And, according to
current research, the number one culprit is chronic understaffing. When there are too few
caregivers for the number of patients, the quality of care goes down.
A recent study from the Department of Health and Human Services reports that more
than half of America's nursing homes don't have the minimum staffing levels necessary to
guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
these homes are more likely to lose too much weight, develop bed sores, and fall into depression.
More than 30 percent of them are dehydrated, malnourished, and at a much higher risk for illness
and infection.
Older Americans who have worked hard all their lives deserve respect, not neglect.
That's why, for more than seven years now, Vice President Gore and I have acted to improve the
quality of care in our nation's nursing homes.
In 1995, we put in place tough regulations to crack down on abuse and neglect, by
stepping up on-site inspections of nursing homes. That same year, when Congress tried to
eliminate federal assurances of nursing home quality, I said no. Then, in 1998, I issued an
executive order requiring all states to increase investigations of nursing homes -- fining those
that failed to provide its residents with adequate care.
Today I'm taking four new steps to improve nursing home conditions across America.
First, working with Senators Grassley and Breaux, and Congressmen Waxman, Stark,
and Gephardt, I'm sending legislation to Congress next week that I believe can be enacted this
year. It will create $1 billion in new grants to boost staffing levels in nursing homes that need it
TOJOP 73112
excouled
yru
been
T
Draft 9/15/00 7:30pm
?
Josh Gottheimer
H
PRESIDENT WILLIAM J. CLINTON
3
of
RADIO ADDRESS ON NURSING HOMES
WASHINGTON, DC
September 16, 2000
kat
recense
faults.
Good morning. I'm joining you today from the Washington Home, a nursing home in our
nation's Capitol, that's been delivering quality care to older Americans for more than a hundred
years. The seniors here with me receive top-quality assistance, from a dedicated and attentive
staff.
, n Rse
Every one of the 1.6 million Americans living in nursing homes all across our country
deserve the same quality care. And, as the baby boomers retire, the demand for quality care will
to
continue to rise even higher. By 2030, the number of Americans over the age of 85 will double -
making compassionate, quality nursing home care even more important.
But while the majority of nursing homes today provide excellent care, too many of our
seniors, in too many homes, aren't getting the proper attention they deserve. And, according to
current research, the number one culprit is chronic understaffing. When there are too few
caregivers for the number of patients, the quality of care goes down.
A recent study from the Department of Health and Human Services reports that more
than half of America's nursing homes don't have the minimum staffing levels necessary to
guarantee quality care. And too often the staff they do have isn't properly trained. Patients in
these homes are more likely to lose too much weight, develop bed sores, and fall into depression.
drief ell.
More than 30 percent of them are dehydrated, malnourished, and at a much higher risk for illness
and infection.
Older Americans who have worked hard all their lives deserve respect, not neglect.
That's why, for more than seven years now, Vice President Gore and I have acted to improve the
quality of care in our nation's nursing homes.
In 1995, we put in place tough regulations to crack down on abuse and neglect, by
stepping up on-site inspections of nursing homes. That same year, when Congress tried to
eliminate federal assurances of nursing home quality, I said no. Then, in 1998, I issued an
executive order requiring all states to increase investigations of nursing homes fining those
that failed to provide its residents with adequate care.
BY
Today I'm taking four new steps to improve nursing home conditions across America.
26
First, I'm directing the Health Care Financing Administration to establish, within two
years, minimum staffing requirements for all nursing homes participating in Medicare and
Medicaid.
+ T4 17th Ne, ect.
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Second, we are improving the way we measure staffing levels at nursing homes, so that
will
even
they can receive the right level of federal funding for the number of patients they serve.
Third Seen we are taking new steps to educate caregivers at nursing homes In fact, just this
reque
Faciliter
to
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week, we launched a new campaign to suna's train nursing home personnellon ways to prevent weight
loss and dehydration in patients.
Bas into
17k
what Breauy about,
TC # Icux
Fourth, working with Senator Grassley, and Congressman Waxman, Stark, and Gephardt,
perfect
more
I'm sending bipartisan legislation to Congress next week that we believe can get done this year.
It will create $1 billion in new grants to boost staffing levels in nursing homes that need it most,
us
improve recruitment and retention, give more training to caregivers, and reward the best-
soins Tel! refats
performing nursing homes.
be exctal
But while working to improve nursing home care, we have to act swiftly to keep nursing
homes safe. That's why this legislation will impose immediate financial penalties on nursing
Homes that are endangering the safety of their residents. And it will relawast This
those
Funds
Of all the obligations we owe to one another, our most sacred duty is to our parents.
to
They kept us safe from harm when we were children. We must do the same for them, as they
impore
grow older. Our parents shouldn't go one more day without the care they deserve.
patat
car.
President Kennedy once said, "It is not enough for a great nation merely to have added
new years to life - our objective must also be to add new life to those years." The steps we're
taking today will help bring new life to our nation's seniors, by bringing a new level of quality to
America's nursing homes.
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Final 09/15/00 10pm
TALKING POINTS FOR NURSING HOME VISIT
THE WASHINGTON HOME
WASHINGTON, DC
September 16, 2000
Ack: Administrator Nancy Ann Deparle (HCVA).
I am honored to join all of you here today. Since 1888,
the Washington Home has been providing top-quality
care to its seniors - and it's in no small part to the work
you all do every day.
In just a few minutes, I'm going to deliver my weekly
radio address to the nation. Like you, millions of
Americans around the country will hear it live, direct
from this room.
In my address, I will announce new steps to improve
the quality of nursing homes. That's something that's
been a priority to me and Vice President Gore for more
than seven years now.
When the radio address is over, we can spend a few
minutes together -- getting to know one another better.
Thanks again for coming out this morning.