Thirteen years ago, six young women, just out of high school. completed an investigation of nursing home conditions for our Center. Working both in these institutions and in Washington interviewing officials and perusing inspection reports, they documented horrid situations in all too many nursing homes–major fire disasters, fatal food contaminations, drug experimentations without real consent, kickbacks in drug sales and an abysmal lack of medical supervision.
Their book was subtitled “The Last Segregation.” Congress held hearings to receive their testimony. The media began reporting about nursing home abuses in their communities. As federal Medicaid and Medicare payments to nursing homes rose to the present $6 billion a year, there were growing demands for stronger enforcement of health and safety standards. Citizen groups formed to monitor nursing homes and to teach people how to select the better homes.
In the course of our project, we received many heartrending letters from people about mistreatment of their elderly parents. None was more poignant and insightful than a 3500 word letter from a woman who described what happened to her parents after they were disabled in a car accident. After rescuing her mother from one such institution, she asked: “I am mad for all the people who have still to endure those nursing homes: the ones who cannot cry out -For help themselves, and who have no families to do it for them–arid who else is there to care?”
Today, the Reagan Administration can answer that question with a quite opposite inflection: Who cares? For after a decade of some progress in reducing some of the more acute abuses in nursing homes, such as blatant fire hazards, the Reaganites came to Washington to propose lowering the health and safety standards that nursing home operators must meet to qualify +o public assistance.
Among the rules slated for revocation or weakening were infection controls, dietary guidelines, staff training programs, social services and drug controls. So extreme were these proposals that then Secretary of Health and Human Services, Richard Schweiker, withdrew them after sharp public criticism. They are still under consideration, however, by the Reagan government.
Schweiker did succeed in reducing the government’s budget for nursing home inspection for two States had to lay off inspectors and could no longer fully comply with the law that requires every nursing home to be inspected once a year. With fewer inspectors came fewer citations for violations. Last December Congress restored the inspection budget, but this year the White House wants a $9 million reduction for 1984.
Congress also blocked the Schweiker regulatory changes, proposed in May 1982 to move toward de-regulation of the industry. The present authority of the federal government to impose sanctions on federally aided nursing home operations for serious violations is practically nil. And the standards in place are no pillars of protection.
The federal certification system is not designed to allow inspectors to determine whether individual residents are receiving proper care. Nursing home inspectors can “go by the book” when they enter nursing homes without ever haying to speak to residents, visitors or employees. Nor have the Reaganites issued regulations to implement an existing law that would give state inspectors the right, in effect, to ban admissions of federally aided elderly residents to non-complying nursing home.
“Gray Gold” is what Forbes Magazine recently called the booming nursing home business. “With the graying of America” the magazine predicts that “many people will have no choice but to board their oldsters. This is a guaranteed opportunity for someone.”
Seventy-six percent of the nation’s nursing homes are operated for profit and one third of those homes are owned or controlled by chains. With 1.3 million elderly Americans now in nursing homes, the government’s statistics show thirty-one percent of nursing homes harboring health-threatening conditions. This is no reason for complacency, much less the abandonment of these vulnerable Americans by Mr. Reagan and his appointees.
Our associate, Kathleen Hughes, has just completed a new report, titled “Leaving Them Defenseless: Reagan’s Drive to Destroy Nursing Home Law and Order,” to alert citizens to the need for a comprehensive and effective federal inspection system. If you wish more information, please write to her at P. 0. Box 19367, Washington, DC 20036.