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US Government and Homes Are At Odds Over Federal Regulations


IMPORTANT new federal standards for nursing homes have taken effect this week with the industry and the federal government very much at odds. The disagreement: Whether government has done as much as it should to help nursing homes by publishing timely regulations. The Department of Health and Human Services in effect says that it has; the nursing industry sharply disagrees. At the same time another problem looms: Many states are failing to provide the funds necessary to meet the rise in Medicaid costs that these regulatory changes produce, say nursing industry representatives. In many state governments ``budgetary concerns have superseded'' concern about providing improved care, says Paul Willging, executive vice president of the American Health Care Association, which represents nursing homes.

Agreement on goals

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At stake is the quality of assistance received by thousands of elderly people in nursing homes.

Both the industry and the government agree that many of the changes, such as more training for nurses' aides and more nurses on duty, are helpful and should result in better care.

And both concur that, in the words of Dr. Louis Sullivan, secretary of Health and Human Services, ``assuring that nursing home residents receive decent care and respect for their personal rights and dignity is a moral obligation as well as a legal duty.''

The new standards are part of the effort of government and leaders in the industry to put more importance on care of patients, and less on paper-work standards. The aim of the new standards is both to produce better care for patients, and to enable government to assess more accurately the quality of care that nursing homes actually provide.

The standards were established in a section of the Omnibus Budget Resolution Act, which Congress passed in 1987.

The disagreement centers on whether the Department of Health and Human Services, which administers this law, has written in timely fashion regulations that spell out the details.

The department says it has. It says the majority of the regulations were published in February of 1989, and that the nursing-home industry has been both consulted and informed of these guidelines during the three years that they have been developed.

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Yet no final regulations have been published on a series of important issues, including nurses' aide training, patient funds, screening of new patients, or use of restraints on patients, says a spokesman for the American Association of Homes for the Aging, which represents 3,500 nonprofit nursing homes.

``We're flying blind, quite frankly,'' says Dr. Willging. With some regulations missing, ``we're taking our best guess as to what [the government] had in mind, and we hope we're right.'' He says nursing homes fear that months from now government will penalize them for failing to carry out regulations issued only later.

Absent regulations

``Clearly there is some legitimate concern right now out in the field,'' says Howard Bedlin, legislative representative of the American Association of Retired Persons, who specializes in health issues. Nursing homes are required to put the new standards into effect now, he says, ``notwithstanding the absence of these final regulations.''

Mr. Bedlin raises an additional point: ``How are they going to enforce it?'' The federal government has no inspectors of its own, and uses state inspectors to check on nursing homes. Will they hold nursing homes to very stiff performance standards although some regulations are not final? Bedlin asks.

``The critical people ... [are] those who go in and do the inspections,'' he says. Many nursing homes ``are concerned that they will be cited for being out of compliance'' in areas for which they have not had full federal guidance, he adds.

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