Concerns about Nursing Home Reform Act

The Nursing Home Reform Act, passed in 1987, established quality standards for nursing homes nationwide, emphasized the importance of quality of life, and preserved residents’ rights. However, despite enactment of this law, serious concerns remain about the quality of care provided to residents in the nation's 16,000 nursing homes. To improve the quality of care and the quality of life for nursing home residents, a growing movement, known as "culture change," is working to deinstitutionalize long-term care and radically transform the nursing home environment.

In the culture change model, which has gained momentum over the past decade, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes. Residents' needs and preferences come first; facilities operations' are shaped by this awareness. To this end, nursing home residents are given greater control over their daily lives—for instance, in terms of meal times or bed times—and frontline workers—the nursing aides responsible for day-to-day care—are given greater autonomy to care for residents. In addition, the physical and organizational structure of facilities is made less institutional. Large, hospital-like units with long, wide corridors are transformed into smaller facilities where small groups of residents are cared for by a consistent team.

Nursing Home care Vs Home Care Medicaid

A Balancing Act: State Long-Term Care Reform, is the first to examine Medicaid spending on long-term care for older people and adults with physical disabilities, separate from other LTC users such as people with mental retardation/developmental disabilities (MR/DD).

Nationally, 75 percent of Medicaid LTC spending for older people and adults with physical disabilities pays for institutional care in nursing homes. In contrast, states have done a much better job balancing Medicaid LTC for people with MR/DD, spending just 39 percent on institutional care. The majority of funds now supports people in home and community-based settings.

"We recognize the success state Medicaid programs are having providing home and community based services to people with mental retardation/developmental disabilities," said AARP Pennsylvania State Director Dick Chevrefils. "It proves that balancing long-term care is doable and should be used as a model to help states provide home and community based services for older adults."

As part of its Commonwealth Long-Term Living Project, Pennsylvania set a goal of 50 percent home-based care to 50 percent institutional care for all long-term care populations by FY 2011-12. Unfortunately, the recently passed 2008-09 state budget included no new spending to reduce existing HCBS waiting lists for Pennsylvania's lottery-funded OPTIONS program.

The report examines Medicaid LTC funding because it is the primary payer for LTC in the country. "This underscores the need for better government and private sector financing options for long-term care. Americans have few options to plan and pay for their long-term care. Balancing Medicaid LTC options will require a commitment from our state officials and cooperation from federal authorities. HCBS can be both cost-effective and responsive to the preferences of older people and adults with disabilities," said Chevrefils.

The new report includes state rankings and can be found at: http://www.aarp.org/research/longtermcare/programfunding/2008_10_ltc.html.

Nursing Home Reform

NCCNHR The national consumer voice for quality long-term care
1828 L Street, NW, Suite 801 Alison Hirschel, President
Washington, DC 20036 Alice H. Hedt, Executive Director
202 332-2275 Fax 202 332-2949
www.nccnhr.org
NCCNHR (formerly the National Citizens’ Coalition for Nursing Home Reform) is a nonprofit membership organization
founded in 1975 by Elma L. Holder to protect the rights, safety, and dignity of America’s long-term care residents.
Support the Nursing Home Transparency and Improvement Act!
Congress is considering the most important nursing home legislation in 20 years. Two of Congress’s leading supporters of nursing home reform, Senator Chuck Grassley of Iowa, Ranking Republican on the Finance Committee, and Senator Herb Kohl of Wisconsin, Chairman of the Special Committee on Aging, have introduced S. 2641, the Nursing Home Transparency and Improvement Act. A companion bill is expected soon in the House of Representatives.
NCCNHR worked with congressional staff to develop the legislation, which would increase transparency of nursing home ownership, operations, staffing, and expenditures; improve the consumer complaint process; increase civil monetary penalties; and expand public information about nursing home quality, including penalties and staffing levels. Please inform your members, colleagues, friends, and nursing home residents and their families about the bill:
• Check the NCCNHR website (www.nccnhr.org) for information and updates.
• Download S. 2641 by clicking on [S.2641.IS].
Summary of major provisions in S. 2641
Transparency and accountability in the ownership and operations of nursing homes
Corporations would be required to disclose their owners, operators, financers, and other related parties. Facilities that were part of chains would be required to submit annual audits. Purchasers would have to demonstrate that they were financially able to run facilities.
Disclosure of how Medicare and Medicaid funds are spent
Providers would have to report wage and benefit expenditures for nursing staff on cost reports. Cost reports would be revised to categorize spending for direct care, such as nursing and therapies; indirect care, such as housekeeping and dietary services; capital costs, including buildings and land; and administrative costs, which often include the company’s profits.
Independent monitoring of chains
The federal government would develop a protocol for an independent monitor of chains to analyze their financial performance, management, expenditures, and nurse staffing levels. It would provide for corrective action and collection of civil monetary penalties.
Accurate information about nurse staffing
The government would collect data electronically from nursing homes on the number of RNs, LPNs, and nursing assistants, using payroll records and contracts with temporary agencies as the source. Data would include turnover and retention rates and hours of care per resident provided by each category of worker.
Better