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Nursing Home Reform
Act 1987
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| Goal of
legislation
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When the Nursing Home Reform
Act was passed in 1987, three major goals were established.
The first is to establish nationwide standards for quality of care
in nursing homes throughout the U.S. The second goal is to
design a formal program to monitor and assure resident (patient)
rights. The third goal focuses on establishing consistent
procedures for the certification process that will determine if
nursing homes are meeting the quality goals.
As one looks at the aging population in our
country and specifically considers the impact of the baby boomers as
they reach toward their 60s, what is the state of nursing home
reform? |
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| Nursing Home
Initiatives
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In 1998, the Senate Committee
on Aging held hearings to investigate reports of widespread death
and suffering caused by inadequate staffing and quality of care.
Findings of studies conducted in California showed 30% of nursing
homes in that state had violations of standards that subjected
residents to actual harm or put them in jeopardy of serious injury.
Alarmingly 33% more nursing homes demonstrated substandard
conditions during the survey process. Only 2% actually met
quality standards. A nationwide study
by the Centers for Medicare and Medicaid Services (known at that
time as Health Care Financing Administration - HCFA) found that
resident outcomes had improved somewhat since the Nursing Home
Reform Act was passed. This study was also conducted in 1998
and concluded that enforcement processes were not strenuously
activated.
The Clinton administration announced that
year (1998) a Nursing Home Initiative. Goal was to improve
enforcement of nursing home quality standards. The following
steps were activated:
- Inspections will occur at random times,
including weekends and evenings
- Repeat offenders with serious violations
will be targeted for frequent follow-up surveys
- If states fail to provide adequate
surveys, their federal funding dollars (for surveys) will be
terminated
- If a nursing home is found guilty of a
repeat offense (and resident is harmed), the nursing home will
receive an immediate sanction
- States may impose civil monetary
penalties for each serious or chronic violation of quality
standards
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| The situation
today
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The Senate Committee on Aging
recently conducted an series of hearings to determine if progress
has been made in the quality of nursing home services in the U.S.
Findings showed that:
- 27% of nursing homes nationwide were
cited with violations that caused harm to residents (placed them
at risk of death or serious injury).
- Surveyors often failed (during their
surveys) to identify pressure sores, malnutrition and dehydration
in residents
- Complaints by residents, family members
and nursing home staff often went uninvestigated
- Enforcement mechanisms often failed
- Over half (54%) of nursing homes had
inadequate numbers of nurse aide time per resident
As a result of these findings, states are
increasing the number of surveyors. Many states are also
automating their information systems to track patient complaints
more effectively. CMS has made organizational changes to
encourage quality of care throughout the country. It will take
a number of years to determine if this initiative is effective in
improving quality of care in nursing homes throughout the U.S. |
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