Nursing homes may have trouble complying with new law on care

September 17, 1990|By New York Times

WASHINGTON -- Nursing homes may have a difficult time conforming to a new federal law designed to protect patients' rights and to improve the quality of care.

Congress passed the law three years ago but the federal government has yet to issue regulations needed to carry out the measure.

The Department of Health and Human Services says it will begin enforcing the law, as required, on Oct. 1.

But without detailed standards that should have been available months ago to enable nursing homes to prepare for the changes, the homes have not trained or hired the additional employees they will need to comply with the law.

Even though the law requires higher payments from government health insurance programs to cover the extra costs of compliance, many states have not increased those payments.

When the law was signed by President Ronald Reagan on Dec. 22, 1987, Thomas G. Morford, director of the health standards bureau at the Department of Health and Human Services, said, "This is a landmark statute and marks the beginning of a new era for the nursing home industry."

The heart of the law is a requirement that nursing homes annually assess each patient's ability to perform such everyday activities as bathing, dressing, eating and walking. Such assessments would be used to devise a plan for he the care of each patient.

Under the law, the Department of Health and Human Services was supposed to specify the information to be collected in assessing patients more than a year ago, but it did not do so until last month.

Other provisions of the law govern the training of nurses' aides, the staffing of the nursing homes, the services that must be provided to patients and the use of drugs and physical restraints to control patients.

But state officials, nursing home executives and consumer advocates now say the promise of the law remains unfulfilled.

The nursing home industry, which supported the legislation three years ago, is now lobbying Congress to delay major provisions, as is the National Governors' Association.

Paul R. Willging, executive vice president of the American Health Care Association, which represents most of the nation's nursing homes, warned, "The law may turn out to be a hollow promise. There is no way nursing homes can carry it out without additional money."

In the absence of final regulations, he said, "We will be flying blind as of Oct. 1."

Federal health officials say they missed statutory deadlines because they were deluged with work. White House officials said the department, not the White House, was responsible for the scheduling and publication of rules mandated by Congress.

Expecting that the department might not meet the deadline, Congress decreed that nursing homes must comply with the 1987 statute even if the government failed to issue regulations. The law was written in unusual detail, but the regulations will be far more specific.

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