Nursing homes: costly federal problem

July 27, 1998|By Carl Rowan

WASHINGTON -- President Clinton wants more money -- a total of $167 million -- next year for inspections of the nation's 17,000 nursing homes.

He says the extra funds are needed for surprise nighttime and weekend inspections that might reduce the neglect, mistreatment and abuse of elderly residents.

Even I get a momentary reaction that here we go again, ever expanding the involvement of government into every area of life. First we commit some $80 billion a year, mainly through Medicare and Medicaid, to the care of some 1.6 million nursing home patients. Then we pay an ever wider bureaucracy to check on what the homes are delivering for that money. But that negative reaction vanishes in the face of reality.

Uncle Sam's job

I'm not really hostile to the president's request, although I admit wondering why it is the federal government that must rein in the profit motive of many nursing homes. I nurture for a fleeting moment the ideal of the American Health Care Association, which represents some 11,000 nursing homes, having its own investigators to police such facilities and ensure that patients get good, safe and friendly care.

But then I remember that my profession, journalism, is an absolute failure when it comes to policing itself, and I know that it's foolhardy to expect members of the nursing home industry to squeal on each other about untended gaping bedsores, patients left lying in their own waste or staffers beating "troublemaker" residents.

Well, why can't the states do it? The states' rights seem to be to take federal money for education, health care and many other things and use it according to local political whims, not national standards. That is the case with regard to nursing home oversight. So Uncle Sam becomes inspector by default.

Then, why not let private inspectors oversee the quality of care in nursing homes? The Clinton administration insists, probably correctly, that an inspector profit motive multiplied by a home operator profit motive is a formula for certain patient tragedy, far beyond the damage and deaths that now occur.

Family matters

So I wind up supporting Mr. Clinton's call for greater federal oversight, with one big caveat: I hope relatives and children don't get the idea that Uncle Sam can browbeat nursing home staffs into giving residents better and more compassionate care than they could get at home. Or that the feds can be a substitute for discreet but detailed inspections by family members.

We all must remember that most nursing home residents have reached an age and a state of health where they are quite a bother, which is why children and grandchildren have allowed them to be placed in a nursing home. If they were a burden, even a nuisance, to blood relatives, imagine how often they irritate nursing home staffers, many of whom have low levels of education and get very low levels of pay.

So inspectors who have the power to order fines must be acutely aware of what is reasonable to expect in a facility that can never be a very pretty sight. We are about to get hearings in Congress that surely will produce many horror stories about such things as being able to look through a bedsore and see an aunt's hip bone. Trained inspectors know that bedridden people are prone to getting bedsores that are huge and virtually incurable.

So nursing home operators can hope that in its more zealous protection of residents, the federal government will at least provide properly trained investigators.

Many Americans may wish, as I do, that there were no need for 17,000 nursing homes. But millions of Americans are now living to such ripe old ages that their needs are more than some families can meet, even if we still had extended families. So a good nursing home with a caring staff, bolstered by federal funds, can be a saving grace for those aged but feeble and frail loved ones for whom we wish more than we alone can deliver.

We must hope that the new federal rules will produce more truly good nursing facilities.

Carl Rowan is a syndicated columnist.

Pub Date: 7/27/98

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