Nursing homes need funding to provide quality health...

Letters to the Editor

May 08, 1999

Nursing homes need funding to provide quality health care

Your April 10 editorial "Better care for nursing homes" reported negatively on nursing home care, but did not adequately address the overall issue.

While a recent study by the General Accounting Office did find that Maryland failed to investigate complaints promptly, Marylanders should not conclude that our nursing home regulations are lax.

In fact, Maryland's nursing home laws have grown more strict in recent years, as have the federal laws.

At the same time, the health conditions of our patients have grown more complex. Many patients now in nursing homes would have been hospitalized just a few years ago.

Nursing home regulatory enforcement has never been tougher. Maryland regulators have not been shy in using such powerful sanctions as fines, decertification from government reimbursement programs, mandated staffing, false claims act suits and even federal racketeering laws.

Unfortunately, the quality of both nursing home care and regulation is integrally tied to funding.

Most nursing home residents have their care paid for by government reimbursement programs that do not adequately fund the complex care provided in nursing homes.

This means that nursing homes cannot pay competitive rates for nursing staff, and a tight job market makes that situation worse. A fast-food employee can now earn as much as a nursing assistant.

The public appears to have a split-personality about nursing homes: it demands the highest level of resident care and regulation, but is not willing to pay to achieve these goals.

The unwillingness to fund quality care and regulatory enforcement may eventually cause the nursing home industry to collapse. Who then will care for older adults in need of skilled nursing services?

Don't look to hospitals, where an average day of care is many times more expensive than nursing home care.

Assisted living facilities can benefit many older adults, but they don't provide for those who need skilled nursing or are dependent on Medicaid reimbursement.

We need to structure a realistic system to deliver the services and care older adults need and deserve.

Gary D. Raffel, Pikesville

The writer is chief executive officer of the Raffel HealthCare Group Inc.

Stop the drug war before it does more damage

In The Sun's April 28 article "The straight dope" Jill Jones, curator of the Drug Enforcement Administration's museum, noted that we are experiencing a drug epidemic. She takes the view that we have had heavy drug use before and the present epidemic will be quelled.

But at what cost? In 1980, after an intitial escalation by President Richard Nixon, the United States was spending less than $2 billion on the drug war and fewer than 2,000 drug-related deaths occurred. In 1998, after further escalations by Presidents Reagan, Bush and Clinton, the cost was approximately $17 billion and 14,000 drug-related deaths.

Escalating the drug war has been counterproductive. Alcohol abuse is destructive, but we repealed Prohibition because it caused even more harm. Drug prohibition shares many of the same problems as alcohol prohibition.

The drug war has corrupted law enforcement, eroded constitutional freedoms, generated a thriving criminal black market and criminalized the casual user and the abuser alike while a steady supply of drugs reaches our youth.

We should treat drug abuse as a public health problem instead of further escalating the drug war.

Kevin Fansler, Havre de Grace

Undeclared wars degrade our consitutional system

We are bombing a sovereign country daily. This is war, pure and simple.

In our country, only the people can authorize such a war, through their elected representatives in Congress. The Constitution is unequivocal about this.

The Constitution does make the president commander-in-chief of the armed forces. This means he wages the war that Congress declares.

We face no national security crisis or imminent threat in the Balkans. Therefore, there can be no justification for flouting the constitutional ban on presidentially-initiated wars.

The legacy of the Cold War has given President Clinton cover for this shameful act.

Previous presidents, Republican and Democrat, initiated wars and military adventures without congressional authorization because we were at risk from communism's relentless and often subterranean bellicosity.

More recently, under Reagan, Bush and Clinton, this cancerous precedent has metastasized in Grenada, Panama, Kuwait/Iraq, Somalia and Haiti.

A president who can use military force without authorization against today's foreign enemy can use police or military force against domestic "enemies" tomorrow.

Once we have lost respect for our Constitution, what will protect us from future despots?

John L. Pattillo, Lutherville

Time for new leaders, more peaceful priorities

On May 1, the NATO bombing of Yugoslavia struck civilians again, incinerating a crowded civilian bus, killing dozens of passengers, many of them children.

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