Senate OKs extensive plan for nursing home reforms

State would increase oversight and provide more money for staff

March 22, 2000|By Timothy B. Wheeler and William F. Zorzi | Timothy B. Wheeler and William F. Zorzi,SUN STAFF

The state Senate approved a sweeping package of nursing home reforms yesterday aimed at strengthening Maryland's regulation of the facilities in the wake of a sharply critical task force report.

By unanimous votes, senators passed six bills that would require the state's 261 nursing homes to improve the care given their 30,000 elderly residents, while also increasing state oversight.

Similar legislation received preliminary approval in the House of Delegates yesterday, making final General Assembly passage likely.

"This is an exciting and far-reaching package that will really make the life of the frail elderly much better," said Sen. Michael J. Collins, a Baltimore County Democrat who has championed nursing home reform. His father, now dead, spent 10 years in one.

Gov. Parris N. Glendening endorsed the legislation and pledged to boost state funding for staffing and regulating nursing homes.

The governor plans to propose $1.1 million for increased state oversight in a supplemental budget for the coming year, said spokesman Michael Morrill. Of that, $600,000 would hire additional inspectors in the Department of Health and Mental Hygiene. The rest would go to start an ombudsman program to help residents.

Glendening also has promised to raise Medicaid funding for nursing homes starting the next year, with the extra money earmarked for hiring more staff and increasing their pay. He said he would increase state funding by $10 million in fiscal 2002 and by another $10 million in 2003. That would mean a total increase of $40 million because the federal government would match Maryland's contribution.

The extra money is important because all sides agree that poor care in nursing homes is tied to difficulties in hiring and keeping trained workers.

"We're really pleased that the governor recognized that one of the things that's going to improve quality of care more than anything is to get good people to take care of the elderly. And that costs money," said Isabella Firth, president of Mid-Atlantic Non-Profit Health and Housing Association, a nursing home industry group.

With pay for nursing assistants -- who deliver most of the hands-on care -- hovering around $8 per hour, turnover at some homes approaches 100 percent a year.

The bills approved by the Senate would:

Subject every nursing home to a full state inspection twice a year, though problem-free facilities would be eligible for less frequent scrutiny.

Empower the health department to levy fines of up to $10,000 a day for serious and immediate threats to residents' safety. In addition to monetary penalties, regulators also could dictate staffing levels and other corrective actions when deficiencies are found.

Require a licensed nurse to inspect every resident daily to look for physical or mental deterioration and to ensure that adequate care is being given.

The package also would establish an oversight committee made up of legislators, state and local officials and industry representatives. The panel would review nursing home care and recommend additional rules or legislation as needed.

"We're not just passing laws this time and hoping things get better," Collins said. "We are going to monitor for the next five years."

Advocates for nursing home reform and industry spokesmen praised the initiative as a major first step toward reversing the declining quality of nursing-home care in Maryland found last year by the U.S. General Accounting Office and confirmed by a state task force.

But Janet Wells, public policy director for the National Citizens Coalition for Nursing Home Reform, said she was disappointed that legislators did not require that every resident get at least four hours of direct care a day, twice the two hours now mandated by regulation. That was among the task force's recommendations, which formed the basis for the legislative package.

Legislators said they decided not to specify four hours of care because the money the governor has promised is only about a third of what the task force said was necessary to achieve that standard.

Industry spokesmen, meanwhile, complained that requiring a nurse to inspect every resident would force homes to increase their nursing staffs at a time when there is a nationwide nursing shortage.

"We can't do it with existing resources, and there aren't staff to be hired," said Mark Woodard, vice president of the Health Facilities Association of Maryland, representing for-profit and nonprofit homes.

The House version contains less stringent requirements for checking on nursing home residents. Lawmakers predicted that an acceptable compromise would be reached to ensure passage of the entire package.

"It's a great start, and we feel like the governor is very committed," said Sen. Paula C. Hollinger, a Baltimore County Democrat who served on the task force.

"This, God willing, is a population that we're all going to enter," she said. "So if we haven't been there already with our own family members, we have something to look forward to ourselves."

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