*This is an archive page. The links are no longer being updated. 
 1994.
11.10 :  Quality in Nursing Homes

Contact:  Anne Verano       (202) 690-6145
Thursday, Nov. 10, 1994                 


                    RULE STRENGTHENS ENFORCEMENT 
                     OF QUALITY IN NURSING HOMES


     HHS Secretary Donna E. Shalala today announced a regulation
providing a wider range of available penalties to strengthen
enforcement of federal quality standards in nursing homes.

     The regulation also defines requirements for unannounced
surveys of nursing homes, authorizing a fine of up to $2,000 for
anyone who alerts a nursing home to the date and time of a scheduled
inspection. 

     "We insist that nursing homes must not only meet residents'
physical needs, but must also offer a quality of life that respects
their rights and humanity," Secretary Shalala said.  "This
regulation improves the process for monitoring care and enforcing
federal standards."

     The final regulation published in the Federal Register provides
a variety of remedies -- including fines of up to $10,000 a day --
that can be applied for deficiencies of varying severity.

     When conditions in a nursing home threaten the health and
safety of residents, the state or the HHS secretary will have the
authority to install temporary management or terminate the facility. 

     Bruce C. Vladeck, administrator of the Health Care Financing
Administration, said the regulation "provides the flexibility in
each case to apply a remedy that fits the problem."

     Previous enforcement tools were limited to terminating nursing
homes from the Medicaid and Medicare programs or denying 
payments for new admissions until deficiencies were corrected. In
the 1993 fiscal year, 75 nursing homes were terminated from the
Medicare and Medicaid programs. 

     "Our mission is not to force nursing homes out of business, but
to achieve compliance with the high standards of care to which we
are committed," Vladeck explained. "The new regulation gives us
better tools with which to accomplish that mission."

     The Medicaid and Medicare programs are a major source of
revenue for nearly all of the nation's 16,700 nursing homes, and
being dropped from those programs can close a facility.

     The administrator stressed that the application of penalties 
is not necessary in most cases because nursing homes act promptly to
correct deficiencies.

     Annual inspections of nursing homes and follow-up visits to
ensure corrective action are conducted by 5,600 state surveyors
operating under agreements with HCFA. Their work is monitored by 160
federal surveyors.

     Comprehensive reforms of federal nursing home requirements were
legislated in 1987 and became effective Oct. 1, 1990.  The 
law covers nearly every aspect of nursing home operations, including
the qualifications and training of staff, residents' rights and
requirements for care.

     Among the requirements is a mandate that nursing homes conduct
initial and annual assessments of the condition of every resident to
develop and update individual plans of care.

     The regulation setting forth new enforcement penalties and
procedures was published as a proposed rule in August 1992.

     Many comments from the nursing home industry questioned the
system for ranking deficiencies. Advocates for the elderly and
disabled insisted on strong enforcement procedures.

     "The law is very specific and congressional intent very clear
on most of the issues raised in the letters," Vladeck said. "We are
committed to effective enforcement that will bring continuing
improvement in the quality of nursing home care."

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