CLEVELAND, Ohio - Federal regulations designed to protect residents in the nation's nursing homes are facing mounting pressure from Congress.
A group of 146 lawmakers has urged federal government officials to re-evaluate revised standards in care centers, claiming some of the measures are excessive and are financial burdens for facility owners.
Advocates for residents have blasted the move. They said the regulations are needed, as the measures will expand care plans, offer greater freedom for residents, increase the amount of training for nurses and aides caring for residents with dementia and provide grievance officers to help handle complaints.
"This is a very concerted effort to undermine the basic protections for residents of nursing homes," said Richard Mollot, the executive director of the Long Term Care Community Coalition, a national nonprofit based in New York City that aims to improve the care of residents in nursing homes.
A vast majority of the nation's more than 15,000 nursing homes accept some form of Medicare or Medicaid. To obtain it, the facilities must comply with the regulations in the Nursing Home Reform Law. The law went into effect in 1991.
Last year, the Centers for Medicare and Medicaid Services revised the regulations, the first reworking of the standards in 25 years. Some of the changes went into effect last year, and others are to be completed over the next two years.
While advocates lauded the revisions, many owners of nursing homes and the industry's lobby said the revisions went too far. They cited the hundreds of changes required, and said that facilities can't possibly make them in the next few years.
Last month, 122 members of the House and 24 members of the Senate signed letters urging Eric Hargan, the acting secretary of the U.S. Department of Health and Human Services, and Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, to re-evaluate the revised guidelines. They stressed the safety of residents, but also flexibility and understanding for the facility's owners.
The letters backed the stance of the nursing home industry, which also urged that the measures be delayed. The industry contributed more than $2.5 million to the campaigns of 128 lawmakers who signed the letters, according to the website FollowTheMoney .org, which trackspolitical contributions.
Regulations "too sweeping"
Jim Renacci, the House Republican from Wadsworth who was elected in 2011, balked at the hint of influence. He said the changes that the Centers for Medicare and Medicaid Services made were "too sweeping." Renacci owned more than 20 nursing homes in Ohio before selling them in about 2000.
"It's ridiculous," said Renacci, who is running for Ohio governor in the May primary. "You have Washington bureaucrats telling nursing home owners how to find a set of lost dentures. The regulations need to be more efficient and flexible. You can't have someone 1,000 miles away dictating how something must be done in a nursing home."
Advocates disagree. They said the government's revisions simply updated the regulations. They also cited The Plain Dealer's series, A Critical Choice, as proof of problems in many nursing homes.
The newspaper reported earlier this year that two of every five nursing homes in Ohio delivered care that federal guidelines deemed substandard in 2015, the most recent year available for the data. The newspaper also found that 70 percent of the state's nursing homes were staffed below what researchers say is the level needed to provide safe, compassionate care.
The changes in the standards offer greater focus on residents' safety and well-being, according to the National Consumer Voice for Quality Long Term Care, an advocacy organization in Washington, D.C. For instance, says the organization, the changes:
- Would stress greater residents' freedoms in choice, from food selection to daily schedules, such as when to go to bed and when to wake up. Also, visitors can stop by at any time.
- Require nursing homes to perform a baseline care assessment within 48 hours of a resident's arrival. The plan sets out initial goals for residents, including physician and dietary orders. Under the previous regulations, nursing homes could take up to three weeks to develop a care plan.
- Include a grievance officer at each facility, who would handle complaints of residents and families. An infection prevention specialist would be added as well. This would not require an additional hire, as a nurse on staff, with increased training, could be assigned the position.
- Add enhanced training for nurses' aides to deal with residents suffering from dementia.
"Of course, not all nursing homes are bad, but we have a serious quality problem in many of them," said Charlene Harrington, a professor emeritus of nursing at the University of California at San Francisco who has studied the nation's nursing homes for years.
"We have a lot of substandard nursing homes. We have complaints. There are deaths. There is abuse," she said. "And what we need are more regulations, not less."
Staffing levels are a primary area of concern.
Advocates for nursing home residents have pushed for years for the CMS to come up with specific regulations for nursing homes regarding the number of nurses and nurse's aides needed per shift. The nursing home industry has fought that, claiming each home is different, and the levels of necessary care differ greatly.
The revisions also don't address the per-shift staffing issue for nurses. They leave it up to the nursing homes to make an assessment to "assure resident safety and attain or maintain the highest practical physical, mental and psychological well-being of each resident."
Renacci and his fellow lawmakers urged a re-evaluation that would alleviate regulatory and financial burdens on nursing home owners. Many of the changes, lawmakers said, are micromanaging in nature, such as the proper way to dispose of trash and the tracking of complaints. They said the regulations, in some cases, pull nursing home administrators away from caring for residents.
"Though well-intentioned, these changes may instead have the opposite effect and direct resources away from the quality care our patients deserve," the letter from House members said.
Lawmakers estimate that the revised regulations could cost $62,900 per facility initially. Added together, it would cost the nation's nursing homes $831 million, they said.
"As you are aware, many skilled-nursing facilities -- particularly those serving rural and under-served areas -- operate on thin financial margins, which is why providers in our states have indicated they will struggle to implement the rule," the letter from senators said.
Advocates, however, said they believe the owners of the care centers nursing homes will face little, if any, struggle to pay for the regulations.
Partisan support
against regulations
Renacci said he had wide support on the issue from members in the House, including David Joyce of Painesville and seven other GOP members from Ohio.
Those House members are Steve Stivers of Hilliard, Patrick Tiberi of Worthington, Bill Johnson of Cambridge, Robert Latta of Bowling Green, Jim Jordan of Lima, Warren Davidson of Dayton, and Brad Wenstrup of Cincinnati.
Joyce declined to comment. Neither of Ohio's U.S. senators, Sherrod Brown or Rob Portman, signed the Senate's letter.
Renacci also said he gained support from both parties. But of the 146 members of the House and Senate who signed the letters, only three were Democrats: House members Collin Peterson of Minnesota, Dave Loebsack of Iowa and Terri Sewell of Alabama.
FollowTheMoney .org, a website that tracks campaign contributions, said the nursing home industry has given Renacci's campaign $166,400 since he took office in 2011. He had the largest dollar amount in donations from the industry of any of the politicians who signed the letters.
The industry gave a total of more than $1.98 million to 104 House members, and $587,000 to 24 Senators, who signed the letters seeking the re-evaluation of the standards, according to FollowTheMoney. Eighteen officeholders did not receive contributions from the industry, according to the website.
The website stated that the contributions make up a miniscule fraction of the legislators' war chests -- in some cases less than 1 percent. But James Thurber, a professor of government at American University in Washington, D.C., said the amount is not always important.
"Even if it is a small amount, it is a way of opening doors," Thurber said. "It all adds up in terms of access. It doesn't mean that [the lawmakers] will do anything for getting this money. It doesn't mean that it is corrupt. It means they could be more friendly to the owners of nursing homes, that they could listen."
Renacci said he does not pay attention to campaign contributions. He said he simply wants the best care for residents while alleviating the financial burden and stress on nursing home owners.
But advocates like Harrington, of the University of California at San Francisco, disagree.
"These letters are extremely concerning," Harrington said. "[Members of Congress] are just going along with what the for-profit nursing home industry wants. To go backwards in the care for residents is very disturbing."
