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Volume 12 Number 236 News: Nursing Homes In the 20 years since nursing home reforms were signed into law as part of the Omnibus Budget Reconciliation Act of 1987, nursing home improvements are evident, but staffing and quality continue to be of concern, industry experts and beneficiary advocates say. Many of the 10 panelists at a Dec. 7 Alliance for Health Reform briefing called nursing home staffing standards a lingering issue that was not addressed in the 1987 Act and continues to be a concern in the debate about how best to ensure quality of care for nursing home residents. Christine Williams and Ruth Katz, who both worked in Congress when the 1987 Act was drafted and passed, said minimum staffing standards were a sticking point in negotiations 20 years ago and remain one of the most critical concerns for nursing homes and other long-term care environments today. Williams is the director for strategic partnerships for the Agency for Health Care Research and Quality. Katz is dean of George Washington University's School of Public Health and Health Services. Similarly, from the nursing home industry perspective, many of the same issues about setting minimum staffing standards arise today as they did 20 years ago, Jack MacDonald, senior vice president for Gold Horizons, said. Golden Horizons is the holding company for the nursing home company Beverly Enterprises. MacDonald and other panelists agreed that nursing homes should staff adequately to meet residents' needs, but also noted that shortages of skilled staff in some markets and the inability of many nursing homes to pay competitive salaries affected the ability of facilities to meet minimum requirements. Concerns also were raised by some panelists about how to best determine what minimum standards should be. Enforcement of Standards While the 1987 Act imposed stringent new oversight of nursing homes and penalties for noncompliant facilities, some panelists said, enforcement of nursing home standards could have been better since passage of the Act. Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform, called enforcement of the Act's nursing home reforms a "big disappointment," citing continued abuses in some facilities. However, one panelist called the enforcement approach in some cases too confrontational. Paul Willging, associate director of the Center on Aging and Health and the Division of Geriatric Medicine and Gerontology at Johns Hopkins University, said the current enforcement approach has caused the focus of quality efforts in nursing homes to be on avoidance of harm rather than on quality of life for residents. Consumers share concerns with industry experts about adequate staffing at nursing homes, according to a Kaiser Family Foundation survey released in conjunction with the Alliance for Health Reform briefing. Survey Sees Concern About Training The study found that about 60 percent of survey respondents believed that nursing home staff were concerned about the wellbeing of their patients, but that staff often were poorly trained. Furthermore, 75 percent of survey respondents said they believed nursing homes were not adequately staffed. A majority of respondents also said they were concerned about the availability of nursing home care and long-term care for beneficiaries living outside institutional settings. Nearly 65 percent said more government regulation was needed in the nursing home industry. Despite concerns about staffing and regulations, half of respondents said they agreed that nursing homes provided adequate care to those who need it. Comparatively, fewer than 20 percent said they strongly disagreed that nursing homes provide adequate care to residents. More than half of respondents said that nursing homes provided affordable care to those who need round-the-clock assistance. Slightly less than half agreed that nursing homes were a decent place to stay. The Kaiser Family Foundation also released a report on nursing home quality since the passage of the 1987 Act. More information about the briefing is available. The Kaiser survey and report are available.
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