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Hearing Before the Special Committee on Aging United States Senate One Hundred Fourth Congress First Session

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Hearing Before the Special Committee on Aging United States Senate One Hundred Fourth Congress First Session S. HRG. 104-384 MEDICAID REFORM: QUALITY OF... CARE IN NURSING HOMES AT RISK HEARING BEFORE THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE ONE HUNDRED FOURTH CONGRESS FIRST SESSION WASHINGTON, DC OCTOBER 26, 1995 Serial No. 104-7 Printed for the use of the Special Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 21-092 CC WASHINGTON: 1996 For sale by the U.S. Government Priming Office Superintendent of Documents, Congressional Sales Office, Waslington, DC 20402 ISBN 0-16-052450-4 SPECIAL COMMITTEE ON AGING WILLIAM S. COHEN, Maine, Chairman LARRY PRESSLER, South Dakota DAVID PRYOR, Arkansas CHARLES E. GRASSLEY, Iowa JOHN GLENN, Ohio ALAN K. SIMPSON, Wyoming BILL BRADLEY, New Jersey JAMES M. JEFFORDS, Vermont J. BENNETT JOHNSTON, Louisiana * LARRY CRAIG, Idaho JOHN B. BREAUX, Louisiana CONRAD BURNS, Montana HARRY REID, Nevada RICHARD SHELBY, Alabama HERB KOHL, Wisconsin RICK SANTORUM, Pennsylvania RUSSELL D. FEINGOLD, Wisconsin FRED THOMPSON, Tennessee CAROL MOSELEY-BRAUN, Illinois MARY BERRY GERWIN, Staff Director/Chief Counsel THERESA M. FoRSTER, Minority Staff Director (11) CONTENTS Page Opening statement of Senator William S. Cohen .............................. ................... 1 Statement of: Senator David Pryor ............................................................ 6 Senator Conrad Burns ................. ........................................... 8 Senator Russ Feingold ................. ........................................... 10 Senator Harry Reid ............. ............................................... 14 Prepared Statement of: Senator Larry E. Craig ................. ........................................... 12 Senator Jim Jeffords ............... ............................................. 13 Senator Herb Kohl ............................................................ 13 PANEL I Dorothy Garrison, Mobile, AL ...................... ...................................... 15 Mildred Manning, New Market, VA .............................................. .............. 19 Gloria Messerley, Harrisonburg, VA .............................................. .............. 22 Accompanied by: Anne S. See, Blue Ridge Legal Services 22 PANEL II Scott Severns, Esquire, president, National Citizens' Coalition for Nursing Home Reform ............................................................ 34 John Willis, president, National Association of State Ombudsman Program and Texas Long-Term Care Ombudsman .......................................................... 55 Ellen Reap, president, Association of Health Facility Survey Agencies ............. 59 Catherine Hawes, senior policy analyst and co-director, Program and Long- Term Care, Research Triangle Institute ............................................................ 72 PANEL III M. Keith Weikel, senior executive vice president and chief operating office, HCR Corporation, Representing the American Health Care Association ....... 91 Sheldon L. Goldberg, president and chief executive officer, American Associa- tion of Homes and Services for the Aging .......................................................... 99 Dr. William Russell, M.D., director of Medical Services, St. Mary's Nursing Home ............................................................ 108 APPENDIX Nursing Home Standards ............... ............................................. 115 Statement submitted by Bruce Vladeck ............................................................ 115 Statement submitted by Stewart Bainum, Jr ....................................................... 118 Statement submitted by American Health Information Management Associa- tion ............................................................ 119 Testimony submitted by Joint Commission on Accreditation of Healthcare Organizations ............................................................ 131 Statement submitted by John H. Pickering on behalf of The American Bar Association............................................................................................................ 135 Statement submitted by The American Society of Consultant Pharmacists ...... 136 Statement submitted by The National Association for the Support of Long Term Care ............................................................ 138 Testimony submitted by The American Dietic Association .............. .................... 138 Testimony submitted by Esther Houser ............................................................ 140 Letter submitted by Aroostook Medical Center .................................................... 164 (III) HEARING ON MEDICAID REFORM: QUALITY OF CARE IN NURSING HOMES AT RISK WEDNESDAY, OCTOBER 26, 1995 U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, DC. The Committee met, pursuant to notice, at 9:30 a.m. in room 628, Senate Dirksen Building, Hon. William S. Cohen (Chairman of the Committee) presiding. Present: Senators Cohen, Pryor, Burns, Feingold, and Reid. Staff present: Mary Berry Gerwin, Staff Director; Priscilla Han- ley, Professional Staff; Victoria Blatter, Professional Staff; Sally Ehrenfried, Chief Clerk; Elizabeth Watson, System Administrator; Lindsey Ledwin, Staff Assistant; Theresa Forster, Minority Staff Director; Theresa Sachs, Professional Staff OPENING STATEMENT OF SENATOR WILLIAM S. COHEN, CHAIRMAN The CHAIRMAN. The Committee will come to order. This morning the Senate Special Committee on Aging is examin- ing one of the issues of critical concern to this committee-namely, the need for strong Federal quality of care standards in nursing homes. Today we are going to examine the importance of keeping Federal nursing home standards in place as we move to reform the Medicaid program. Placing a parent, spouse, disabled child, or other loved one in a nursing home is one of the most agonizing decisions that any fam- ily ever faces, and even once we come to peace with that decision, there is the nagging fear that a loved one may not receive adequate care, or may be abused or neglected in a nursing home. That fear continues to haunt families nationwide. Over two decades ago, family members came before this Commit- tee to reveal their worst nightmares had come true-relatives in nursing homes lying in soiled bed clothes with flies swirling about, tied to bed, or wheelchairs against their will, overdrugged or suffer- ing from severe neglect, at times resulting in death. Staffing at nursing homes was often untrained, unqualified or inadequate, and the nursing homes themselves were often fire traps or safety code violators. In. short, some nursing homes were simply warehouses for the dying. Ultimately, these shocking revelations did not fall on deaf ears. Major coalitions of consumer groups, families, grass root advocates, and the nursing home industry itself worked with Congress on a bipartisan basis to begin the slow march toward preserving and (1) 2 protecting the rights of nursing home residents and achieving nurs- ing home reform. Shortly after the Institute of Medicine issued its landmark blue- print for Federal nursing home reforms, the Congress enacted the Nursing Home Reform Act of 1987, the so-called "OBRA 87" re- quirements for nursing homes receiving Medicare or Medicaid pay- ments. The basis for this Federal law was simple, strong, and very clear-that residents in nursing homes which receive Federal Medi- care or Medicaid dollars should be treated with care and with dig- nity. The law provides a framework through which facilities can help each resident reach his or her highest practicable physical, mental, and general well-being. It also provides critical oversight and enforcement of nursing home standards, following years of evi- dence that the States simply did not make enforcement of nursing home standards a high priority. We have witnessed dramatic improvements since 1987. There has been a sharp decline in the use of physical restraints to tie up residents, dropping from 40 percent to 22 percent between 1992 and 1994. Substantial progress has also been made in reducing the inappropriate use of antipsychotic drugs or so-called "chemical re- straints" that had been widely used to plunge residents into stu- pors or disorientation in order to make them more manageable. We have come a long way, but we are not there yet. Recent in- spections of nursing homes reveal that deficiencies ranging from substandard care to conditions posing immediate harm to residents still exist in many nursing homes nationwide. According to the data from the Health Care Financing Adminis- tration, 73 percent of the 2520 facilities surveyed as of September were initially found to be out of compliance. Since July, 3 percent of the facilities surveyed were found to pose immediate jeopardy to the residents or have chronic problems, while almost 20 percent of those facilities were found to have substandard care. A sample of the cases from these surveys provide a glimpse of the real lives behind these statistics: In a Florida nursing home a resident was sexually assaulted by a nurse's aide. That same aide had attempted to assault another resident and 10 other residents in the same facility had bruises and skin tears from rough treatment received from nursing assist- ants. In Ohio a resident died after being strangled by a vest-type re- straint that was applied incorrectly and without doctor's orders. In Indiana, a resident was found with maggots in wounds, de- spite earlier citations to the facility to improve care. It is folly to believe that we will ever totally eliminate poor care from each and every nursing
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