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THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release July 21, 1998

                 PRESIDENT CLINTON ANNOUNCES INITIATIVE 
                 TO IMPROVE THE QUALITY OF NURSING HOMES

                               July 21, 1998

Today, President Clinton announced tough new legislative and administrative actions to improve the quality of nursing homes. These actions include: ensuring swift and strong penalties for nursing homes failing to comply with standards, strengthening oversight of state enforcement mechanisms, developing a national registry to track and identify individuals with a record of abusing residents, and implementing unprecedented efforts to improve nutrition and prevent bed sores.

Background on Nursing Homes. About 1.6 million older Americans and people with disabilities receive care in approximately 16,700 nursing homes. Since the Health Care Financing Administration (HCFA) put new regulations in place in 1995, the health and safety of nursing homes has improved. For example, the inappropriate use of physical restraints has been cut by more than half and the number of nursing home residents receiving hearing aids is up 30 percent. But HCFA's ongoing review, as well as the report that HHS is transmitting to Congress today, shows that tougher enforcement is needed to ensure high quality care in all nursing homes. In response, the President is announcing a tough new initiative to crack down on poor quality nursing homes and ensure high quality care.

The President Is Sending Legislation to Congress This Week That Calls for:

New Criminal Background Checks. An important way to improve the quality of nursing homes is to prevent personnel who have a criminal record from entering the system in the first place. The legislation the President is proposing would require nursing homes to conduct criminal background checks on all potential personnel.

National Abuse Registry. Once inadequate personnel have been identified, they should be kept out of the system for good. The new legislation would establish a national registry of nursing home employees convicted of abusing residents.

Improved Nutrition and Hydration. Currently, too few nursing home staff are available to help feed residents. To improve nutrition in nursing homes, this legislation would allow more categories of nursing home employees to receive training in and then to perform crucial nutrition and hydration functions.

Reauthorization of the Nursing Home Ombudsman Program. The President also called on Congress to reauthorize the nursing home ombudsman program run by the Administration on Aging, which provides consumers with critical information on poor-quality nursing homes, including records of abuse and neglect.

The President Also Announced New Administrative Actions To Improve the Quality of Nursing Homes. Today, the President announced a series of new penalties, new inspections, and tougher oversight that HCFA will implement immediately, including:

Immediate Civil Monetary Penalties on Nursing Homes That Violate Federal Standards. To crack down on inadequate providers, HCFA will direct enforcement authorities to impose civil monetary penalties immediately upon finding that a nursing home has committed a serious or chronic violation. Under current practice, enforcement officials often give nursing homes numerous opportunities to come into compliance, rather than imposing immediate sanctions.

Tougher Nursing Home Inspections. Starting today, HCFA will take several steps to strengthen states' inspection of nursing homes, such as:

Staggering survey times: The report that HCFA is transmitting to Congress finds that nursing home inspections are too predictable, allowing inadequate nursing homes to prepare for inspections. Enforcement officials will now stagger survey times and conduct some surveys on weekends and evenings.
Targeting chains with bad records: Federal and State officials will target nursing home chains that have a poor record of compliance with quality standards, to ensure these nursing homes receive frequent inspections.
Prosecuting egregious violations: HCFA also will work with the HHS Office of Inspector General and Department of Justice to refer egregious violations of quality of care standards for criminal or civil investigation and prosecution when appropriate.

Stronger Federal Oversight of State Nursing Home Enforcement Mechanisms. HCFA will increase its oversight of state surveyors and take new tough actions against states that are failing to enforce standards adequately. It will:

Terminate Federal nursing home inspection funding to states with continual poor records. The report being released by HCFA finds that some states have cited few or no nursing homes for substandard care. In states where oversight is clearly inadequate, HCFA will terminate state contracts and contract with other entities to conduct Federally-required inspections.
Increase oversight of state inspections. HCFA will increase its review of the surveys conducted by the states to ensure thorough oversight, as well as provide additional training and assistance to state enforcement officials.
Ensure that nursing homes are in compliance with standards before lifting sanctions. HCFA will increase oversight of state enforcement officials to ensure that they will not lift sanctions until after an on-site visit has verified compliance.

Preventing Bed Sores, Dehydration, and Malnutrition. HCFA will implement new oversight to ensure that nursing homes take actions to prevent bed sores, dehydration, and malnutrition. State surveyors will be required to monitor these activities and to sanction nursing homes with patterns of violations. HCFA also will work with the Administration on Aging, the American Dieticians Association, clinicians, consumers, and nursing homes to develop best practice guidelines to prevent malnutrition, dehydration, and bedsores.

Publishing Survey Results on the Internet. To increase accountability and flag repeat offenders for families and the public, HCFA will, for the first time, post individual nursing home survey results on the Internet.

Implementing New Efforts to Measure and Monitor Nursing Home Quality. In June 1998, HCFA began collecting information on resident care through a national automated data system, known as the Minimum Data Set. This information will be analyzed to identify potential areas of inadequate care in nursing homes and to assess performance in critical areas, such as nutrition, avoidable bed sores, loss of mobility, and use of restraints. This assessment will help HCFA and state surveyors to conduct thorough evaluations of nursing homes and detect problems early.

Speaking Order:
Secretary Shalala
President Clinton