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PRESIDENT CLINTON'S RADIO ADDRESS TO THE NATION:PRESIDENT CLINTON ANNOUNCES NEW, $1 BILLION INVESTMENT IN NURSING HOME
QUALITY
Takes Additional Steps to Increase Staffing and Accountability in
Nursing Homes
September 16, 2000
Today, in a live radio address broadcast from The Washington Home in
Washington, DC, President Clinton will announce that he will be sending
legislation to the Congress next week to improve nursing home quality
nationwide. This initiative: (1) invests $1 billion over 5 years in a
new grant program to increase staffing levels nationwide and improve
quality of nursing home care; (2) imposes immediate penalties on nursing
facilities placing residents at risk and reinvests these funds in the
new grant program; (3) directs the Health Care Financing Administration
to establish national minimum staffing requirements and complete
recommendations for appropriate reimbursement within two years; (4)
helps families make informed decisions by providing accurate information
on staffing levels; and (5) launches a new campaign to identify and
prevent unintended weight loss and dehydration among nursing home
residents. He will state that these proposals can and should be
included in any legislation that increases funding for health care
providers being considered by the Congress. The President will praise
Senators Grassley and Breaux, as well as Congressmen Gephardt, Waxman,
and Stark, for their leadership on this issue and encourage the Congress
to act quickly on this new initiative.
MORE MUST BE DONE TO IMPROVE QUALITY OF CARE IN NURSING HOMES. About
1.6 million older Americans and people with disabilities receive care in
approximately 17,000 nursing homes. The Clinton-Gore Administration has
made the health and safety of nursing home residents a top priority --
implementing the toughest nursing home regulations in the history of the
Medicare and Medicaid programs. Many nursing homes provide high quality
care to the frail and vulnerable elderly individuals they serve.
However, recent reports have demonstrated a strong correlation between
inadequate staffing and poor quality of care. Specific findings
include:
Over fifty percent of nursing homes do not maintain the minimum
staffing levels necessary to ensure the delivery of quality care. The
Health Care Financing Administration (HCFA) recently released a report
demonstrating that patients are significantly more likely to develop
pressure sores, lose weight, and undergo unnecessary hospitalizations
once staffing ratios fall below the level of two hours per resident for
certified nurse aides daily. That amount of time is the minimum
necessary for nursing staff to reposition residents and change wet
clothes; assist residents with toileting; provide feeding assistance;
provide morning care; and encourage or assist residents with exercise as
appropriate.
Poor staffing results in many nursing home residents becoming
malnourished or dehydrated, unnecessarily increasing their risk of
infection and impaired mental function. Certified nursing assistants
(CNAs) typically help seven to nine residents with their daytime meals,
and as many as 12 to 15 residents with their evening meals. A recent
study by the Commonwealth Fund estimates that over 30 percent of nursing
home residents are malnourished, placing them at risk for infections,
pressure sores, depression, confusion and impaired cognition, and hip
fractures. Compared with well hydrated and nourished residents, these
nursing home patients have a five-fold increase in mortality when
admitted to the hospital.
Nursing home staff often need additional training to carry out
their assigned duties adequately. A 93 percent turnover rate in CNAs
compounds the problems caused by inadequate numbers of nursing home
staff. A shortage of nursing supervisors leaves CNAs to do the best
they can without assistance from registered nurses or physicians.
PRESIDENT CLINTON ANNOUNCES NEW INITIATIVE TO IMPROVE THE QUALITY OF
CARE PROVIDED IN NURSING HOMES. Today's initiative will:
Invest $1 billion over 5 years in a new grant program to improve
quality of nursing home care. This portion of the initiative, which is
financed through the undedicated portion of the President's $40 billion
provider restoration initiative and should be included in any such
initiative being considered by the Congress, will:
Create a competitive grant program to increase staffing levels in
nursing homes nationwide. States would be able to receive funds to
provide financial and technical assistance to nursing facilities,
unions, non-profit organizations, or community colleges. States
applying for funds would be required to develop, through an open public
process, a proposal to enhance staff recruitment and retention efforts;
establish career ladders for CNAs; provide increased training for staff;
or conduct other staffing initiatives to assure improved patient
outcomes as approved by the Secretary of Health and Human Services.
States may also use a portion of the funds to reward nursing facilities
with exemplary quality of care records. At least 75 percent of funds
are to be awarded to states whose current staffing levels are below two
hours per resident for certified nurse aides daily, but who commit to
raising their staffing levels to the two hour level within two years.
Up to 25 percent of the funds are reserved for states whose staffing
levels are currently at or above the two hour threshold. This
legislation requires the Secretary to increase the staffing thresholds
as recommended by the upcoming HCFA report on staffing levels with the
goal of reaching the staffing level necessary to provide optimum care.
Imposes immediate penalties on nursing homes endangering patient
safety. Currently, if a nursing home appeals the imposition of a fine
for endangering patient safety (G level violation), the Federal
government does not collect the fine until after the appeal is settled,
allowing many facilities to avoid paying fines for years after the
violation was committed. This initiative would require civil money
penalties to be immediately withheld from future payments to the nursing
home. If a nursing home appealed the imposition of the fine and won,
the Federal government would return the funds with interest.
Invests Federal financial penalties levied against nursing homes
endangering patients in the new grant program. Any civil money
penalties collected by the Federal government will be automatically
reinvested in the new $1 billion grant program and used to improve the
quality of care provided to nursing home residents rather than returned
to the Medicare Trust Fund.
Providing the public with accurate information on staffing levels.
Nursing homes participating in the Medicaid and Medicare programs will
be required to provide HCFA with detailed information on their current
staffing levels, including the total number of hours; coverage levels
per shift; identifying staff as CNAs, LPNs or RNs; and the average wage
rate for each class of employees. This information will be posted for
the public to review in individual facilities as well as on HCFA's
Nursing Home Compare website.
Direct HCFA to establish national minimum staffing requirements
within two years. Today, the President will direct HCFA to complete its
comprehensive study on staffing ratios within 12 months and develop and
publish Federal regulations establishing minimum staffing levels no
later than September 1, 2002. As part of this process, HCFA will
concurrently evaluate whether any changes in Federal reimbursement are
necessary to implement the new staffing standards established by the
report. In addition, HCFA will include a recommendation on the
feasibility and advisability of increasing training requirements for
CNAs from 75 to 160 hours. -- Launch a new campaign to prevent
unintended weight loss and dehydration among nursing home residents.
This week, HCFA launched a new education campaign that is sending all
17,000 nursing homes in the country a new set of training materials to
identify and prevent malnutrition and dehydration. These materials will
help CNA and other caregivers identify residents at risk for unintended
weight loss and dehydration and then take the necessary action to
prevent it.
PRAISES A BIPARTISAN CONTINGENT OF MEMBERS FOR THEIR LEADERSHIP IN
IMPROVING NURSING HOME QUALITY. Senators Grassley, Breaux, Reid, and
Kohl, as well as Congressmen Gephardt, Waxman, and Stark, have shown
exemplary leadership on this issue and their efforts to improve nursing
home quality nationwide.
BUILDS ON THE CLINTON-GORE ADMINISTRATION'S STRONG COMMITMENT TO
IMPROVING NURSING HOME QUALITY. Protecting patients in nursing homes
has been and will continue to be a priority of the Clinton-Gore
Administration. In 1995, the President threatened to veto legislation
pending before the Congress that would eliminate Federal enforcement of
nursing home quality standards, and issued the toughest nursing home
regulations in the history of the Medicare and Medicaid programs,
leading to measurable improvements in quality of care for nursing home
residents. In July of 1998, the Clinton-Gore Administration initiated a
new nursing home quality initiative that ensures swift and strong
penalties for nursing homes failing to comply with standards,
strengthened oversight of state enforcement mechanisms, and implemented
unprecedented efforts to improve nutrition and prevent bed sores.
Finally, the Administration recently instructed states to eliminate
corrective periods during which nursing homes could avoid the imposition
of sanctions, such as fines, when a nursing home is found to have caused
harm to a resident on consecutive surveys, in order to put additional
pressure on nursing homes to meet all health and safety standards.