NURSING HOMES
Reform lite
LAST week, legislative leaders in Jefferson City unveiled a compromise reform bill to protect nursing home residents. Measured against excellent reform attempts that have failed during each of the last three sessions - or even against the reforms suggested earlier this year by Gov. Bob Holden and Lt. Gov. Joe Maxwell - this compromise bill is reform lite. It is both more palatable to nursing home owners and less protective of elderly patients.
But the compromise bill has a key advantage: the blessing of state Sen. Peter Kinder, R-Cape Girardeau, the Senate president pro tem who scuttled last year's reform bill. That means the bill stands a good chance of passing.
Missouri's existing nursing home laws are toothless and ineffective. They let nursing homes escape punishment - fines or jail time - for placing patients' lives at risk. They make it difficult to prosecute workers and administrators for abuse or neglect. They shield corporate officers, whose bottom-line mentality causes chronic understaffing that results in neglect, from being held accountable for the quality of care. Any improvements, even incremental changes in the compromise bill, are better than the existing laws.
The compromise bill contains some key protections:
It would require that all deaths in nursing homes be reported to county coroners before the body is removed. That simple step could help detect patterns of abuse or neglect that might otherwise go unnoticed.
It would also increase the maximum fines for serious violations that place patients' lives at risk.
It closes a dangerous loophole that allows homes to escape punishment for the most serious violations, such as not feeding a patient, simply by filing a plan detailing how it will correct problems. Unfortunately, the bill leaves that loophole open for all but the most serious violations. That means some potentially life-threatening violations, like not giving a patient medicine ordered by a doctor, could go unpunished. The compromise bill also removes a requirement that inspectors revisit homes to make sure the plan of correction is being carried out. Both of those weaknesses must be addressed before the bill goes any further.
The original reform bill required nursing home CEOs to vouch for the quality of care in their homes. That would have made it easier to prosecute the big fish when patients are abused or neglected. That provision was dropped. It ought to go back in.
The compromise also fails to address minimum staffing requirements. Study after study links inadequate staffing with patient mistreatment and neglect. And while the compromise bill requires homes to report suspected abuse or neglect within 24 hours, it directs those reports to nursing home inspectors. They often perform their "investigations" over the telephone. That's not good enough. Abusing or neglecting patients is a criminal offense. Suspected cases should be reported to law enforcement officials, who can investigate and prepare a case.
Another problem is the double standard for proving abuse and neglect. In criminal cases - when, for instance, a day care worker forgets a child on a bus during a hot summer day - prosecutors only must show that the worker failed to recognize a substantial risk. In nursing homes, however, they must prove that staff members "knowingly" placed a patient at risk. That means they not only failed to recognize a risk, but also knew there was a risk and still refused to act. Vulnerable nursing home residents deserve the same protections as vulnerable children.
The most controversial change is a reduction in the number of inspections at homes with good records. Supporters say that will let inspectors focus scarce resources on the worst homes. But some critics worry that conditions could quickly deteriorate in homes that are inspected less frequently.
One solution would be to plow some nursing homes' fines back to the health department to pay for additional inspections. Instead, the bill calls for fines to used for quality improvement programs and meals on wheels. But it's uncertain that such programs would have as much impact on the quality of care in nursing homes as enhanced inspections.
After three straight years of failure, Missouri is poised to get nursing home reforms. The compromise is a meaningful start. But a few changes will make it even more powerful tool for protecting the elderly.
