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As Nursing Home Reform Act Turns 20, Committee Considers Stricter, More Public Sanctions, and Nationwide Background Check System for Employees

WASHINGTON - At a hearing held today on the state of the nursing home industry twenty years after the landmark Nursing Home Reform Act (better known as OBRA '87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the shortcomings of a system that has allowed some poorly performing nursing homes to escape significant penalties. Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to tough sanctions, and may therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents. According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

"Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation's 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing," said Chairman Kohl. "This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment."

The GAO report also found that those deficient facilities that do make the effort to attain compliance often slip back into poor performance, and that of the poorly performing nursing homes studied by the government in 1999, nearly half of those had made no progress in their standard of care by 2006. In his opening statement, Chairman Kohl said he would be sending a written request to the Centers for Medicare and Medicaid Services (CMS) for a bimonthly briefing on any progress made in regard to today's GAO recommendations. Chairman Kohl also expressed interest in improving the availability of public information on the quality of individual nursing homes, so that consumers can easily access information concerning any deficiencies found or sanctions levied against a nursing home in order to make an educated decision about which facility can best serve the long-term care needs of a family member.

Additionally, Chairman Kohl announced his intention to introduce legislation that would create a streamlined, cost-effective system of background checks nationwide for those who apply for jobs in long-term care facilities, much like the pilot program that is being conducted by the state of Michigan. After establishing a comprehensive system that combined several state registries with the state criminal background check and an FBI check, Michigan prevented more than 600 people with criminal and/or abusive histories from working in the long-term care industry in the past year alone.

On hand to provide testimony about the years of oversight work GAO has done in the areas of nursing home quality and enforcement was Kathryn Allen, Director of Health Care at GAO. Allen shed light on the government's "survey and cert" system, which is charged with inspecting and certifying nursing home facilities. Joining her on the first panel was James Randolph Farris, M.D., who testified on behalf of CMS. Farris is the Regional Administrator of the Dallas office at CMS, and serves as the point of contact between national and regional surveyors.

The second panel included Charlene Harrington, a professor of Sociology and Nursing at the University of California. Harrington was a member of the Institute of Medicine panel that released a seminal report on the nursing home industry in 1986, the recommendations of which helped spur Congress to enact the Nursing Home Reform Act the following year. The panel also included Alice Hedt of the National Citizen's Coalition for Nursing Home Reform, a prominent advocacy organization that has successfully pushed for reforms within the industry; Mary Ousley, former chair of the American Health Care Association, which represents for-profit and some non-profit nursing homes; and Orlene Christie, Director of the Legislative and Statutory Compliance Office in Michigan's Department of Community Health.

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