Statement About Actions To Improve the Quality of Care in Nursing Homes

THE VAST majority of Americans over 65 years of age are eager and able to play a continuing role as active, independent participants in the life of our country. Encouraging them to play this role--and providing greater opportunities for them to do so--is a cornerstone of this Administration's policy concerning older Americans.

For almost one million of our 20 million senior citizens, however, a dignified and humane existence requires a degree of care from others that can usually be found only in a nursing home or extended care facility. For those who need them, the nursing homes of America should be shining symbols of comfort and concern.

Many of our nursing homes meet this standard most admirably. Day after day and year after year they demonstrate the capacity of our society to care for even the most dependent of its elderly citizens in a decent and compassionate manner. It is the goal of this Administration to see that all of our nursing homes provide care of this same high quality.

Unfortunately, many facilities now fall woefully short of this standard. Unsanitary and unsafe, overcrowded and understaffed, the substandard nursing home can be a terribly depressing institution. To live one's later years in such a place is to live in an atmosphere of neglect and degradation.

In my speech to the regional convention of the National Retired Teachers Association and the American Association of Retired Persons in Chicago on June 25, I pledged action to meet this challenge. Members of my Administration have been vigorous in their development of specific plans to carry out that pledge. Today I am announcing certain decisions which we have already made in this important area.

A PLAN FOR ACTION

Nursing homes presently receive over $1 billion or 40 percent of their total income from the Federal Government--most of it through Medicare and Medicaid payments. (An additional $700 million comes from the States and localities, and $900 million comes from private sources.) As I emphasized in my Chicago speech, "I do not believe that Medicaid and Medicare funds should go to substandard nursing homes in this country and subsidize them." This is not only a matter of personal belief, it is also the law of the land-and has been since 1965.

The reason that many substandard facilities have often continued to receive such payments are many and complex. It has been difficult to enforce the law that requires participant homes to meet certain standards. In the final analysis, however, there can be no excuse for lax law enforcement-and I therefore am taking a number of steps to improve enforcement efforts.

1. I am ordering that the Federal program for training State nursing home inspectors be expanded so that an additional 2,000 inspectors will be trained over the next 18-month period. The major responsibility for surveillance and regulation in the field is now carried out by State governments, and this action will enable them to increase their effectiveness most significantly. One of three places in the country where such training is now provided is the W. K. Kellogg Center for Continuing Education at the University of New Hampshire in Durham. This program trains people not only to inspect nursing homes but also to provide technical assistance and consultative services which can help improve these facilities. This New Hampshire program is funded through a grant from Department of Health, Education, and Welfare, and it is our intention to establish similar programs in other areas of the country. This expansion effort will cost approximately $3 million.

2. Toward this same end, I am asking the Congress to authorize the Federal Government to assume 100 percent of the necessary costs of these State inspection teams under the Medicaid program. This will bring the Medicaid law, which now requires the States to pay from 25 to 50 percent of these costs, into line with the Medicare law, under which the Federal Government pays the entire cost for such inspections. Again, State enforcement efforts would be significantly enhanced by this procedure.

3. I am ordering that all activities relating to the enforcement of such standards-activities which are now scattered in various branches of the Department of Health, Education, and Welfare--be consolidated within the Department into a single, highly efficient program. This means that all enforcement responsibility will be focused at a single point--that a single official will be accountable for success or failure in this endeavor. I am confident that this step alone will enormously improve the efficiency and the consistency of our enforcement activities.

4. I am requesting funds to enlarge our Federal enforcement program by creating 150 additional positions. This will enable the Federal Government more effectively to meet its own responsibilities under the law and to support State enforcement efforts.

5. I have directed the Department of Health, Education, and Welfare to institute a new program of short-term courses for physicians, nurses, dieticians, social workers, and others who are regularly involved in furnishing services to nursing home patients. Appropriate professional organizations will be involved in developing plans and course materials for this program and the latest research findings in this complex field will also be utilized. In too many cases, those who provide nursing home care-though they be generally well prepared for their profession-have not been adequately trained to meet the special needs of the elderly. Our new program will help correct this deficiency.

6. I have also directed the Department of Health, Education, and Welfare to assist the States in establishing investigative units which will respond in a responsible and constructive way to complaints made by or on behalf of individual patients. The individual who is confined to an institution and dependent upon it is often powerless to make his voice heard. This new program will help him deal with concerns such as accounting for his funds and other personal property, protecting himself against involuntary transfers from one nursing home to another or to a mental hospital, and gaining a fair hearing for reports of physical and psychological abuse.

7. I am also directing the Secretary of Health, Education, and Welfare to undertake a comprehensive review of the use of long-term care facilities as well as the standards and practices of nursing homes and to recommend any further remedial measures that may be appropriate. such a review is badly needed. Study tells us-- compellingly--that many things are wrong with certain nursing home facilities, but there is not yet a clear enough understanding of all the steps that must be taken to correct this picture.

Of course, I am also looking to the White House Conference on Aging, which meets this December, to offer specific recommendations regarding this same difficult question.

8. Finally, I would emphasize my earnest hope that all these efforts will bring about the improvement of existing substandard homes rather than their abolition. The interests of the elderly are far better served when a home is reformed and renewed than when a home is eliminated. But let there be no mistaking the fact that when facilities fail to meet reasonable standards, we will not hesitate to cut off their Medicare and Medicaid funds.

We are particularly hopeful that our efforts will bring reform, since any reasonable expenses incurred as a result of improving care can often be financed under the existing Medicare and Medicaid programs. We are fully prepared to budget the necessary funds to meet reasonable cost increases which result from such improvements

The Federal Government stands ready to help in this great reform effort in other ways as well. Under the Hill_Burton Act, for example, we are able to provide loan guarantees and direct loans for the modernization of old nursing home facilities and the construction of new ones. The Federal Housing Administration also provides help in this field by insuring mortgages to finance construction or rehabilitation of nursing homes and intermediate care facilities. And the Small Business Administration also guarantees loans and makes direct loans to assist proprietary nursing home in constructing, expanding, or converting their facilities, in purchasing equipment or materials, and in assembling working capital

In addition to all of these efforts, the Administration is working in a number of other ways to improve the life of all older Americans--whatever their place of residence. Some of our strongest initiatives to help older people--including major reforms in both the welfare and social security systems--are contained in the legislation designated H.R. I would emphasize again, the passage of this legislation could make a major impact for good in the lives of older Americans, including those who need to live in nursing homes and extended care facilities

As we work to improve the quality of life for the elderly--and especially for those who must rely on the care provided in the nursing homes of our country--we should not expect overnight miracles. The problems we face have developed in too many places over too long a time. But we can expect that our efforts will result in significant and continuing progress. With the cooperation of the Congress, the State governments, and the nursing home industry, we can truly transform substandard nursing homes so that the very best nursing homes of today will be the typical nursing homes of tomorrow.