Bombs away

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Nursing homes have experienced more than their share of government scrutiny the last few months.

It’s almost like the industry has a sign on it that says, “Hey, examine us! Look at our defects!”

The biggest bomb of all fell this week when Sens. Charles Grassley (R-IA) and Herb Kohl (D-WI) introduced the Nursing Home Transparency and Improvement Act of 2008. The bill would severely ratchet up transparency and disciplinary efforts on the industry.

In brief, it would include more information about a nursing home on the Nursing Home Compare Web site, including ownership information and the identify of participants in the Special Focus Facility program. It also would require more detail in cost reporting. Perhaps most seriously, it would strengthen enforcement, increasing possible maximum civil monetary penalties to $100,000 from $10,000 for a deficiency resulting in death. It also would raise the limit from $3,000 to $25,000 for other serious deficiencies.

Wow. That’s what I call enforcement.

The industry, in reaction, seems to be forcing a smile while it quietly seethes. Nursing home organizations have provided a range of diplomatic reactions, but it’s easy to detect the annoyance under the surface.For example, the Alliance for Quality Nursing Home Care commended the senators “for their longstanding and continuing commitment to nursing home improvement.” It also noted that it would “work closely and cooperatively with Senators Kohl and Grassley to strengthen some provisions of their legislation, which we believe would benefit from provider input.”

The American Health Care Association went further. It said it “has serious concerns about the legislation in its current form.” It said it objected to the disclosure of financial information and the doubling of Civil Money Penalties fines. It also mentioned that the bill neglected to address the severe nursing and caregiving shortage in the campaign to improve quality.

It’s easy to understand the industry’s reaction. I offer my kudos to the Alliance and AHCA. When was the last time you took a major rebuke of your character lightly?

I think both the senators and the industry have legitimate positions. Transparency cannot be a bad thing. And, unfortunately, it is human nature that we behave better with consequences. Still, if we don’t address underlying societal problems, punitive actions will only succeed in frustrating. The organizations should work with the senators and tinker with the bill and address those bigger problems – many of them uncontrollable - that affect quality.

The legislation, while a big pill to swallow if enacted, might be most effective because it is forcing the industry to problem solve. No more excuses. It's time to focus on quality – at all costs.
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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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