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Nursing Home Reform Act Assessed After 20 Years


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11/17/2008
Larry
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Upon the 20-year review of the Omnibus Budget Reconciliation Act (OBRA) of 1987 enacted by Congress in 1987, ElderLawAnswers.com reports in 2006, nearly one-fifth of all certified facilities were cited for deficiencies that caused harm or immediate jeopardy to residents. Studies show nursing homes still are understaffed.

Yet, the Kaiser Family Foundation reports there has been progress. But where?

Also known as The Nursing Home Reform Act, the new law instituted higher standards for patient care. But have they been met? The law increased staffing requirements and established the right to be free from abuse, mistreatment and neglect. It also merged Medicare and Medicaid standards and certification requirements. Kaiser said the biggest improvement is the reduction of physical restraints, which can lead to muscle atrophy and depression, among other problems.

The American Health Care Association said 90% of the 15,827 nursing homes in the United States were cited for at least one deficiency in 2006. Almost one and half million (1,425,484) residents lived in those nursing homes.

It’s commendable the federal government instituted policy to safeguarding our dependent elderly. Yes, there are state and federal inspections. And if deficiencies are extreme, administrative judges can shut down operations and transfer residents.

Quality of Care Manifests at Lowest Level

Despite these checks and balances, it still comes down to the grass-roots operations on the graveyard shift of a nursing facility tucked away in the wilderness far away from the Health and Human Services monitoring crews in Washington.

Is working on the lowest level in a nursing home sexy? No. Does it pay? No. Is the work appreciated. Rarely. Is a staffer with a thick accent from the Caribbean who happens to have legal status unfairly criticized by family members for how they speak? Probably. Without a college degree in health administration, is there room for promotion? Definitely not. And this is where problems manifest. Who is watching what happens in the back hallways of nursing homes at 3 in the morning? And what elderly resident totally dependent on staff is going to blow a whistle? None of them.

If these aides were paid respectably, maybe problems would decrease. If there was an opportunity to become vested in a retirement program, maybe morale would blossom. If their benefit packages were on a par with the tie-wearing administrators, maybe they would take pride in what they do, even if that was emptying bed pans and changing diapers. Who knows for sure? It couldn’t hurt. And isn’t the goal to improve the quality of care. At what cost, lawmakers will ask. That’s a worthy point when spending affects all taxpayers. But those same taxpayers probably will be lying in one of those beds some day.

Chandeliered dining rooms and smiling greeters in carpeted lobbies aside, the heart and soul of the quality of care in a nursing home lies in the basement, where the resident with dementia lies helplessly. Is the aide on that ward conscientious about his or her job? That is where government efforts need to be targeted to strengthen the crippled image of America’s nursing home. Is proper care being given? Is there a sense of compassion for the resident? Are rules and laws obeyed? Only when these queries can be answered in the affirmative will “life” in a nursing home in this country improve.



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