Clinton cracks down on nursing homes

Nursing homes are facing a withering barrage of fraud and abuse controls as the Clinton administration targets facilities that provide poor patient care. The White House announced a slew of quality control measures that could mean big fines or exclusion for guilty providers.

"For states with poor enforcement, it’s going to be a shock," says Peggy Goldstein, assistant executive director of the California Association of Health Facilities, Sacramento.

Clinton’s directives mean nursing homes will face:

- Automatic sanctions — without a grace period for corrections — for providers found guilty a second time of resident abuse.

- More frequent nursing home inspections for chronic violators. Inspections will be done at staggered times and during nights and weekends.

- More civil monetary penalties. "HCFA will instruct states to impose civil monetary penalties for each instance of serious or chronic violation," says a White House statement.

- Special attention for nursing homes that belong to chains with a bad record.

- Tougher inspections as HCFA beefs up training of inspectors in states that are not found to be adequately protecting patients. HCFA also will implement standard evaluation protocols to be used by states.

- More aggressive state enforcement as HCFA threatens to pull federal funds for states that conduct lax surveys.

- Residents and their families will be informed of their nursing homes’ plans for controlling abuse and theft.

- More prosecutions as HCFA refers more cases to OIG and the Justice Department.

- Survey results and violation records will be posted on the Internet.

The administration also will ask Congress to mandate criminal background checks for nursing home employees, push for a greater number of trained workers, and institute a nursing ombudsman program through the Administration on Aging.

These moves come in the wake of a new HHS report that dismisses proposals to have JCAHO perform surveys rather than HCFA, as well as suggestions that the current survey system be replaced with nursing home incentives and quality improvement initiatives.