Hearing of the Senate Special Committee on Aging - Nursing Home Transparency and Improvement

Interview

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SEN. RON WYDEN (D-OR): Thank you, Mr. Chairman, I want to commend you and Senator Smith, and so appreciate the bipartisan approach that you all take to this issue. And I'd just make three points very quickly. First is, something is out of whack in this country when it's a lot easier to find information about the quality of a washing machine than it is to get information about the quality of long-term care facilities, and this a fact.

All over this country, you can easily get access to information about home appliances and a variety of other retail purchases you make, but you can't get information about the essential healthcare services that are available. And I think that's why it's so good that you're going forward in your leadership, Chairman Kohl and Senator Smith.

Second, on this trend towards the large chains in private equity firms getting into the field, I think it's worth noting.

Senator Smith and I see it as we have a great many long-term care facilities in our state that are essentially small family-owned facilities. And I think it's pretty clear that those kinds of healthcare facilities do a lot more than make information available to families, share information with respect to long-term care choices than some of these big chains.

So there's a notion that you can't be straight with the public, and with the consumer and the families that Senator Casey speak so eloquently about, that's not correct, number one.

And number two, we have some concrete examples of how to have more transparency in long-term care, and that's particularly in a lot of our small towns, we have family-owned long-term care facilities. They are showing how to get information out to families, work with families, and make sure they know more about their choices.

One last point, Mr. Chairman, as you and I have talked about, in the Healthy Americans Act, the legislation, I have -- we now have 11 United States senators. It's the first bipartisan universal coverage bill in more than 13 years here in the United States Senate. We have a significant long-term care affection in that legislation, both on the public side and on the private side.

And one of the reasons, I think, your hearings are so helpful, Mr. Chairman, it's my intent to take the information that you all get through the leadership in this committee and to add to that legislation some of what you have found about how to promote transparency.

Frankly, we have taken some baby-steps in the legislation to get more information out, but as a result of your good work in these important hearings, it's my intent to take the information that comes out of these hearings on long-term care facilities and transparency, take that information, and put it into our legislation. And I think that's one additional way the Senate can work in a bipartisan way to promote better long-term care choices for our people.

Mr. Chairman, thank you, and I look forward to working with you.

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SEN. WYDEN: Thank you, Mr. Chairman.

Mr. Weems, one, let me thank you for that kind note about the Wyden twins. It was gracious of you to acknowledge their arrival. And let me pick up just on one last question on the very good points that Senator Casey was making.

The issue with the change, of course, is about hidden ownership.

MR. WEEMS: Yes.

SEN. WYDEN: And I am not clear, can the government now identify all the nursing homes throughout the country owned by one corporate entity?

MR. WEEMS: Probably not, is the answer. We know nursing homes by the provider agreement that we have with them. Especially, as we move -- as there is fractional ownership, we have difficulty telling that. The PECOS system that Senator Casey alluded to, that we are building, will give us the ability to determine who owns the facility down to the fraction of 5 percent.

SEN. WYDEN: So it is not possible to have the information today, but essentially, hidden ownership is going to -- information about hidden -- hidden ownership is going to be made available --

MR. WEEMS: Yes.

SEN. WYDEN: -- and brought to light under your project essentially down to the small fraction.

MR. WEEMS: Yes, sir.

SEN. WYDEN: And when will that be available?

MR. WEEMS: At our current pace that would be 2009, to have a completely populated database.

SEN. WYDEN: Okay. One question with respect to the information that is being made available to consumers. We have been trying to go through some of it and I am looking at a page involving a facility in Illinois Hillcrest Home, it was a long section -- it involves a variety of things. I am looking at a category called vertical openings deficiencies. And this says something about exit doors and the like.

Have you all brought together consumers and families to have them involved in looking at whether this kind of information is useful to them?

MR. WEEMS: We have brought together focus groups in that regard. We still need to improve the way that that information is useful. We need to, first of all, make sure that the information that we are providing is useful in making a decision. And then secondly, we need to make sure that it is understandable.

But I would also tell the panel that there really is no substitution for visiting a nursing home, when making that decision. That it is absolutely critical that a visit occur and on the CMS website you can get actually a fairly simple checklist of, when you go to a nursing home what you should look for. That might help ask the right questions in that visit.

SEN. WYDEN: Now, just one last question. Again it sort of speaks to the way decisions get made in the real world. A lot of older adults in our families have to make quick decisions about nursing home placements, typically while you have a senior in the hospital.

And at that point, the discharge planner plays a very important role with respect to getting out information about the quality of facilities. What are you all doing to get the discharge planners involved in this quality area?

MR. WEEMS: We work with the discharge planners to make sure that they are aware of the choices in the area. But we also want to make sure that the families are involved in that decision as well.

SEN. WYDEN: It just seems to me that if the families are going to get timely information, and I share your view about how important they are, it is the discharge planner, who in a lot of instances, is going to lay that information out.

In other words, you know, in a typical instance, you are not going to have a family in a position to run through a website and crank up their laptop and look at the information. They are going to have a discharge planner to help them with the choices.

I hope you all will be more aggressive in reaching out to them because I think that's, in the real world, is a way a lot of these decisions get made.

Look forward to working with you and also on the Finance Committee as well.

Thank you, Mr. Chairman.

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