Statements on Introduced Bills and Joint Resolutions

Floor Speech

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - February 14, 2008)

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By Mr. GRASSLEY (for himself and Mr. Kohl):

S. 2641. A bill to amend title XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the targeting of the enforcement of requirements with respect to such facilities; to the Committee on Finance.

Mr. GRASSLEY. Mr. President, I come to the floor for the purpose of introducing a bill. The bill's title is the Nursing Home Transparency and Improvement Act of 2008.

I introduce this bill along with Senator Kohl of Wisconsin. It is a bipartisan bill. Senator Kohl, because he is in the majority, has the distinguished pleasure of serving as chairman of a special committee on aging which is also a very important responsibility, particularly since our Government spends about more than $50 billion a year on nursing home care for elderly, among other things that are the responsibility tie of that committee.

The bill that we are introducing is an important piece of legislation that aims to bring some overdue transparency to consumers regarding nursing home quality. It also provides long-needed improvements to our enforcement system.

This legislation further strengthens nursing home staff training requirements. In America today, there are over 1.7 million elderly and disabled individuals in roughly 17,000 nursing homes.

As the baby boom generation ages, that number probably will rise, unless we do something about the problems of osteoporosis and Alzheimer's and diabetes. Hopefully, we can do those things so our nursing homes do not fill up more. But those are some of the health problems that are facing 77 million baby boomers. Some of them undoubtedly will end up in nursing homes.

So we have to have not only a tremendous interest in ensuring nursing home quality based upon the number of people who are already there, but we are going to have more in the future.

While many people are using alternatives such as home care or other methods of community-based care, nursing homes are going to remain a critical option for our elderly and our disabled. I always think in terms of nursing homes being at the end of a continuum of care for people who need some help.

People want to stay in their own home. When there is a question, can they do that without endangering them, bring some help to the home, relatives or home health care types.

If that is not the right environment, then assisted living. And then other things that might eventually bring a person to a nursing home. But a nursing home is a last resort. I say that because during my tenure as chairman of the Aging Committee from 1997 to the year 2001, versus the period of time I was chairman of the Senate Finance Committee, dealing with a lot of aging issues, interacting with a lot of older people, I have never once had anybody say to me that: I am just dying to get into a nursing home.

So I think it is important we do whatever we can to keep people out of nursing homes. But there are some people, a lot of people, and a growing number of people who are going to need that type of care.

So we have to be concerned about the quality of care in nursing homes. We surely owe it to them to make sure they receive the safe and quality care they deserve. Unfortunately in many areas, the nursing homes, we have a few bad apples always spoiling the barrel. Too many Americans receive poor care, often in a subset of a nursing home.

Unfortunately, this subset of chronic offenders stays in business, in many ways keeping their poor track records hidden from the public at large and often facing little or no enforcement from the Federal Government.

As ranking member of the Senate Finance Committee, I have a longstanding commitment to ensuring that nursing home residents receive the safe and quality care we expect for our own loved ones. But this effort requires transparency, transparency in the nursing home industry so consumers are armed with information, consumers having information they need to make the best decisions possible for loved ones. This same transparency also provides additional market incentives for bad homes to improve.

This effort also requires a strong mandatory enforcement and monitoring system to ensure safe and quality care at facilities that would not take the steps needed to do so voluntarily.

The Grassley-Kohl legislation seeks to strengthen both areas, transparency and enforcement. It is a bill that is good for consumers, good for nursing home residents, and good even for the nursing home community.

Let's look at transparency. In the market for nursing home care, similar to all markets, consumers must have adequate data to make informed choices. For years people looking at a nursing home for themselves or loved ones had no way of knowing whether that home was--this is kind of a legal term in the regulations--a ``special focus facility,'' a designation meaning they had been singled out as a consistently poor performer.

Why should consumers not have access to this information? The Government has it and so should consumers. To that end, this bill requires that the ``special focus facilities'' designation be placed on the CMS website. Nursing Home Compare is the name of that website.

By giving consumers this information, we will both give consumers information necessary to make informed choices and poorly performing homes an extra incentive to shape up or consumers then can go elsewhere.

This bill also requires more transparency about ownership information. What is so secretive about who owns a nursing home? Also, it provides transparency in inspection reports and more accountability for large nursing home chains and the development of a standardized resident complaint form so there is a clear and easy way to report problems and have them resolved.

The bill would also bring more transparency on what portion of a nursing home's spending is used for direct care for residents and also bring more uniformity to the reporting of nursing staffing levels so people can make an apples-to-apples comparison between nursing homes.

But even with improved transparency, there are some nursing homes that will not improve on their own. In the nursing home industry, most homes provide quality care on a consistent basis. But as in many sectors, this industry is given a bad name by a few bad apples that spoil the barrel.

So we need to give inspectors better enforcement tools. The current system provides incentives to correct problems only temporarily and allows homes to avoid regulatory sanctions while continuing to deliver substandard care to residents. That system must be fixed.

In ongoing correspondence that I have had with Terry Weems, the Acting Administrator of CMS, that agency has requested the statutory authority to collect civil monetary penalties sooner and hold them in escrow pending appeal. To that end, this bill requires penalties be collected within 90 days following a hearing; after that, they be held in escrow pending appeal.

Penalties should also be meaningful. Too often they are assessed at the lowest possible amount, if at all. Penalties should be more than merely the cost of doing business, they should be collected in a reasonable timeframe and should not be rescinded easily.

These changes would help prod the industry's bad actors to get their act together or get out of business. In addition to increased transparency and improved enforcement, this bill provides commonsense solutions to a number of other problems as well.

This legislation requires the Secretary of Health and Human Services to establish a national independent monitoring program to tackle problems specific to interstate and large intrastate nursing home chains. This legislation directs the Government Accountability Office to, one, conduct studies on the role, if any, of financial problems in the poor performance of special focus facilities; identify best practices at the State level in temporary management programs; and, three, determine what are the barriers preventing the purchase of nursing homes with a record of poor quality.

Finally, in the case of nursing homes being closed due to prior safety or quality of care, the bill requires that residents and their representatives be given a sufficient notice so they can adequately plan a transfer to a better performing nursing home. I happen to be very sensitive to the fact that nursing home residents are often old and fragile. Moving them into new facilities is often very traumatic. So we have to make sure these residents are transferred appropriately and with the time and care deserved.

This bill would also strengthen training requirements for nursing staff, by including dementia and abuse prevention training as part of the preemployment training.

The Grassley-Kohl bill also requires a study on the appropriateness of increasing training requirements for nurse aids and supervisory staff.

I am proud to introduce this bill today, along with the distinguished Senator from Wisconsin, Mr. Kohl, the chairman of the Aging Committee. He and I have a long history of working on issues together, particularly for the elderly. We will continue to do everything we can to make sure America's nursing home residents receive the safe and quality care they deserve. Increasing transparency, improved enforcement tools, and strengthening training requirements will go a long way toward achieving this goal.

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