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HCFA Administrator Nancy-Ann DeParle today announced new steps the agency is taking to ensure high quality nursing home care and make better consumer information available to residents and their families.

DeParle said these actions build on the Clinton Administration's aggressive initiative to improve enforcement of federal and state nursing home standards and to promote quality care for 1.6 million elderly and disabled Americans in nearly 17,000 nursing homes. HCFA, which administers Medicare and Medicaid, is:

• today issuing a regulation that subjects nursing homes with problems to tougher fines;
  
  
• instructing states to investigate complaints about harm to nursing home residents more quickly;
  
  
• launching a national campaign this spring to prevent neglect and abuse of nursing home residents;
  
  
• promoting a website today where families can get comparative information about nearly 17,000 nursing homes nationwide.
  

"Today's actions are one more chapter in our on-going campaign to assure that nursing home residents get attentive, good quality care, and that their concerns are taken seriously and addressed," HCFA Administrator Nancy-Ann DeParle said. "We owe it to these residents and their families to prevent problems where we can and address them quickly when they occur."

DeParle also called on Congress to pass patient protection legislation proposed by President Clinton in his Fiscal Year 2000 budget.

In 1995, the Administration issued the nation's toughest-ever nursing home enforcement rules, which led to measurable improvements in quality of care. Ongoing monitoring found that many nursing homes continued to violate rules and that enforcement by some states -- which conduct on-site inspections for HCFA and recommend penalties against homes that violate health and safety rules -- remained lax. Those findings helped the Administration develop additional actions announced in July 1998 to enhance protections and target specific needed improvement in nursing home care.

"Americans deserve the peace of mind that they and their loved ones will receive quality, compassionate care in nursing homes. We have taken action to improve the quality of life in nursing homes and to prod states to do a better job of inspecting nursing homes and recommending sanctions. But we need to do even more," DeParle said.

Tougher Fines for Health and Safety Violations

HCFA is issuing a regulation, on display today at the Federal Register, that creates a more effective tool to use against nursing homes that fail to meet the needs of vulnerable residents.

It will enable states, which inspect nursing homes, to recommend fines -- up to $10,000 -- for each serious incident that threatens residents' health and safety. Existing rules simply link fines directly to the number of days that nursing homes fail to comply with federal requirements.

This new civil monetary penalty regulation ensures that regulators do not have to wait until a violation is fixed to assess a penalty. In addition, nursing homes will not have an opportunity to avoid such fines by fixing the violations that led to their imposition. Nursing homes will continue to have the right to appeal such remedies as the law requires.

Quicker State Investigations of Complaints

HCFA will strengthen complaint-investigation requirements because some state investigations of allegations have lagged.

States already are required to investigate complaints alleging immediate jeopardy to residents within two days and all other complaints in a timely manner. Now, HCFA will require states to investigate within 10 working days whenever a complaint alleges harm to a resident. States also must now add confirmed violations to HCFA's database that tracks compliance in nursing homes. DeParle explained these new requirements in a letter sent to states today.

HCFA also will develop minimum federal standards for states to conduct complaint investigations and will identify ways to better oversee states' performance.

Existing remedies when surveys and investigations find nursing homes fail to follow federal requirements include terminating their Medicare and Medicaid participation; cutting off payments for new residents; appointing temporary managers; and requiring on-site state monitoring.

HCFA toughened enforcement in the 1998 initiative by requiring states to conduct more frequent inspections of nursing homes with repeated serious violations and impose sanctions without a grace period against poor performers. States also must stagger surveys and conduct many on nights and weekends, when safety and staffing problems often occur. HCFA also implemented a new federal monitoring system to ensure that states conduct effective surveys and fulfill their enforcement responsibilities.

Campaign to Detect and Prevent Neglect and Abuse

HCFA will launch a national education campaign this spring on how to identify, report and stop neglect and abuse. By teaching residents, their families, nursing home workers and other caregivers to stay alert for signs of neglect and abuse and to act quickly to spot it, the campaign will help residents stay safer and healthier.

The campaign will include a new publication, "Living in a Nursing Home;" a video with tips on selecting a nursing home; posters that tell residents and their families where to report abuse; and a new version of HCFA's "Guide to Choosing a Nursing Home."

Nursing Home Comparison Information on the Internet

A new website -- Nursing Home Compare at www.medicare.gov -- will enable Americans to more easily obtain and review that information, which can help them make educated decisions about nursing homes for their loved ones.

Nursing homes already are required to make survey results available to residents who request them, but the new web site has the most recent information from state inspections of every Medicare- and Medicaid-certified nursing home in a consumer-friendly format, as well as location, size and ownership. Users can search nursing homes by name, city, county or ZIP code, and compare data from two or more homes. The information comes from HCFA's Online Survey, Certification, and Reporting (OSCAR) database, which comprises survey data provided and updated by states.

HCFA will continue to refine Nursing Home Compare to increase its usefulness for consumers, such as by adding information about staffing and the condition of residents. Since testing began in September 1998, HCFA has clarified material on the site in response to comments from users.

Additional Budget, Legislative Proposals

These newest enforcement tools and education efforts are part of HCFA's strategy for ongoing quality improvement in nursing homes. The Administration is also seeking additional funds and legislation to carry out its initiative to protect residents.

To implement fully the initiative announced last July, the fiscal year 2000 budget proposes an additional $60.1 million in funding. The Administration has legislative proposals to require nursing homes to conduct criminal background checks of employees; to establish a national registry of workers who have been convicted of abusing residents; and to allow more types of nursing home workers with proper training to help residents eat and drink during mealtimes. The Administration also supports legislation before Congress protecting Medicaid beneficiaries from being evicted inappropriately by nursing homes.

DeParle said HCFA will monitor the implementation of these and earlier actions, making other improvements whenever necessary.

"Continuing to work with Congress, Medicare and Medicaid must use every available tool to make sure nursing homes do right by their residents," DeParle said. "States must investigate thoroughly and use the full range of sanctions. Residents and their families must have useful information. Together, we can provide strong incentives for nursing homes to provide quality care and a safe environment in the first place."