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In its latest step to better protect vulnerable nursing-home residents, the Health Care Financing Administration is distributing posters and other educational materials to help residents and their families identify and report incidents of abuse and neglect.

HCFA is asking nursing homes to display the posters as part of its education campaign to prevent abuse and neglect. Other components of the campaign include updated video and print guides to choosing a nursing home and Nursing Home Compare, HCFA's national database of nursing-home inspection reports available on the Internet.

The education campaign is part of the Clinton Administration's aggressive initiative to promote quality care and further strengthen enforcement of federal and state standards for the 1.6 million Americans who live in nearly 17,000 nursing homes nationwide. HCFA now requires states to crack down on nursing homes that repeatedly violate health and safety requirements and is changing the inspection process to increase its focus on preventing bedsores, malnutrition and resident abuse.

The posters and accompanying information cards describe physical signs of abuse and neglect, such as unusual bruises, scratches and broken bones, as well as less obvious indicators, such as fearful behavior, weight loss and dehydration. The posters, which feature the phrase "sometimes abuse is not so obvious," display a phone number that residents, visitors or staff members can use to report abuse.

"Most nursing homes provide quality care to their frail and vulnerable residents and want to make sure that their residents don't become victims of abuse or neglect," HCFA Administrator Nancy-Ann DeParle said. "By displaying these posters, nursing homes can send a clear message that residents will get the respect and dignity they deserve."

HCFA initially will send the posters to more than 3,000 nursing homes in 10 states -- Arizona, Colorado, Georgia, Idaho, Louisiana, Massachusetts, Missouri, New Jersey, West Virginia and Wisconsin. With the help of each state's long-term care ombudsman, HCFA will evaluate the campaign's effectiveness before distributing the posters nationally.

Nursing homes found to abuse residents can face penalties ranging from fines to the loss of all Medicare and Medicaid funds and the cancellation of their provider agreements.

HCFA's abuse-prevention education campaign also includes:

• A video with tips on what to look for in a nursing home, featuring television newsman Hugh Downs as narrator. The video will be available through state ombudsmen, survey agencies, and resident and consumer advocates, and HCFA is working to make it available for free in some video stores. Distribution of the video will begin in July.
  
  
• An updated version of HCFA's "Guide to Choosing a Nursing Home," which is designed to help families through the process. The guide, which will be available in August, includes questions to ask, a nursing-home checklist, contact information and other resources, as well as expanded information about preventing abuse and neglect.
  
  
• Nursing Home Compare, HCFA's Internet database that allows consumers to compare inspection results when choosing a nursing home. Since the site went live in September 1998, Nursing Home Compare users have logged about 1.4 million pageviews -- more than any other section of HCFA's consumer website, www.medicare.gov. HCFA plans to enhance Nursing Home Compare by adding information about staffing levels and the condition of residents in each home.
  
  
• A questionnaire to gather consumer feedback. HCFA has worked with resident advocates to develop the questions, which ask residents to rate their treatment by the staff, staffing levels, the cleanliness of the facility, and other aspects of their care. In late summer, state ombudsmen will help distribute and collect the responses in several states to test the approach before going national.
  
  
• Working with the Administration on Aging (AoA) and state long-term care ombudsmen to develop new ways to educate the public about preventing abuse and neglect. This year HCFA will fund several demonstration projects in collaboration with the AoA to educate residents, family members, staff workers and others about risks and prevention strategies.
  
  
• A "best practices" Internet site that allows nursing home administrators and caregivers to share successful efforts to improve care for residents, especially those at risk for weight loss or malnutrition. Nursing home administrators, staff and others can learn about those best practices by visiting the Internet site at www.hcfa.gov/medicaid/siq/siqhmpg.htm.
  
  
• A national campaign to educate consumers and nursing home staff about the risks of malnutrition and dehydration and nursing home residents' rights. HCFA has worked with clinicians, consumers and nursing homes to develop approaches for this campaign, which will start later this year.
  

In 1995, the administration issued the nation's toughest-ever nursing home enforcement regulations, 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. As a result, the administration began to take additional steps last year to enhance protections and target specific needed improvements in nursing home care.

"All Americans deserve to know that they and their loved ones will receive attentive, quality care in nursing homes, and that's what most caregivers and administrators strive to deliver," DeParle said. "By working together to prevent abuse, we will improve people's lives."