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Health - Nursing Homes Nursing Homes Overview
of Representative Henry A. Waxman's Efforts
2003-Present: Focusing on Safety and Staffing Rep. Waxman has opposed the Bush Administration's efforts to weaken the federal enforcement system that protects nursing home residents. In September 2001, Rep. Waxman wrote to President Bush to express his concern about an HHS proposal to reduce the frequency of nursing home inspections and eliminate automatic penalties for poorly performing nursing homes. The Administration subsequently backed away from the proposal. In November 2001, Rep. Waxman and Sen. Charles Grassley wrote to President Bush to express their concern about an HHS proposal that would have made it more difficult for nursing home inspectors to cite poorly performing nursing homes for serious harms. Again, the Administration backed away from this proposal. In February
2002, Rep. Waxman and Sen. Grassley released a report which concluded
that HHS's website of nursing home violations was providing an incomplete
picture of the compliance status of many nursing homes. The report
found that the HHS website failed to include tens of thousands of
serious violations that were uncovered by state inspectors during
investigations of complaints made by nursing home residents and
their family members. Two months after the release of this report,
HHS announced that it would begin including such information about
complaint investigations on its website. In the 106th and 107th Congresses, Rep. Waxman directed the Special Investigations Divisions of the minority staff of the House Government Reform Committee to investigate the conditions in nursing homes around the country. This ongoing investigation has led to the issuance of over 20 reports for members of Congress detailing substandard health and safety conditions and understaffing in many nursing homes. At Rep. Waxman's request, the Special Investigations Division has also issued reports on the prevalence of abuse in nursing homes. 1999: Preventing Patient Dumping Rep. Waxman worked to assure passage of legislation to prohibit "patient dumping." This legislation, the 1999 Nursing Home Resident Protection Act, prohibits nursing homes which have already accepted a resident from evicting or transferring that resident when the resident qualifies for Medicaid. This legislation is an important step towards ensuring that residents receive quality nursing home care without fear of inappropriate eviction when their assets are depleted and they are forced onto Medicaid. 1995: Defeating the GOP "Devolution" of Nursing Home Quality In 1995, the Republican-led 104th Congress mounted an assault on America's seniors. The most egregious proposal would have dismantled the federal Medicaid program and given each state a fixed amount of money, with which the states would have almost complete freedom to reduce nursing home benefits. In addition, the Republicans sought to repeal the nursing home spousal impoverishment protections written in 1988 and to repeal the federal standards for nursing homes written in 1987. Rep. Waxman, together with the Democratic congressional leadership, played a central role in defeating the proposed repeal of the federal nursing home standards and the block granting of Medicaid. Through their efforts, they were able to stop the proposals which would have undermined the quality of care for nursing home residents. 1992: Improving Nurse Education Rep. Waxman has long been an advocate for more federal funding for the training of long-term care providers. The Health Professions Education Extension Amendments, which was introduced by Rep. Waxman, provided fellowships to nurse aides employed by nursing homes to receive additional training through professional or vocational nursing programs. The bill became law in 1992. 1988-1992: Proposing Increased Access to Nursing Home Care Under the Medicare and Medicaid programs, there is a large gap in the coverage of nursing home care. Medicare only pays for the first 100 days of nursing home care, and Medicaid only pays for nursing home care for indigent persons. As a result, seniors requiring nursing home care must exhaust their financial resources before they qualify for coverage under Medicaid. Rep. Waxman sought to correct this problem by introducing the Elder-Care Long-Term Care Assistance Act in 1988 and 1989 and the Long-Term Care Family Security Act in 1992 to provide seniors with universal access to long-term care. Under these proposals, Medicare would have covered a large portion of the costs of nursing home care and community care for qualified seniors. However, these proposals were not enacted into law. 1988: Preventing Spousal Impoverishment
Rep. Waxman introduced legislation, the Medicaid Community Spouse Protection Amendments, to reduce the risk of financial devastation from nursing home costs. The bill revised the Medicaid program to allow the spouse of a nursing home resident to retain enough of the couple's income and resources to continue to live in the community. This provision helped ensure that spouses were able to live out their lives with independence and dignity. This bill became law in 1988 as part of the Medicare Catastrophic Coverage Act. 1987: The Nursing Home Reform Act After a two-and-a-half
year study, the IOM issued its report "Improving the Quality
of Care in Nursing Homes." Rep. Waxman chaired a series of
hearings on the report and the widespread abuses in nursing homes
documented in the report. The report concluded that "individuals
who are admitted receive very inadequate -- sometimes shockingly
deficient -- care that is likely to hasten the deterioration of
their physical, mental, and emotional health." The report and
Rep. Waxman's hearings showed widespread misuse of drugs and physical
restraints and appalling failures in care, including prolonged neglect
and physical abuse. In 1987, Rep. Waxman wrote broad reform legislation, commonly referred to as the Nursing Home Reform Act, which was enacted into law as part of the Omnibus Budget Reconciliation Act ("OBRA ‘87"). This legislation greatly strengthened federal nursing home standards. The law placed a new focus on resident rights. It gave nursing home residents the right to choose a personal attending physician, to participate in planning their own care and treatment, and to be free from physical and mental abuse, corporal punishment, involuntary seclusion, and "any physical or chemical restraints imposed for purposes of discipline or convenience." The law also specified that facilities must care for residents in a manner and an environment that promotes the maintenance and enhancement of quality of life. The facilities were also required to provide services so that each resident will attain or maintain the highest practicable physical, mental, and psycho social well-being. 1982: Repelling the Threat of Deregulation In 1982, the Reagan Administration pushed to repeal the federal rules that governed nursing homes. Among the rules being considered for repeal were basic requirements that nursing homes maintain a safe and sanitary environment and respect the privacy and dignity of residents. The Administration's proposed rule also would have reduced the frequency of nursing home inspections, weakened the requirements for corrections of deficiencies, and relinquished responsibility for inspections to a private organization. Rep. Waxman led the fight to block the Reagan Administration's proposals to repeal federal nursing home protections. He sponsored the National Nursing Home Standards Act of 1982. This bill mandated a moratorium on the Administration's proposed changes in nursing home rules. It also created a federal commission, under the Institute of Medicine (IOM), to examine the adequacy of nursing home regulations and make recommendations for improvement. Congress ultimately enacted two moratoriums prohibiting the proposed repeal from going into effect. Faced with the strong opposition in the Congress, the Reagan Administration agreed to postpone any substantive changes in federal nursing home regulations until the Institute of Medicine examined and reported to the Congress on nursing home conditions.
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Send a Message to Rep. Waxman
Rep.
Waxman was responsible for securing passage of new provisions to
prevent spousal impoverishment. Prior to passage of this law, many
older Americans found themselves in the quandary of "spousal
impoverishment" -- a situation where spouses were forced to
spend down all of their assets and were forced into poverty before
Medicaid would pay for their husband or wife to receive care in
a nursing home. 