------------------------------------------------------------------------------ NewsBank, inc. - The Commercial Appeal - 2000 - Article with Citation ------------------------------------------------------------------------------ Headline: NURSING HOMES - Who's looking out for residents, taxpayers? Date: March 1, 2000 Section: EDTORIAL Page: A15 Edition: Final Length: 431 words Index Terms: MEMPHIS NURSING HOME TAXPAYER Text: STATE OFFICIALS provide hundreds of millions of dollars in tax subsidies each year to a certain kind of licensed care facility in Tennessee, but exert little oversight of how that money is spent. The poor, vulnerable and largely voiceless recipients of this "care" too often find themselves at risk of neglect and physical harm, even death. The owners of these facilities insist their operating margins are so small, their state and federal support is so scant and their employee turnover is so high, they can't afford to pay their workers much more than minimum wage or train them intensively. Yet their critics accuse them of rewarding themselves handsomely through lucrative leasing and contracting deals. Even in cases of serious or chronic rules violations, family members and advocates complain, state regulators respond sluggishly in assessing fines and other penalties. Disciplinary actions against violators tend to be conducted quietly. And providers, who maintain a politically potent lobby on Capitol Hill, vow to fight proposed reforms aimed at greater public accountability - unless, of course, the state gives them more money. Sound familiar? This discussion is not, for a change, about day care centers. It's about Tennessee's nursing homes. But many of the dynamics of the debate are similar. And along with such matters as day care, TennCare and the state budget and tax system, nursing home reform is yet another critical issue that state lawmakers seem determined to ignore. During several hearings in Nashville over the past week, relatives of Tennessee nursing home residents described how regulators ignored them and home administrators dismissed them as "troublemakers" when they challenged the care their loved ones were getting. They cited a lack of care options. Others described how the nursing home staffs seemed sure of when state inspectors would make "surprise" visits - in one instance because a state Health Department employee, still on the job, evidently was peddling the inspection schedule. Still others offered horrifying accounts of neglect of patients' basic needs, insufficient and abusive staff, and dirty and dangerous facilities. Their anecdotes yielded tears, but no commitment to action. State officials concede that the number of complaints they have fielded against nursing homes has nearly doubled in recent years, and that they are incapable of responding to all of those complaints promptly. Gov. Don Sundquist seeks eight new nursing home inspectors in next year's budget - to help keep tabs on tens of thousands of residents. And even that small complement is in doubt, since lawmakers who seek re-election this year are likely to disdain any request for more spending that they can defer. It's easier to bluster about "waste, fraud and abuse" than to find and eliminate it. As with day care, the state could link the subsidy payments a nursing home receives to the quality of care it provides. As with day care, it doesn't. Many nursing home residents do not need around-the-clock institutional care and would be served more effectively- and cheaply - at home. Tennessee ranks 49th among the states in funding per person for home- and community-based care of elderly and disabled citizens. Sundquist proposes a small pilot program for long-term home care in next year's budget, but that too is jeopardized by the General Assembly's inaction on tax reform. The alternative is to shift money away from nursing home care - a diversion industry lobbyists vow to prevent, noting that the state taxes nursing home beds. Amid this unhealthy stalemate, legislators have ample time to debate Tennessee's legal definition of "breakfast" - an exercise that, to the extent it has any value at all, is meaningful only to competing fast-food special interests. It's good to know that lawmakers have their priorities in order. Copyright 2000 The Commercial Appeal, Memphis, TN Accession Number: 0011170113 ------------------------------------------------------------------------------