Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

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Cicilline Spearheading key comeback?

Rep. Wants to Reestablish House Select Committee on Aging

Published in Woonsocket Call on December 20, 2015

Four years after the Rep. Claude Pepper, (D-Florida) died in 1989, the former Chairman of the House Select Committee on Aging, would be turning in his grave with the elimination of his beloved Aging Panel three other House Select Committees in 1993.  Serving as its chair for six years, the nation’s most visible spokesperson for the elderly, put the spotlight on aging issues in his chamber.

In 1973, the House Select Committee on Aging was authorized by a House whopping vote of 323 to 84.  While in lacked the authority to introduce legislation (although its members often did so in their standing committees), the House Aging panel begin to conduct comprehensive studies on specific aging issues to identify issues, problems and trends.  It was not limited by narrow jurisdictional boundaries of the standing committees but looked broadly at the targeted aging issue.

Congressional belt-tightening to match President Clinton’s White House staff cuts and efforts to streamline its operations would seal the fate of the House Select Committee on Aging. House lawmakers supporting the elimination of the House Aging panel viewed its $1.5 million a waste because 12 standing committees had jurisdiction over aging issues. Those opposed to putting the House Select Committee on Aging on the chopping block to rein in Congressional spending charged that the standing committees staff did not have time broadly investigate issues of the nation’s seniors as this select committee did..

Even with the mobilization and lobbying efforts of a coalition of aging groups including AARP, National Council on Aging, National Council of Senior Citizens, and Older Woman’s League to save the House Select Committee on Aging, House leadership ultimately chose to “put the nails in the coffin.”  No vote was scheduled to continue its existence on March 31, 1993 when its authorization automatically expired.

But did the House Select Committee on Aging really have an impact on the development of aging policy crafted by Congress as its supporters contend?   In 1993, with the demise of this select committee staff, writer Rebecca H. Patterson reported on March 31, 1993 in the St. Petersberg Times (p.8A)that Staff Director Brian Lutz noted that during its 18 years, the House Aging panel “has been responsible for about 1,000 hearings and reports.” This writer believes that the House Select Committee on Aging’s advocacy role prodded Congress to act abolishing forced retirement, investigating nursing homes, monitoring breast screening for older woman, improving elderly housing and putting the spotlight on elder abuse and the issues nation’s caregivers face when caring for a loved one with Alzheimer’s Disease.

Bringing the Aging Panel Back from the Ashes

After the disbandment of the House Select Committee on Aging in 1993, a brief effort was undertaken by Rep. Nancy Pelosi (D-California) when she became House Speaker to bring back the Aging panel but this attempt was not successful.  Last month, Rep. David N. Cicilline (D-Rhode Island), representing the State’s First Congressional District, urged newly elected GOP House Speaker Paul Ryan in November 6th  correspondence to bring back the Aging Panel to the House Chamber.  There were 63 cosigners out of 435 lawmakers, all of them democrats, says the Democratic Lawmaker, who noted that many who did not sign wanted “additional time to review the proposal with their staff.”

It was extremely obvious to Cicilline and his cosigners as to the House Aging panel’s importance to today’s Congress.  “The considerable challenges that face our nation’s seniors, including Social Security and Medicare solvency, the rising cost of prescription drugs, poverty, housing issues, and location term care and other important issues, deserve dedicated attention from lawmakers, said Cicilline in his correspondence to Ryan and House GOP leadership.

Furthermore, Cicilline stressed the select committees relevant today as America’s baby boomers face the struggles of growing old.  “The addition of this demographic to the senior population will require thoughtful policy development and a focused effort to meet the many challenges by the increasing senior population”. He added that “Strains on resources for America’s seniors not only impact the elderly, but also those who support them, including family and professionals who provide care to seniors.”

A Quick Legislative Process

Cicilline notes that the House can readily create a temporary ad hoc select committee by approving a simple resolution that contains language establishing the committee – giving purpose, defining members and detailing other issues that need to be addressed. All standing and select committees of the House (except Appropriations) are authorized by a House resolution, and funding is then provided through appropriations, he adds.  “If the Speaker is supportive of the initiative, we would like draft and introduce a House Resolution establishing the committee, says Cicilline.

Robert Blancato, the longest serving staff member on the House Select Committee on aging, knows that the cost issue may be brought up to derail Cicilline’s efforts to reestablish the House Aging panel in 2016.  “There are certainly costs involved but an effective committee can be operated with a reasonable budget,” he says.  Now with Matz, Blancato and Associates, a strategic consulting and public relations firm, he is firmly behind Cicilline’s efforts.

“The aging population and its issues from chronic care to care giving have grown dramatically since the end of the House Select Committee on Aging in 1993.  No [Congressional] committees and defined Congressional champion has emerged since that time.  A new Aging panel would be very relevant for the future,” notes Blancato.

As an eye-witness to the legislative activities of the Aging panel for 17, Blancato’s keen political observations must be heard by House Speaker Paul Ryan and Minority Leader Nancy Pelosi.  The House Select Committee on Aging, with its bipartisan approach to crafting sound aging policy, is sorely needed now with a House divided and “compromise” being touted by some in the chamber as a “dirty word.” By bring this select committee back to life, House lawmakers can send a powerful symbolic message that they are ready to roll up their sleeves and tackle issues of concern to the nation’s seniors. Cicilline along with his letter’s cosigners calling for bringing by the Aging panel are definitely on the right track.