Bill too slow to ID troubled nursing home, advocates say

Sen. Elizabeth H. Roberts says she is concerned about balancing the needs of patients with the appropriate time to tell the public about problems.

Thursday, June 2, 2005 BY JENNIFER LEVITZ, Journal Staff Writer

PROVIDENCE -- Bills endorsed by House and Senate leaders require the state to flag and investigate nursing homes that are financially unsound, but the legislation as written would delay telling the public even when shaky finances have affected the standard of care.

The American Civil Liberties Union and advocates for the elderly yesterday argued that the state is obligated to tell the public immediately when the Health Department has confirmed a financial crisis severe enough to affect care.

The "Nursing Facility Quality Monitoring and Early Intervention for Resident Safety" bill debated yesterday by the Senate Health and Human Services Committee would keep validated financial problems confidential until the nursing home has filed a "plan of correction" with the Health Department. There is no timeline for the process, and in the meantime, the residents would not know they were in an unstable nursing home and people searching for a nursing home would not have the facts needed to choose a facility, advocates argued.

Carolyn Swift, a representative with the grass-roots lobbying group Senior Agenda Consortium, said she spoke as a senior who might suddenly confront a crisis and need to quickly choose a nursing home. She should be able to call the Health Department and find out everything regulators know about a particular nursing home, she said.

"As citizens, we have the right to have them serve us that way," Swift said. "I don't want to enter a nursing home and then find that they've been found to be inferior in some ways. I don't want to enter a home that needs improvement. I don't think you do either."

Sen. Elizabeth H. Roberts, D-Cranston, chairwoman of the Senate committee, and a sponsor of the bill, which has a companion bill on the House side, said she was moved by Swift's testimony.

Roberts, one of the legislators now trying to overhaul Rhode Island's regulation of 100 nursing homes, said she is concerned with balancing the "needs of patients for safety and security, with 'when is the appropriate time' " to tell the public about issues involving particular nursing homes.

She said the bill, one of several nursing home bills that underwent a first hearing by the Senate committee yesterday, would probably be revised several times after comments from the public.

Roberts said the ultimate decision "may have to do with the severity of a complaint and whether there is a safety issue."

"That's why we're here, to take testimony," she said.

The legislation is part of a five-bill package unveiled last week by the General Assembly's Joint Committee on Health Care Oversight after studies by the committee, the lieutenant governor and governor. The bills are meant to improve life for the state's estimated 10,000 nursing-home residents in the wake of several nursing-home failures.

The bills would increase inspections for poorly performing nursing homes, speed up complaint investigations, and give the state unprecedented power to monitor the finances of nursing homes.

The link between financial problems and poor care became clear last year with the failure of Hillside Health Center in Providence, which was bouncing checks for food and supplies and staff while racking up the worst inspection record in the state.

But the current debate is how much the state should share with the public and when.

Under the legislation considered by the Senate committee yesterday, the state would call a meeting with nursing homes found to have financial problems and care that caused harmed or could harm residents.

That meeting would occur within 10 days of the state's findings.

The nursing home would then have the opportunity to respond to the state's concerns, to say whether the concerns are valid.

If the state confirms the problems, regulators would require the nursing home to prepare a plan of correction that could include a spending plan, monthly cash reports, and details on the status of vendor bills, and ability to pay for food and other necessities.

But none of this would be disclosed to the public until the nursing home filed its plan of correction, and the state accepted that plan.

The process could "literally drag on for months," Steven Brown, director of the Rhode Island Affiliate of the American Civil Liberties Union, testified. "During that period of time, everyone would be left in the dark."

Brown urged the senators to strike the "confidentiality provisions" from the bill altogether. He said many people would have a legitimate interest in knowing of the stability at a nursing home, "such as people looking at entering" the facility.

The nursing-home industry argues that the state could go overboard in informing the public, and cause undue anxiety. Alfred Santos, director of the Rhode Island Health Care Association, the lobby for for-profit nursing homes, said public disclosure should depend on the problem. He said he worried about misinformation and situations that could be taken out of context.

Sen. Charles J. Levesque, D-Portsmouth, said the bill should be revised to include a timeline for public disclosure. His timeline, which he suggested in an interview before yesterday's hearing, would still cause a delay for almost two months of information to nursing-home residents and the public.

Jessica Buhler, project director for the Senior Agenda Consortium, said that by not informing the public immediately about what it knows, the state is taking away the "watchdog right of families." She said families should get all the information and be able to use their own judgment.

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