Trying to head off election-year criticism of the enforcement of nursing home quality standards, the Clinton administration last week announced the tightening of inspection regulations.
HCFA will require states to make it difficult for nursing homes to predict when inspectors will conduct surveys. Some inspections will be scheduled in the evening or on weekends.
HCFA also will sanction poorly performing nursing homes-those whose violations threaten immediate harm to residents-the second time such a violation is found. And the agency will direct state inspectors to target chains with bad records and publish the results of nursing home surveys on the Internet.
Administration officials said the new regulatory initiative is part of HCFA's ongoing efforts to improve nursing home quality enforcement. HCFA released a 900-page report on nursing home quality enforcement under regulations that took effect in 1995.
HHS Secretary Donna Shalala said the latest initiative represents a "first shot" at improving enforcement "based on practical experience in the field."
But congressional Republicans were quick to point to the timing of the initiative as proof the administration is trying to disguise poor oversight of nursing homes.
This week the Senate Special Committee on Aging is to hear testimony on nursing home quality in California. At the hearing, the General Accounting Office will release a report, almost a year in the making, about enforcement in California.
"By his actions today, the president and the administration are telling me they are convinced there is a nationwide, systemic problem," said Sen. Charles Grassley (R-Iowa), chairman of the committee. "Today, the enforcement system is comatose. The president needs to bring new political muscle to enforcement and oversight efforts."
The federal government spends $30 billion a year on nursing home care through the Medicare and Medicaid programs.
About 17,000 long-term-care facilities receive some reimbursement from HCFA.
A group representing not-for-profit long-term-care providers welcomed the new initiatives but cautioned against overregulation of good nursing homes.
"(Regarding) the recommendations the president made yesterday, the devil's in the details, but generally speaking, we're supportive of them," said Michael Rodgers, senior vice president of government relations and public affairs with the American Association of Homes and Services for the Aging. "We have no interest in protecting people who continuously provide substandard care."