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Bill Repeals Nursing Home Rules Medicaid Plan Also Removes Families’ Economic Protection

The GOP Medicaid reform bill moving through Congress would repeal federal standards that protect nursing-home patients from abuse, as well as economic safeguards that shield families from staggering nursing-home bills.

Republicans say their bill would require states to have their own nursing-home quality standards, under federal guidelines. As for the economic safeguards, Republicans are also directing states to establish their own protections.

But nursing-home watchdog groups, relatives of nursing-home residents, and academic researchers say GOP lawmakers are making a costly mistake by throwing out standards that took years to put in place, and are now paying off with measurable improvements in quality.

Advocates for the elderly also say there’s no guarantee that states will retain economic safeguards for the spouses and families of nursing-home residents, especially if state budgets get squeezed by rising health costs.

A 1988 federal law - now subject to repeal - allows nursing-home residents to qualify for Medicaid while their spouses keep the family home, certain assets, and a share of income. Before the law, stories of couples divorcing to avoid impoverishment were not unheard of.

Millions of families could be affected by the changes in nursing-home laws. There are now more than 1.5 million nursing-home residents, a figure that’s expected to grow in coming years. Medicaid pays the bills for about 70 percent of nursing-home patients, about $57 billion a year.

Republicans say the criticism is misguided.

“We’re not going back to the bad old world,” said a House GOP aide. “We’re just trying to get away from a highly prescriptive baloney system that’s costing states millions that could be spent on people instead.”

But quality of care continues to be a major concern.

“It does no good to be fiscally conservative and open the gate to hurting nursing-home residents,” said Kathy Gannoe, who works for the non-profit Nursing Home Ombudsman Agency in Lexington, Ky.

Gannoe said she believes state standards would not be as strict. “We wouldn’t have had federal standards if states had done their job,” she said.

Patient advocates say the nursing-home industry enjoys much stronger lobbying clout in state capitals than at the federal level.

xxxx LAWS THAT WOULD BE CANCELED Here’s a summary of federal nursing home standards approved in 1987 that congressional Republicans want to repeal. Under current law: Nursing homes are forbidden to physically restrain or sedate patients unless it is medically necessary. Nursing homes have to perform a comprehensive assessment of each resident, and develop a care plan aimed at maintaining or improving a patient’s ability to function. Nursing homes have to meet minimum staffing requirements, including having a licensed nurse on duty at all times. Nurses’ aides must undergo training. Residents have basic rights, including safety, dignity and due process. Nursing homes can be fined for violating rules. Enforcement of fines was scheduled to begin this fall.