[Congressional Record Volume 144, Number 139 (Wednesday, October 7, 1998)]
[Senate]
[Pages S11707-S11708]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KOHL (for himself, Mr. Reid, and Mrs. Feinstein):
  S. 2570. A bill entitled the ``Long-Term Care Patient Protection Act 
of 1998''; to the Committee on Finance.


             long-term care patient protection act of 1998

  Mr. KOHL. Mr. President, I rise today to introduce the Long-Term Care 
Patient Protection Act of 1998, along with Senators Reid and Feinstein. 
I am pleased to introduce this legislation on behalf of the 
Administration.
  Recently, the Department of Health & Human Services Office of 
Inspector General issued a report describing how easy it is for people 
with abusive and criminal backgrounds to find work in nursing homes. On 
September 14th, the Senate Aging Committee held hearings on this 
disturbing problem, where we heard horrifying stories of elderly 
patients being abused by the very people who are charged with their 
care. While the vast majority of nursing home workers are dedicated and 
professional, even one instance of abuse is inexcusable. This should 
not be happening in a single nursing home in America.
  Senator Reid and I have already introduced legislation, the Patient 
Abuse Prevention Act, to require background checks for health care 
workers. Those with prior abusive and criminal backgrounds would be 
prohibited from working in patient care. I am pleased that the 
Administration has also recognized the importance of addressing this 
problem, and I have been glad to work with them in this effort. While 
the bill we introduce today on the Administration's behalf is not 
perfect, I believe it is another important step in our efforts to pass 
strong patient protections.
  Mr. President, it is estimated that more than 43 percent of Americans 
over the age of 65 will likely spend time in a nursing home. The number 
of people needing long-term care services will continue to increase as 
the Baby Boom generation ages. The vast majority of nursing homes do an 
excellent job in caring for their patients, but it only takes a few 
abusive staff to cast a dark shadow over what should be a healing 
environment.
  A disturbing number of cases have been reported where workers with 
criminal backgrounds have been cleared to work in direct patient care, 
and have subsequently abused patients in their care. Just last year, 
the Milwaukee Journal-Sentinel ran a series of articles describing this 
problem. This past March, The Wall Street Journal published an article 
describing the difficulties we face in tracking known abusers.
  These news stories are only the tip of the iceberg. Unfortunately, it 
is just far too easy for a worker with a history of abuse to find 
employment and prey on the most vulnerable patients. The OIG report 
found that 5 percent of nursing home employees in Maryland and Illinois 
had prior criminal records. And it also found that between 15-20 
percent of those convicted of patient abuse had prior criminal records. 
It is just too easy for known abusers to find work in health care and 
continue to prey on patients.
  Why is this the case? Because current state and national safeguards 
are inadequate to screen out abusive workers. All States are required 
to maintain registries of abusive nurse aides. But nurse aides are not 
the only workers involved in abuse, and other workers are not tracked 
at all. Even worse, there is no system to coordinate information about 
abusive nurse aides between States. A known abuser in Iowa would have 
little trouble moving to Wisconsin and continuing to work with patients 
there.
  In addition, there is no Federal requirement that nursing homes 
conduct a criminal background check on prospective employees. People 
with violent criminal backgrounds--people who have already been found 
guilty of murder, rape, and assault--could easily get a job in a 
nursing home or other health care setting without their past ever being 
discovered.
  The Administration's bill that we introduce today builds upon the 
extensive work that Senator Reid and I have done to address this issue, 
and incorporates some new ideas as well.
  First, this legislation will create a National Registry of abusive 
nursing home employees. States will be required to submit information 
from their current State registries to the National Registry. Nursing 
homes will be required to check the National Registry before hiring a 
prospective worker. Any worker with a substantiated finding of abuse 
will be prohibited from working in nursing homes.
  Second, the bill provides a second line of defense to prevent people 
with criminal backgrounds from working in nursing homes. If the 
National Registry does not include information about the prospective 
worker, the nursing home is then required to contact the state to 
initiate an FBI background check. Any conviction for patient abuse or a 
relevant violent crime would bar that applicant from working in nursing 
homes.
  Let me be clear: I realize that this legislation is not perfect. I 
have significant concerns about several unresolved issues that I 
believe must be addressed. We must continue to work on minimizing costs 
and determine a fair and reasonable way to distribute those costs. We 
must ensure that the system is efficient and effective, with a quick 
turnaround time and accurate information for providers. And I believe 
that we must apply these requirements to other health care settings 
besides nursing homes. It would do little good to ban these people from 
working in nursing homes, and still permit them to work in home health 
care.
  Senator Reid and I have worked for a long time with patient 
advocates, the nursing home and home health industries, and law 
enforcement officials to address these issues. I have been very 
heartened by their enthusiasm and willingness to work with us in this 
effort. It is in all of our best interests to pass legislation that is 
strong, workable, and enforceable.

[[Page S11708]]

  Despite the unresolved issues I have mentioned, I am introducing the 
Administration's legislation today because I believe it will provide a 
strong incentive for everyone to stay at the table and resolve these 
issues. All of us--the President, Congress, health care professionals 
and consumer advocates--we all share the common goal of protecting 
patients from abuse, neglect and maltreatment. We must keep working 
together to create a viable national system that will prevent abusive 
workers from working with patients.
  Although the remaining days of this Congress are few, we all need to 
come together once again to reach consensus on the remaining issues and 
prepare to move this process forward. This legislation gives us an 
opportunity to act now. I look forward to continuing our work on this 
issue, and I welcome comments and suggestions for improving the bill.
  Mr. President, I want to repeat that I strongly believe that most 
nursing homes and their staff provide the highest quality care. 
However, it is imperative that Congress act immediately to get rid of 
the few that don't. When a patient checks into a nursing home, they 
should not have to give up their right to be free from abuse, neglect, 
or mistreatment. They should not have to worry about dying from 
malnutrition and dehydration.
  Our nation's seniors made our country what it is today. Before we 
cross that bridge to the next century that we have all heard so much 
about, we must make sure we treat the people that brought us this far 
with the dignity, care, and respect they deserve. I look forward to 
working with my colleagues and the administration in this effort to 
protect patients. Our Nation's seniors and disabled deserve nothing 
less than our full attention to this matter.
  Mr. President, I ask that the text of the bill be printed in the 
Record.
  [The bill was not available for printing. It will appear in a future 
issue of the Record.]
  Mr. REID. Mr. President, I rise today to join my colleague, Senator 
Kohl, in introducing the ``Long Term Care Patient Protection Act of 
1998''. This legislation represents our latest step in a series of 
efforts to institute greater protections for nursing home residents.
  Over the past year, Senator Kohl and I, along with our colleagues on 
the Senate Special Committee on Aging, have worked to ensure that 
seniors are not placed in the hands of criminals in nursing homes. The 
disturbing problem of nursing home abuse by workers with a violent or 
criminal history was brought to our attention just over a year ago. 
Shortly thereafter, Senator Kohl, Grassley, and I introduced S. 1122, 
``The Patient Abuse Prevention Act.'' This measure would require 
criminal background checks for potential long-term care facility 
workers and would create a national registry of abusive health care 
workers.
  This past July, Senator Kohl and I sponsored an amendment that would 
authorize nursing homes and home health agencies to use the FBI 
criminal background check system. This amendment is an important step 
towards our goal of mandatory background checks, and I am proud to 
report that this language was included in the Commerce, Justice, State 
Appropriations Bill.
  Upon our request, the Senate Special Committee and Aging dedicated a 
hearing to the issue of criminal background checks for long-term care 
workers. At this time, the Office of the Inspector General (OIG) at the 
Department of Health and Human Services released a report entitling, 
``Safeguarding Long Term Care Residents''. The year-long investigation 
by the OIG spanning facilities across the country produced the very 
recommendations Senator Kohl and I have been advocating for over a 
year. Specifically, the OIG concurred with our proposal to develop 
criminal background checks, and to create a national registry for 
nursing facility employees. Their findings were consistent with our 
position that a criminal background check system could help weed out 
potential employees with a history of abuse and prevent them from 
working with patients.
  Recently, President Clinton acknowledged the need for tough 
legislative and administrative actions to improve the quality of 
nursing homes. Using our original legislation as a guide, the 
Administration drafted a proposal to address the crucial issue of 
criminal background checks for nursing home workers. I am pleased that 
the Administration has recognized the need for criminal background 
checks and has modeled its initiative after our legislation. I am 
introducing the ``Long-Term Care Patient Protection Act of 1998'' on 
behalf of the Administration because it builds on our extensive work in 
this area and represents an important step in the right direction.
  The ``Long-Term Care Patient Protection Act of 1998'' would create a 
national registry of abusive workers. Further, the bill would expand 
the existing State nurse aide registries to include substantiated 
findings of abuse by all nursing facility employees, not just nurse 
aides. States would be required to submit any existing or newly 
acquired information contained in the State registries to the national 
registry of abusive workers. This provision is crucial because it would 
ensure that once an employee is added to the national registry, the 
offender will not be able to simply cross state lines and find 
employment in another nursing home where he may continue to prey on 
vulnerable seniors.
  Another important portion of the bill outlines the process by which 
nursing homes must screen prospective employees. According to this 
legislation, all nursing homes must first initiate a search of the 
national registry of abusive workers. In cases where the prospective 
employee is not listed on the registry, the nursing home would be 
required to conduct a State and national criminal background check on 
the individual through the Federal Bureau of Investigations.
  Finally, nursing homes would be required to report to the State any 
instance in which the facility determines that an employee has 
committee an act of resident neglect, abuse, or theft of a resident's 
property during the course of employment. The OIG at the Department of 
Health and Human Services reported that 46 percent of facilities 
believe that incidents of abuse are under-reported. This provision 
would ensure that offenders are reported and added to the national 
registry before they have the opportunity to strike again.
  One of the most difficult times for any individual or family is when 
they must make the decision to rely upon the support and services of a 
long-term care facility. Families should not have to live with the fear 
that their loved one is being left in the hands of an individual with a 
criminal record. No one should have to endure the pain and outrage of 
learning that their loved one has fallen prey to a nursing home 
employee with a violent or criminal record. At last month's Aging 
Committee hearing, we heard the real life nightmare of Richard Meyer, 
whose 92 year-old mother was sexually assaulted by a male certified 
nursing assistant who had previously been charged and convicted for 
sexually assaulting a young girl. We can and we must work to prevent 
tragedies like this one from occurring again in the future.
  Americans over the age of 85 are the fastest growing segment of our 
elderly population. There are 31.6 million Americans over the age of 
sixty-five, and as the baby boom generation ages, that number will 
skyrocket. Over 43 percent of Americans will likely spend time in a 
nursing home. As our nation seeks ways to care for an aging population, 
we must establish greater protections to ensure that our seniors will 
receive the best care possible.
  I have visited countless nursing homes in my home state of Nevada. 
During these visits, I have always been impressed by the compassion and 
dedication of the staff. Most nurse aides and health care workers are 
professional, honest, and dedicated. Unfortunately, it only takes one 
abusive staff member to terrorize the lives of the residents. That is 
why we must work to wed our the ``bad apples'' who do not have the best 
interest of the patient in mind. I urge you join Senator Kohl and me in 
our efforts to provide greater protections for all nursing home 
residents.
                                 ______