[Congressional Record Volume 145, Number 118 (Monday, September 13, 1999)]
[Senate]
[Pages S10745-S10746]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         NURSING HOME INDUSTRY

  Mr. GRASSLEY. Mr. President, I chair the Committee on Aging. We

[[Page S10746]]

have been holding some hearings about the nursing home industry over 
the last several months. I would like to make a comment.
  First of all, I would like to speak about credibility. It is similar 
to an old maple tree. It takes years to develop, but a big storm can 
wipe it out just like that. I have a story that makes the point.
  The nursing home industry challenged the credibility of nursing home 
inspectors. The nursing home industry, after this challenge, lost.
  When I refer to the nursing home industry, I mean the American Health 
Care Association. This group represents the for-profit nursing homes. 
It has thousands of members across the country.
  Nursing home inspectors operate in every State. They inspect every 
nursing home that accepts Federal money. The inspectors gauge whether 
nursing homes follow the Federal laws that were passed to protect 
nursing home residents. They evaluate everything from the most severe 
problems to the most minor problems. The most severe problems include 
malnutrition, dehydration, bedsores, inadequate medical treatment--
matters that can be life-threatening. The most minor problems might 
include things such as comfortable lighting and access to stationery.
  At my request, the General Accounting Office has issued a series of 
reports documenting severe problems in too many nursing homes, thus 
pointing up the shortcomings of the inspection.
  On March 18, when I released one of these reports, the American 
Health Care Association issued a critical news release. The association 
said:

       Inspectors have closed down facilities, without consulting 
     residents and their families, for technical violations posing 
     no jeopardy to residents.

  The association also said:

       Unfortunately, the current Federal inspection system has 
     all the trademarks of a bureaucratic government program out 
     of control.

  These, of course, were very serious charges made by the association 
of nursing homes, and I took those charges very seriously. The Federal 
inspection system is responsible for the welfare of 1.6 million nursing 
home residents. If that system fails, these frail individuals will bear 
the brunt. That is something that should concern every one of us in the 
Senate.
  Following up, I asked the American Health Care Association for proof 
of its claims issued in that news release critical of what the General 
Accounting Office had to say at my behest to study the issue. On May 6, 
I received an information packet from the American Health Care 
Association describing 10 examples that the association saw as proof of 
overzealous regulations. I turned this information over to the General 
Accounting Office and asked for its analysis.
  The GAO did not find evidence of overzealous regulation. In fact, the 
General Accounting Office found just the opposite. There was adequate 
information for an objective assessment for 8 of the 10 industry 
examples. In each of those 8 cases, the General Accounting Office found 
that regulators acted appropriately.
  I am not going to go through all eight examples, but I will use 
three. I think they show that there is a big difference in what the 
industry presented and what the General Accounting Office found; in 
other words, the industry's accusations that the inspection system was 
a bureaucratic thing out of control and that it was based upon just 
technicalities was wrong.
  Example No. 1: The industry complained that a Michigan nursing home 
was severely punished for providing complimentary coffee to family 
members, staff, and residents. The General Accounting Office said that 
the nursing home inspectors saw two vulnerable residents pulling at the 
spigot of the hot coffee urn. The inspectors believed that the 
residents were in immediate danger of suffering serious burns from the 
coffee. Of course, with this, the General Accounting Office agreed.
  Example No. 2: The industry complained that a California nursing home 
was cited for bed sores on a resident's foot that predated his 
admission, and in fact the bed sores were healing. The General 
Accounting Office said the inspector found conditions that actually had 
worsened the bed sores. The resident was wearing leather shoes when in 
a wheelchair. His feet were not elevated when in bed. His bedsore 
dressings were changed without proper techniques to prevent infection. 
There again, the example given by the nursing home association was 
wrong.
  Example No. 3: The industry claimed that an Alabama nursing home was 
cited for a bald kitchen worker who failed to wear a hair net. The GAO 
reported that the industry did not identify the nursing home involved 
nor provide any documentation; therefore, the General Accounting Office 
could not assess what had happened.
  I could go on in more detail from the General Accounting Office 
report. I have that report here, and I would like to point out to my 
colleagues that they should look at it, read it. Hopefully, everyone is 
interested and they will do so. It tells a valuable cautionary tale. 
Members of Congress, as I felt a responsibility to do, should always 
seek out both sides of every story. Industry associations work hard to 
seek our agreement with their side and, of course, in our system of 
government, and whether individual, or an association of individuals, 
that is their right. But it is our obligation as representatives of the 
people to weigh every issue with all the facts at hand. It is equally 
our obligation to consider the credibility of every source.
  I yield the floor and reserve the remainder of time for Senator 
Thomas.
  Mr. THOMAS. I thank the Senator. Certainly, he has been the leader in 
rural health care, which is very important to my State, as it is for 
the State of the Presiding Officer.
  I am pleased to have the Senator from Maine, Ms. Collins, join us 
this morning for some comments on our future activities. I yield 15 
minutes to the Senator from Maine.
  The PRESIDING OFFICER. The distinguished Senator from Maine is 
recognized.
  Ms. COLLINS. Mr. President, I want also to join in the Senator's 
praise of Senator Grassley for his leadership on many of the issues 
affecting senior citizens and rural health care in America.

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