[Congressional Record Volume 148, Number 137 (Thursday, October 17, 2002)]
[Senate]
[Pages S10606-S10608]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             NURSING HOMES

  Mr. BOND. Mr. President, I rise today to comment on a series of 
articles running this week in the St. Louis Post-Dispatch. The series 
began last Sunday with the headline ``Nation's Nursing Homes are 
Quietly Killing Thousands'' and anyone with a conscience should pause 
to consider its opening sentences:

       Thousands of America's elderly mothers, fathers and 
     grandparents are being killed each year in the nation's 
     homes--frail victims of premature and preventable deaths. 
     This quiet pandemic is rarely detected by government 
     inspectors, investigated by law enforcement, appraised by 
     medical examiners or prosecuted by anyone. These deaths are 
     not at the hands of crazed ``angels of death.'' Most are 
     caused by fatal neglect traced to caregivers upon whom 
     residents depend for food and liquid and for turning them in 
     their beds to prevent the formation of life-threatening 
     sores. . . .

  In short, elderly nursing home residents are dying in our country 
today due to failures to provide the most basic and fundamental 
elements of care. The Post-Dispatch reports statistics from the 
National Center on Health Statistics, which show that starvation, 
dehydration or bedsores were the cause of death for 4,138 nursing home 
residents in 1999, including 138 such deaths in Missouri.
  However, these appalling statistics may only be the tip of the 
iceberg. The Post-Dispatch reported that investigators and researchers, 
who have taken the time to take a closer look and compare patient 
medical records with their death certificates, conclude that the number 
of preventable deaths due to malnutrition, dehydration and bedsores is 
most likely considerably higher. Our colleague, Senator Breaux, 
believes that the number of avoidable deaths could number in the tens 
of thousands and research shows that anywhere between 500,000 to 5 
million cases of abuse and neglect of our elders occur each year.
  Personally, I know that Missouri has a terrible problem with some bad 
apple nursing homes. I know this because plenty of good folks back home 
have told me about their own horrific experiences with abuse and 
neglect of their loved ones. Furthermore, the General Accounting Office 
in recent years has amply documented decades of death and neglect due 
to the poor quality of care in too many of our Nation's nursing homes. 
In 1999, the GAO estimated that residents of one in four nursing homes 
in Missouri suffered actual harm from the care they received. Hearing 
these staggering stories and statistical figures was a wake-up call. I 
submit to my colleagues that no one here today can say ``not in my 
backyard''--abuse, neglect and homicide in nursing homes in truly a 
national problem.
  In my opinion, neglecting an elderly, fragile individual is no 
different than neglecting a child. Both are defenseless, both lack a 
vibrant voice, both are vulnerable and both suffer at the hands of 
those who are nothing more than cowards and criminals. Abuse of the 
elderly should be treated no differently than abuse of children.
  Many of us on the floor today have taken strong stances with regard 
to corporate accountability. However, sending corporate titans up the 
river for cooking the books while excusing nursing home operators and 
others with fines and a slap on the wrist just doesn't square with me. 
Surely the lives of innocent folks who are not just suffering, but 
dying due to neglect

[[Page S10607]]

should be just as precious under the law as anybody's pension fund. We 
need to send a crystal clear message that these individuals are 
criminals who should be wearing orange jump-suits instead of pin-
stripes. A criminal is a criminal and, unfortunately, the ``criminal'' 
actions of some nursing home operators have tarnished the reputations 
of nursing homes generally and unfairly.
  There is much that we need to accomplish to improve the plight of 
those elderly men and women who reside in nursing homes. The 
unnecessary human toll directly related to the failures in the nursing 
home industry is nothing short of shameful. There will be no miracle 
fix to this problem and there is no one obstacle to overcome that will 
improve the situation. First and foremost, we need to recognize that a 
revolution is really the only alternative. The powers that be in this 
area, namely the Department of Health and Human Services and the 
Centers for Medicare and Medicaid, as well as the corporate honchos in 
the nursing home industry need to recognize and acknowledge the need 
for revolutionary change. We as legislators need to summon the will and 
courage to spur that revolution.
  Last month, I became an original co-sponsor of the Elder Justice Act 
of 2002. This bill is the first comprehensive federal effort to address 
the issue of elder abuse. It is an attempt to combine law enforcement 
and public health to study, detect, treat, prosecute and prevent elder 
abuse, neglect and exploitation. It is a successful approach that has 
been applied to combat child abuse and violence against women. This 
bill creates Federal leadership and resources to assist families, 
communities and states in the fight against elder abuse; coordinates 
Federal, State and local elder abuse prevention efforts; establishes 
new programs to assist victims; provides grants for education and 
training of law enforcement; and facilitates criminal background checks 
for elder care employees.
  The tragic toll of nursing home deaths in Missouri is so compelling, 
that I have also sought new ways to approach this seemingly intractable 
problem. I met with HHS Secretary Tommy Thompson this past summer and 
discussed with him new bedside technology that can easily and 
accurately record individual information about nursing home residents 
and the care they receive. We discussed the success of a program in 
Missouri called QIPMO--Quality Improvement Program for Missouri, a 
patient care monitoring system that provides reports on the quality of 
care delivered by all Missouri nursing homes. This award-winning 
program is a cooperative project between the Sinclair School of Nursing 
and the Missouri Department of Health and Senior Services. I urged 
Secretary Thompson to consider adapting QIPMO's free on-site clinical 
consultation and technical assistance as an integral piece of a new 
federal technology demonstration and evaluation program. If enhanced 
with cutting-edge technology, I believe QIPMO may be a viable platform 
to help HHS lead nursing homes and state regulators to greatly improve 
on-site monitoring and clinical care. We urgently need a technogical 
revolution in nursing home care that can save lives and spare our 
elders of unnecessary suffering. A groundbreaking technology 
demonstration and evaluation program has the potential to erect an 
early warning system to alert care-givers to life-threatening problems 
before they become widespread or have tragic consequences. I thank 
Secretary Thompson for working with me and for offering his 
enthusiastic support and commitment to ensure that the demonstration 
and evaluation program happens.
  I think all of us realize that at some point in our lives we may have 
to take a parent, grandparent, or elderly relative, or even a good 
friend to a nursing home. Some of us may wind up there ourselves. We 
know from experience that there are a lot of good nursing homes and 
there are a lot of homes in Missouri where we are very proud of the 
care the people receive. On the other hand, there are a few tragically 
bad apples that need to be picked out so when you take a family member, 
a loved one to a nursing home, you don't have to be worried that person 
will die of starvation or dehydration or bed sores. What a horrible way 
to go.
  The article points out the need for additional staffing. Many nursing 
homes are short staffed. That is a problem that needs to be confronted. 
In some instances, when they have the Medicaid reimbursements, they are 
not adequate. If the money is not getting there--if it is going to care 
but there is not enough of it, that is one thing. There are other 
abuses that have been pointed out in these articles, where too much 
money that should go to care of patients is being siphoned off to 
family members who run other businesses on the side.
  This is an area where continued vigilance, first from State 
enforcement agencies, and then the Department of Health and Human 
Services, is warranted. When one reads the stories and the record of 
the tragedy that has occurred, and it has been documented in this 
series, I believe all my colleagues are going to want to do something 
to assure that we separate the good nursing homes from the bad; and 
properly punish and chastise and charge those who are bad apples.
  I ask unanimous consent additional material to which I referred be 
printed in the Record.
  There being no objection, the additional material was ordered to be 
printed in the Record, as follows:

           [From the St. Louis Post-Dispatch, Oct. 17, 2002]

Special Report: Neglected to Death--Preventable Deaths in Nursing Homes

       Nursing home patients are dying from causes like 
     malnutrition, dehydration and bedsores--causes that could be 
     prevented with proper care. But such cases are rarely 
     investigated or prosecuted, and advocates say the suffering 
     won't end without an outcry for reform.


         congress renews an old battle for nursing home reform

       The senior member of Congress wrapped his gnarled hands 
     around the microphone sitting on the green felt-covered 
     witness table and asked his distinguished colleagues: ``What 
     have the elderly in this country done to make their 
     government and their neighbors so willing to have them 
     staved, neglected and uncared for?''

               Day 1--Nursing homes are killing thousands

       Nation's Nursing Home Are Quietly Killing Thousands (10/12/
     2002)--Patients are dying of causes that are preventable with 
     proper care--and such cases are rarely investigated or 
     prosecuted. Advocates say the suffering won't end without an 
     outcry for reform.
       Survivors of Lost Loved Ones Tell Stories of Broken Trust 
     (10/12/2002)--They are victims of poor care in nursing homes, 
     a cross section cut from the fabric of America--mothers and 
     fathers, war heroes and homemakers, black and white.

         Day 2--Inadequate staffing results in patient neglect

       Woefully Inadequate Staffing Is at the Root of Patient 
     Neglect. (10/14/2002)--Nursing homes don't have enough people 
     to provide even basic care, and the job often falls to low-
     paid, low-skilled workers. And when quality employees do come 
     along, they often don't stick around.
       Inadequate Medicaid Payments Squeeze Homes' Level of Care 
     (10/14/2002)--Some tie low staffing to drive for profits; 
     reimbursements fall short, industry counters.
       Operator Has Toiled To Rescue Troubled Home in University 
     City (10/14/2002)--The State called on Sharo Shirshekan to 
     save the newly named U-City Forest Manor. His orders were to 
     bring the homes' budget under control and correct chronic 
     care problems. At one point facing closure, he persuaded the 
     state to give him a chance--and now he has given the home 
     just that.

              Day 3--Neglect can continue even after death

       Many Nursing Home Patients Are Neglected Even After Death 
     (10/14/2002)--Police and prosecutors are reluctant to pursue 
     criminal cases, partly because they are difficult to prove. 
     And with little involvement from medical examiners, most 
     misdeeds are buried with the dead.
       Fraud Units Employ the Element of Surprise in Protecting 
     Elderly (10/14/2002)--Throughout the country, small groups of 
     federal and state investigators are protecting the vulnerable 
     elderly from wrongful deaths in nursing homes by using 
     midnight raids and a Civil War-era law.
       Army of Advocates Keeps Up the Pressure for Reform (10/14/
     2002)--Violette King is buzzing around her home office in 
     Godfrey searching through photos and cluttered files 
     detailing nursing home abuse when a ringing telephone 
     interrupts.

         Day 4--Regulators are losing the fight against neglect

       Ombudsmen often feel powerless in efforts to blow the 
     whistle (10/15/2002)--In 1972, Congress passed a law that 
     legislators believed would help end deadly care in America's 
     nursing homes. It mandated that each state set up an 
     ombudsman program to identify and investigate complaints in 
     hopes of preventing the neglect and abuse that were harming 
     the elderly in the facilities paid to care for them.
       Regulators Are Losing War Against Neglect, If They're 
     fighting at All (10/15/2002)--

[[Page S10608]]

     Missouri officials acknowledge failings in their ability to 
     protect residents. Their counterparts in Illinois see no 
     significant problems despite complaints from inspectors.

          Day 5--Legislative efforts try to make things better

       Inadequate Laws Are Blamed for Lack of Prosecution in 4 
     Heat-Related Deaths (10/16/2002)--When four elderly women 
     baked to death from soaring temperatures in a University City 
     Nursing home in April last year, public officials expressed 
     outrage and vowed to take swift action against those 
     responsible.
       Nursing Home Industry Wields Clout in State Capitals (10/
     16/2002)--More than 40 percent of the nearly $2.6 million the 
     nursing home industry contributed nationwide in state 
     elections in 2000 flowed into Missouri and Illinois.
  Mr. BOND. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The senior assistant bill clerk proceeded to call the roll.
  Mr. ALLEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded and that I be allowed to speak for as much 
time as I may consume.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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