[Congressional Record Volume 155, Number 48 (Thursday, March 19, 2009)]
[Senate]
[Pages S3553-S3556]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY (for himself and Mr. Kohl):
  S. 647. A bill to amend titles XVIII and XIX of the Social Security 
Act to improve the transparency of information on skilled nursing 
facilities and nursing facilities and to clarify and improve the 
targeting of the enforcement of requirements with respect to such 
facilities; to the Committee on Finance.
  Mr. KOHL. Mr. President, I rise today to introduce the Nursing Home 
Transparency and Improvement Act of 2009.
  My colleague, Senator Grassley, and I have worked on this legislation 
together. He is on the floor now and will speak of the bill when I 
finish my comments.
  As chairman of the Special Committee on Aging, the quality of care 
that is provided to nursing home residents is of great concern to me, 
and I am proud to introduce this bill with Senator Grassley today.
  I have worked with Senator Grassley on nursing home policy for 
several years. We have commissioned GAO reports, sought input from both 
industry and reform advocates, and collaborated with the executive 
branch on various initiatives. This work has generated some positive 
results, such as the government's new five-star nursing home rating 
system.
  But we must do more. We believe the bill we introduce today will 
raise the bar for nursing home quality and oversight nationwide, by 
strengthening the Federal Government's ability to monitor and advance 
the level of care provided in nursing domes. for up to five minutes.
  First, our bill would give the Government better tools for enforcing 
high quality standards. For instance, nursing homes would be required 
to disclose information about all the principal business partners who 
play a role in the financing and management of the facility, so that 
the Government can hold them accountable in the case of poor care or 
neglect. It would also create a national independent monitor pilot 
program to tackle tough quality and safety issues that must be 
addressed at the level of corporate management.
  Second, our bill would give consumers more information about 
individual nursing homes and their track record of care. Our bill would 
grant consumers access to a facility's most recent health and safety 
report online, and would develop a simple, standardized online 
complaint form for residents and their families to ensure that their 
concerns are addressed swiftly. And it would require the Government to 
collect staffing information from nursing homes on a real-time basis, 
and make this information available to the public.
  Finally, our bill would encourage homes to improve on their own. 
Under this legislation, facilities would develop compliance and ethics 
programs to decrease the risk of financial fraud, and quality assurance 
standards to internally monitor the quality of care provided to 
residents. We also authorize funds for a national demonstration project 
on ``culture change,'' a new management style in nursing home care that 
rethinks relationships between management and frontline workers by 
empowering nursing aides to take charge of the personalized care of

[[Page S3555]]

residents. Finally, our bill makes an investment in nursing home staff 
by offering training on how to handle residents with dementia.
  Twenty-two years have passed since Congress last addressed the safety 
and quality of America's nursing homes in a comprehensive way. As we 
prepare to debate reforms across our health care system, there has 
never been a better time to implement these critical improvements to 
our nation's system of nursing homes. We ask our colleagues for their 
support.
  Madam President, I turn now to Senator Grassley, with whom I worked 
diligently with a great effort and with tremendous results. He is a man 
I have enjoyed working with across the aisle now for many years. He is 
a high-quality guy. It is in that respect and with that regard that I 
turn to him now.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Madam President, I thank the Senator for his kind 
words. I have had an opportunity to work with him not only on 
legislation of this type but a lot of other pieces of legislation, and 
I enjoy working with him because he is a person of great common sense. 
I thank him for his leadership in this area, and, more importantly, I 
thank him for serving in the outstanding position as chairman of the 
Special Committee on Aging, with a lot of responsibilities in the area 
of making sure aging problems are brought to the forefront.
  This legislation we are introducing is called the Nursing Home 
Transparency and Improvement Act. It brings to the surface some very 
important issues he is watching as chairman of the Aging Committee. I 
have some interaction with it because I am a member of the Finance 
Committee.
  This is a critical piece of legislation that brings overdue 
transparency to consumers regarding nursing home quality and 
operations. It also provides long needed improvements to our 
enforcement system.
  In America today, there are well over 1.7 million elderly and 
disabled individuals in over 17,000 nursing home facilities. As the 
baby boom generation enters retirement, this number is going to rise 
dramatically. While many people are using alternatives, such as 
community-based care, nursing homes are going to remain a critical 
option for elderly and disabled populations.
  As the ranking member of the Senate Finance Committee, I have a 
longstanding commitment to ensuring that nursing home residents receive 
the safe and quality care we expect for our loved ones. Why? Because 
the taxpayers put in tens of billions of dollars--I would imagine over 
$47 billion or $48 billion now, and maybe that figure is higher than 
the last time I looked, but it is billions of dollars. Our Aging 
Committee and all of Congress have a special responsibility to make 
sure that money is spent well, and one way of spending it well is to 
make sure it delivers quality care to these people who are in need.
  Unfortunately, as in many areas, with nursing homes, a few bad apples 
often spoil the barrel. Too many Americans receive poor care, often in 
a subset of nursing homes. Unfortunately, this subset of chronic 
offenders stays in business, often keeping their poor track records 
hidden from the public at large and often facing little or no oversight 
or enforcement from the Federal Government, based on laws that were 
passed in 1986 and 1987.
  There is a lack of transparency, a lack of accountability, and 
sometimes in our approach to nursing homes, quite simply, a lack of 
common sense--the sort of common sense the Senator from Wisconsin 
always exhibits in the legislative approach. These are things this 
legislation seeks to bring to nursing homes and their residents--
transparency, accountability, and common sense.
  Let's look at transparency. In the market for nursing home care, as 
in all markets, consumers must often have adequate information to make 
informed choices. For years, people looking at a nursing home for 
themselves or their loved ones had no way of knowing a nursing home 
facility's record of care, inspection history, or which individuals 
were ultimately responsible for caring for their loved ones.
  This bill is intended to change that and to emphasize this point 
about why we have to be concerned about the type of facility in which a 
person is placed.
  I have never once in my life run into a single elderly or disabled 
person who said to me: I am dying to get into a nursing home. This is 
on the continuum care, the stop where people cannot be taken care of 
beforehand. We need to make sure that is right.
  This legislation requires nursing facilities to make available 
ownership information, including the individuals and entities that are 
ultimately responsible for a home's operation and management.
  Today when I am discussing this bill with people in the industry, I 
don't have anybody objecting who actually owns a nursing home. But 
early on, that seemed to be something that, for some reason or another, 
did not seem to be anybody's business. Tell me it isn't anybody's 
business who owns a nursing home if they are receiving $45 billion to 
$50 billion of taxpayer money going to that industry. That ownership is 
very important.
  How nursing homes are staffed can greatly affect the care they 
provide, especially when dealing with complex conditions, such as 
nursing homes. So you go behind who owns a nursing home, who is working 
there, and that is pretty important. If you do not have all this 
information, it leaves residents and their families without clear 
information about who is ultimately responsible for ensuring that a 
resident is consistently provided with high-quality care.
  This provides transparency, as well, concerning nursing home staffing 
and surveys. Homes differ widely in terms of the number of specialized 
staff available to residents, as well as the number of registered 
nurses and certified nursing assistants who provide much hands-on care.
  Let me say it a second time. How a nursing home is staffed can 
greatly affect the care it provides, especially when dealing with 
complex cases. This legislation requires better tracking of this 
information and requires that this information is available to 
prospective residents and their families.
  In addition, this legislation will help families have a better idea 
of a nursing home's track record in that it requires better 
transparency for nursing home inspection reports that are completed on 
a routine basis.
  The Secretary will also now be required to provide consumers with a 
summary of information on enforcement actions taken against a facility 
during the previous 3 years.
  This same transparency will also provide additional market incentives 
for poor homes to improve. If customers know about problems, that home 
is incentivized to improve or face going out of business.
  This effort also requires a strong, effective enforcement and 
monitoring system to ensure safe and quality care at facilities that 
will not take the necessary steps voluntarily. But even with improved 
transparency, there are some nursing homes that will not improve on 
their own.
  In the nursing home industry, most homes provide quality care on a 
very consistent basis. So we need to give inspectors better enforcement 
tools.
  The current system provides incentives to correct problems only 
temporarily and allows homes to avoid regulatory sanctions while 
continuing to deliver substandard care to residents. This system must 
be fixed.
  Last year, CMS requested two things: one, statutory authority to 
collect civil monetary penalties sooner, and, two, the ability to hold 
those penalties in escrow pending appeal.
  To that end, this bill requires nursing homes that have been found in 
violation of law be given the opportunity to participate in an 
independent, informal dispute resolution process within 30 days. After 
that point, depending on the outcome of the appeal, the penalties are 
collected and held in escrow pending the exhaustion of the appeals 
process. This will ensure that nursing homes found to be violating the 
rules actually pay the penalties assessed if it is determined those 
penalties are appropriate. But we should not have to resort to 
enforcement. Problems resulting in penalties should be avoided or 
detected and fixed immediately by the nursing home in the first place. 
That is why this bill now requires all nursing homes to have compliance 
and ethics programs, as well as quality assurance and performance 
improvement programs.

[[Page S3556]]

  In addition to increased transparency and improved enforcement, this 
bill provides commonsense solutions to a number of other problems.
  This legislation requires the Secretary of HHS to establish a 
national independent monitoring program to tackle problems specific to 
interstate and large intrastate nursing chains.
  In the case of nursing homes being closed due to poor safety or 
quality of care, this bill requires that residents and their 
representatives be given sufficient notice so they can adequately plan 
a transfer to an appropriate setting.
  We need to be very sensitive--and I am very sensitive--to the fact 
that nursing home residents are often elderly and fragile. Moving them 
into a new facility is traumatic. So we have to make sure these 
residents are transferred appropriately and with adequate time and 
care.
  This bill also aims to help nursing homes that self-report their 
concerns and remedy certain deficiencies, giving those homes that are 
trying to do their best and find things wrong on their own to get 
credit for that. By doing so, nursing homes then may have any penalties 
reduced by 50 percent. This will encourage facilities to take the lead 
in finding, flagging, and fixing violations.
  This bill is also intended to strengthen training requirements for 
nursing staff by including dementia and abuse prevention training as 
part of pre-employment.
  I am proud to introduce this bill along with my friend Senator Kohl. 
The Committee on Aging and I have a long history of working together on 
elderly care issues, and I am happy to continue that work.
  I also note today the Government Accountability Office is releasing a 
report critical of CMS's funding of State oversight entities, such as 
nursing homes. This report notes that survey activity is sometimes so 
unreliable that certain homes have not even been inspected in more than 
6 years. The report makes a number of recommendations to CMS, and I 
will be looking very carefully at how CMS follows those 
recommendations. In the meantime, it is important that we improve 
transparency and accountability for the inspections that are taking 
place.
  We will continue to do everything we can to make sure that American 
nursing home residents receive the safe and quality care they deserve. 
Increasing transparency, improving enforcement tools, strengthening 
training requirements will go a long way toward achieving that goal. I 
thank, once again, Senator Kohl.
                                 ______