[Congressional Record (Bound Edition), Volume 145 (1999), Part 4]
[Senate]
[Page 5158]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            HCFA'S A NO-SHOW

  Mr. GRASSLEY. Mr. President, yesterday the Special Committee on 
Aging, which I chair, held a hearing on the government's oversight role 
in ensuring quality care in our Nation's nursing homes. The committee 
has been investigating systemic flaws in nursing home care for two 
years. A series of reports by the General Accounting Office and the HHS 
inspector general have now shown this to be a national problem.
  The Aging Committee investigates in a bi-partisan manner. The rules 
of the committee require it. The committee's ranking member, Senator 
Breaux, has very ably assisted the committee's work. His insightfulness 
and interest in issues affecting the elderly population has brought 
greater credibility to our work.
  At yesterday's hearing, we learned much about the breakdown in the 
complaints process. In other words, when someone makes a formal 
complaint about the treatment of a loved-one in a nursing home. The 
various states operate the process. But the federal government has the 
ultimate responsibility to oversee it to make sure complaints are being 
addressed.
  Yesterday we heard from two citizen witnesses who experienced 
firsthand a broken-down complaints process. Their stories were tragic, 
yet real. The committee, the government, and the public learned much 
from their testimony.
  We also heard from the GAO and from the HHS IG.
  The committee did not hear from the Health Care Financing 
Administration, or HCFA. HCFA is the federal agency charged by law to 
protect nursing home residents. HCFA must ensure that the enforcement 
of federal care requirements for nursing homes protects the health, 
safety, welfare, and rights of nursing home residents. Yet, HCFA was a 
no-show.
  There is a very specific reason for yesterday's hearing, and this 
series of hearings. It's because the health, safety, welfare, and 
rights of nursing home residents are at great risk. Yet, the agency 
responsible was not here.
  The committee invited the two private citizens in the public 
interest. Through their eyes, we saw a complaint process turned upside-
down. It's a process that has put some nursing home residents at risk. 
Their testimony could help correct the process so others don't have to 
suffer the same wrongful treatment.
  The reason HCFA wasn't here is puzzling, given the committee's focus 
on listening to citizen complaints. HCFA is an agency within the 
Department of Health and Human Services--HHS. HHS determined that HCFA 
should not show up because HHS witnesses do not follow citizen 
witnesses. That's their so-called policy.
  In other words, HCFA--the organization that is supposed to serve our 
elderly citizens by protecting the health, safety, welfare, and rights 
of nursing home residents--was not here because its protocol prevents 
them from testifying after citizen witnesses.
  Last Friday, when discussing this matter with HHS officials, my staff 
was told the following: ``Our policy is that we testify before citizen 
witnesses.''
  Now, I have four comments on this. First, how serious is the 
Department about the problems we're uncovering in nursing homes when a 
protocol issue is more important than listening to how their complaints 
process might be flawed?
  Second, I have conducted hearings, in which citizen witnesses go 
first, since 1983. Other committees have done the same. I don't recall 
any department at any hearing I conducted since 1983 that became a no-
show, even when private citizens testified first. Especially for an 
issue as important as this.
  Third, the Department may be trying to convince the public it cares. 
But this no-show doesn't help that cause. The public might confuse this 
with arrogance.
  Finally, this situation yesterday could not possibly have illustrated 
better the main point of the hearing; namely, that citizens' complaints 
are falling on deaf ears. These witnesses traveled many miles 
yesterday. They were hoping that government officials--the very 
officials responsible--would hear their plea. Instead, what did they 
get? A bureaucratic response. Their agency-protectors were no-shows 
because of a protocol. Because of arrogance, perhaps.
  So, we'll move forward with yesterday's testimony, learning how the 
nursing home complaint system is in shambles. And the agency 
responsible for fixing it wasn't here to listen. Of course, they can 
read about it once it's in writing--a process they are comfortable 
with.
  Since I have been in the Congress, I have never taken partisan shots 
at an administration. I believe only in accountability. My heaviest 
shots were against administrations of my own party. The record reflects 
that very clearly.
  The easy thing to do would be to take partisan pot shots over this. 
It's much harder to redouble our efforts, in a bipartisan way on the 
committee--which I intend to do--until HHS and HCFA get the message. 
When will HHS and HCFA hear what's going on out there in our nation's 
nursing homes? Perhaps when they learn to listen to the citizens we--
all of us in government--serve. Until they get the message, these 
problems will get worse before they get better.
  One key reason why HCFA's presence was important, yesterday, was to 
nail down just who is in charge. At our hearing last July, Mr. Mike 
Hash, HCFA's deputy administrator, told the committee that HCFA is 
responsible for enforcement for nursing homes. Yet in yesterday's 
written testimony submitted for the record, Mr. Hash says the states 
have the responsibility.
  This needs to be clarified. Who's in charge, here? Is this why we're 
seeing all these problems in nursing homes? Because no one's in charge?
  In my opinion, this matter has to get cleared up at once. Every day 
that passes means more and more nursing home residents may be at risk. 
The Department of HHS has to restore public confidence that it truly 
cares, that it's doing something about it, and that improving nursing 
home care is a higher priority than protocols for witnesses at a 
hearing.

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