[Congressional Record (Bound Edition), Volume 154 (2008), Part 16]
[Extensions of Remarks]
[Page 22937]
[From the U.S. Government Publishing Office, www.gpo.gov]




 NURSING HOME TRANSPARENCY AND QUALITY OF CARE IMPROVEMENT ACT OF 2008

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Friday, September 26, 2008

  Mr. STARK. Madam Speaker, I rise today to introduce the ``Nursing 
Home Transparency and Quality of Care Improvement Act of 2008'' with my 
colleague Ms. Schakowsky of Illinois. This legislation is a companion 
bill to one introduced by my Senate colleagues, Senators Grassley (R-
IA) and Kohl (D-WI). I thank them for their leadership and look forward 
to working with them on this issue in the next Congress.
  It has been 20 years since passage of the Nursing Home Reform Act. 
Despite improvements in some areas of quality, there is still much to 
be done. I am introducing this bill because the lives of our most frail 
senior citizens are at stake, and our return to this issue is long 
overdue. I recognize we are in the waning days of this Congress, and I 
look forward to hearing feedback from my colleagues and interested 
parties in the coming months. It is my hope we will move forward on 
this issue in the 111th Congress.
  A disturbing trend has been underway in the nursing home industry 
recently. Nursing home chains have changed their corporate structure in 
ways that conceal the ownership and management of individual 
facilities. In doing so, the chains are able to shield assets and limit 
liability. They obscure regulators' efforts to find the responsible 
party and seek corrective action or collect monetary penalties. 
Beneficiaries are similarly limited in their ability to seek 
remuneration for injury or neglect.
  The result is a woeful lack of transparency and accountability. How 
can we hold nursing home chains accountable for the quality of care if 
they are hiding their true ownership relationships?
  Even more worrisome is the negative effect on quality that may result 
from these changing corporate structures. The heightened focus on 
profit maximization in the restructured organizations may come at the 
expense of quality of care. When cost cutting leads to staffing cuts, 
patient care suffers, and our most frail seniors and people with 
disabilities are put in jeopardy.
  We must not forget that this industry operates largely on the 
government dime. Medicare and Medicaid pay for the majority--60 
percent--of spending on nursing homes annually, with the remainder 
coming from people's own wallets or from private insurance. At anyone 
time, nearly 80 percent of residents living in nursing homes are 
supported by public funds.
  These troubling trends in ownership and quality are occurring at the 
same time that the nursing home industry is enjoying healthy Medicare 
margins of nearly 13.1 percent in 2006. For profit nursing homes are 
doing even better, with soaring stock prices and Medicare margins of 16 
percent in 2006.
  The federal government has a moral and fiduciary responsibility to 
make sure we know who those providers are and what they are doing, and 
ensure they are using government dollars to provide high quality care 
for our nation's nursing home residents. That is why we are introducing 
this legislation.
  The Nursing Home Transparency and Quality of Care Improvement Act 
would place patients before profits. It provides protections to 
residents when a home closes, and brings structure to the complaint 
process. It increases the transparency of nursing home ownership and 
operations so that seniors and their families know who is calling the 
shots, and what level of care is being provided in the home. It 
improves the data available on Medicare's Nursing Home Compare Web site 
so that families are well-informed when making decisions about the care 
of their loved one. The bill also improves staff training. The bill 
strengthens the current enforcement system via mandatory compliance and 
ethics programs, new quality assurance efforts, and meaningful 
enforcement penalties.

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