NCCNHR Public Policy Update

NCCNHR: The National Consumer Voice for Quality Long-Term Care

NCCNHR Public Policy Bulletin

This bulletin is being sent to the NCCNHR Board, Citizen Advocacy Groups,

State and Local Ombudsmen, Individual and Group Members

(Please share with others in your organization.)

November 14, 2008

This Public Policy Bulletin:

Tells you what NCCNHR is doing related to the transition to a new Administration.
Summarizes what happened in Congress this year and what you can do now to support these bills in the 111^th Congress.

Transition to a New Administration

As you probably know, President-elect Barack Obama has a transition team that is already vetting candidates for Cabinet posts and other political appointments. It is also considering policy recommendations that will be considered by the new Administration. NCCNHR, like many national organizations, is developing recommendations to the transition team for actions we would like the new Administration to take early next year—mindful of the unprecedented budget deficit and ongoing economic emergency. We are coordinating with several other organizations on recommendations to:

Require transparency and accountability in nursing home ownership and operations.
Strengthen the survey and enforcement process, including providing sufficient resources to the Centers for Medicare and Medicaid Services and state regulatory agencies to improve their performance; addressing chronically bad performance in individual nursing homes and chains; and improving the consumer complaint process.
Provide adequate resources and strengthen the long-term care ombudsman program.
Raise nurse staffing standards and provide the public accurate staffing information.
Ensure quality in federally funded home and community-based services.

NCCNHR will share its transition paper with members when it is completed.

Meanwhile, the Government Accountability Office (the investigative arm of Congress) came out with “urgent” recommendations to improve care and safety in nursing homes. See http://www.gao.gov/transition_2009/agency/hhs/overseeing-patient-care.php.The recommendation includes links to GAO reports on enforcement problems.

The transition team includes several faces familiar to consumer advocates:

Chris Lu, Executive Director of the team, was Senator Obama’s legislative director. As counsel to Rep. Henry Waxman (D-CA)’s government reform committee before he went to the Senate, Chris oversaw a series of investigative reports on understaffing and weak enforcement in nursing homes; was responsible for the committee’s frequent critiques of CMS; and led Rep. Waxman’s efforts to enact NCCNHR’s nurse staffing ratios. In one memorable effort, when CMS maintained it didn’t have the capacity to include deficiencies from complaint surveys on Nursing Home Compare, Chris and the committee staff recreated the federal website with complaint deficiencies included. Shortly after the Waxman version of Nursing Home Compare appeared on his committee website, CMS followed suit.

·        Debra Whitman and William M. Altman co-chair the long-term care team in the health care transition team. Debra Whitman is the staff director for Sen. Herb Kohl (D-WI) on the Senate Special Committee on Aging. Bill Altman is senior vice president of strategy and public policy for Kindred Healthcare. He was previously senior vice president for compliance and government programs with the chain.

If you want to follow public activities of the transition team, go to its website, http://www.change.gov/.

Legislation: Prepare Now for the 111^th Congress

Although Congress will come back for a short lame duck session to try to pass an economic stimulus package, most of the work of the 110^th Congress is completed—without final action on the bills we supported this year. Expectations for next year are mixed. While the new Congress and President are expected to be more sympathetic to social legislation, the economic recession, burgeoning budget deficit, and prospective need to continue bailing out the financial services industry and other businesses threaten the prospects for legislation that adds to the deficit. Your active support for these bills will be crucial to passing them in 2009!

Fortunately, the Nursing Home Transparency and Improvement Act (S. 2641; Sen. Chuck Grassley, R-IA, and Sen. Herb Kohl, D-WI) and the Nursing Home Transparency and Quality of Care Improvement Act (HR 7128; Rep. Pete Stark, D-CA, and Rep. Jan Schakowsky, D-IL) are bipartisan, “no-cost” bills. The two bills, which are similar, increase transparency of nursing home ownership; improve oversight of chains; and give consumers better information about nursing home quality, deficiencies, staffing, and enforcement. The Senate bill has nine co-sponsors, including Senator Obama, but H.R. 7128 was introduced too late in the session to pick up additional support.

The Fairness in Nursing Home Arbitration Act (S. 2838; Sen. Mel Martinez, R-FL, and Sen. Herb Kohl, D-WI, and HR 6126; Rep. Linda Sanchez, D-CA, and Rep. Ileana Ros-Lehtinen, R-FL) is also a bipartisan, no-cost bill. It passed both the House and Senate judiciary committees this year, improving its chances of moving quickly in 2009. It would prevent long-term care facilities from forcing consumers to go to arbitration, rather than suing, if a resident was injured through neglect or abuse.

NCCNHR will continue its strong support in 2009 for the Elder Justice Act (S. 1070; Sen. Orrin Hatch, R-UT, and Sen. Blanche Lincoln, D-AR; and H.R. 1783; Rep. Rahm Emanuel, D-IL, and Rep. Peter King, R-NY). S. 1070 passed the Senate Finance Committee this year, and part of the bill passed the full House of Representatives as H.R. 5352, the Elder Abuse Victims Act. (This “lite” version of the EJA did not include long-term care provisions most sought by long-term care consumer advocates.) The full Elder Justice Act would expand resources to address elder abuse in the community and in long-term care facilities, including providing new resources for ombudsman training; and it would provide new anti-abuse and residents’ rights protections in long-term care facilities. President-elect Obama has named the EJA’s House sponsor, Rahm Emanuel, as his chief of staff.

The Patient Safety and Abuse Prevention Act (S. 1577; Sen. Herb Kohl, D-WI; and HR 3078, Rep. Tim Mahoney, D-FL) would provide for national criminal background checks on long-term care workers. It also passed the Senate Finance Committee this year, and has moved in tandem in the Senate with the Elder Justice Act.

There is more information about the bills on the NCCNHR website, www.nccnhr.org.

Set a Goal: Get all members of your congressional delegation to co-sponsor all four bills!

Download a list from the NCCNHR website of all the members of the 110^th Congress who co-sponsored these important bills. (Note: the list was compiled before the Nov. 4 election. Some sponsors retired or were defeated—or are going on to greater things.)
Between now and January, set up meetings with your Senators and Representative or their staffs in your state or congressional district to talk about long-term care concerns in your area. If they co-sponsored a bill this year, urge them to become co-sponsors again when the legislation is reintroduced next year. If they haven’t co-sponsored a bill, urge them to support it in 2009.
Get to know your new Senators and Representatives. Set up meetings with them or their staffs to begin educating them about your concerns and ask them to co-sponsor the four bills above.
If you aren’t able to meet with members, send them letters at the U.S. Senate, Washington, DC 20510, or the U.S. House of Representatives, Washington, DC 20515.

Election Note: Among members of Congress defeated on Nov. 4 was Senator Gordon Smith (R-OR), Ranking Republican on the Senate Special Committee on Aging and former chairman of the committee. Senator Smith was a co-sponsor of the Elder Justice Act and had waged a valiant fight against the Deficit Reduction Act, with its steep Medicaid cuts and punitive transfer of assets provisions. However, he had not been favorable to nursing home consumer legislation. In addition, he was a sponsor of an industry bill, the Long-Term Care Quality and Modernization Act (S. 1980), which would allow CMS to waive OBRA survey requirements in facilities that participated in a two-year demonstration program that the industry characterizes as encouraging collaboration between surveyors and providers.

In these challenging times, NCCNHR is committed to keeping quality long-term care on the national agenda. Your support will enable us to do this.

Janet C. Wells

Director of Public Policy

NCCNHR: The National Consumer Voice for Quality Long-Term Care

1828 L Street, NW, Suite 801

Washington, DC 20036

Phone: 202.332-2275, ext. 205

FAX: 202.332-2949