The government yesterday spelled out a "bill of rights" for 2.2 million elderly people living in nursing homes, and warned that it will cut off Medicare and Medicaid payments to non-complying facilities.

About half of the $16 billion a year spent for nursing home care comes from the federal or state payments under the Medicaid program for the poor and from the federal Medicare program for the elderly.

Nathan Stark, under secretary of Health and Human Services, said strong protective regulations are needed because some nursing homes:

Use excessive physical force or excessive drugs to keep residents quiet;

Force patients to buy toothpaste and similar supplies at inflated price from the nursing hom drugstore;

Refuse to respect residents' dietary preferences, deny reasonable visiting hours to relatives and friends, or deny the right to hang pictures of relatives on walls.

Stark said the proposed regulations, which will be made final after hearings, would spell out patients' rights on these and other matters and be "a major step toward ending the impersonality, indifference and isolation that characterize life in some nursing homes."

HHS estimated that putting the regulations into effect will cost about $80 million a year, but the National Council of Health Centers, which represents privately owned homes, said the cost would be closer to $1 billion.

The council said it didn't object to upgrading patients' rights, but other features of the regulations, like requiring a complete assessment of each patient's "medical, physical and psychosocial needs" and "specific treatment goals and timetables," would be immensely costly and strain the available personnel supply.

In a milder comment, the American Health Care Association, which represents 7,500 nursing homes, said it is concerned with the costs and "certain provisions which would interfere with the professional judgement providers must exercise."

With the population aging rapidly, there has been a substantial growth (and more is expected) in the number of people living in nursing homes requiring skilled or intermediate level nursing care. A heavy portion of the cost is borne by Medicare and Medicaid, particularly Medicaid. The bill in some facilities may be $12,000 or more a year.

Stark said about 18,000 long-term care facilities take part in government nursing care programs. These facilities handle about 2.2 million patients -- some of them totally private but about 1.3 million having all or most of their costs paid by Medicare or Medicaid. The regulations would apply to all persons in a facility and protect the private patients as well as the government clients.

Stark said the new regulations would specify the following rights: free association with other patients and visitors and sharing of a room with one's spouse; at least 12 hours of visiting time per day; access for ombudsmen; the right to form a patients' council; personal privacy, access to one's own records and the right to keep books and other prized possesions; the right to one's own physician and to information about one's condition; protection against involuntary transfers from room to room and unnecessary physical and chemical restraints; information on charges; reasonable accommodation of dietary preferences.