Despite administration efforts to ease nursing home regulation, the General Accounting Office warned yesterday that changes in those facilities and simultaneously reduced state outlays make it "crucial" that inspection certification procedures be adequate to maintain standards.
According to preliminary GAO findings, a greater proportion than ever of the nation's nursing home residents are infirm and require more care.
"An increase in the dependence of the nursing home population may mean that they will require more intensive care that is costly to provide," the GAO said in a letter to Henry A. Waxman (D-Calif.), chairman of the House health and environment subcommittee.
At the same time, the GAO said, "states are finding it difficult to pay the escalating cost of this care and are taking steps to reduce their nursing home expenditures. . . . States are cutting reimbursement rates, freezing bed supply and taking other actions that may change both the quality of nursing home care and patients' access to it."
The administration has proposed changing existing nursing home inspection and certification regulations, which would result in less frequent inspection of some facilities, and allowing a non-governmental body to examine them.
Those proposals came under intense criticism yesterday from the Senate Special Committee on Aging, which heard testimony from state officials and Carolyne K. Davis, head of the Health Care Financing Administration.
Davis' testimony centered on HCFA's proposal to have the Joint Commission on Accreditation of Hospitals conduct inspections of nursing homes seeking certification for federal funds under Medicare and giving states the option of using such an inspection in lieu of their own when making certification for the state-federal Medicaid program.
Davis asserted that JCAH's standards for nursing homes are equal to or more stringent than those of the federal government and that states would be free, if they chose, to conduct their own inspections.
Committee Chairman John Heinz (R-Pa.) told Davis that it was the committee's "near unanimous" position that "you have just about zero support for using the JCAH . We hope you'll take that under advisement."
Committee members and state officials who testified charged that the administration is attempting to ease inspection standards while reducing aid to states, making it difficult for them to hold the line.
In one acrimonious exchange, Davis told Sen. Bill Bradley (D-N.J.) that he was "trading on emotions" after he summarized her testimony and asked her, "Wouldn't you feel a little uneasy about the administration's commitment to quality in nursing home care?"
The GAO study, a comprehensive study of nursing home patients' characteristics, did not include a look at HCFA's proposed changes, and no direct comment was made on them in the letter to Waxman. One GAO official, however, made explicit what the report implies, saying:
"This is really not the time you want to reduce the number of times you go in and look at a home."
Considering the larger percentage of infirm patients in nursing home and declining state support for them, the official said, "something's got to give. If you're not looking at those patients, you're just asking for trouble. This is a very volatile time. You would want to watch the quality of care very carefully."