American nursing homes: make sure that society passes the test

WOULD that one day the news media could report an investigation of nursing homes which found them all clean and decent, with the patients appropriately tended to, and the families involved satisfied that their elders were receiving proper care. But we aren't there yet. The Senate Special Committee on Aging heard testimony recently that some 11 percent of the nation's 8,852 skilled-care facilities were ``chronically'' or ``grossly and chronically'' out of compliance with federal standards. Tearful survivors gave heartbreaking accounts of the conditions their deceased relatives had endured in such homes.

For those who got lost, though, in the ensuing debate over whether the majority of these violations are merely a matter of paper work, the word is that at least 600 nursing homes are in the appalling conditions those grieving relatives described.

Legislation is in the works to improve the medicaid reimbursement system, to which some of the abuses are traced. Among the proposals is the idea of adjusting the reimbursement system so that nursing homes have greater financial incentives to care for those patients who need more attention. At present there are no such incentives, and some nursing homes have difficulty accepting those who need more than minimal care.

Medicaid payments vary widely from state to state, and evening out some of these variations will presumably be of help as well.

And the US Department of Health and Human Services has dropped its policy that nursing homes should be ``self-policing'' after the 10th Circuit Court of Appeals ruled that that policy was a violation of federal law. Inspections are being made again -- although homes still have enough advance notice to let them hire nurses just for the occasion, to be able to prove they have ``24-hour nursing care.''

One test of a civilization is the care it takes of its most vulnerable members. Clearly nursing homes will need a lot more attention from the Department of Health and Human Services, and from state authorities, if the United States is not to flunk the test.