Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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Appendix A: History of Federal Nursing Home Regulation
Appendix A: History of Federal Nursing Home Regulation
Pages 238-253
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From page 238... ...
This stimulated the growth of voluntary and proprietary nursing homes. By the time of the first national survey of nursing homes in 1954, there were 9,000 homes classified as skilled nursing or personal care homes with skilled nursing facilities; 86 percent were proprietary, 10 percent were voluntary, and 4 percent were public.3 In 1950, amendments to the Social Security Act authorized payments to beneficiaries in public institutions and enabled direct payments to health care providers.
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From page 239... ...
In the meantime, legislation in 1958 and 1959 authorized the Small Business and Federal Housing administrations to aid proprietary nursing home construction and operation.7 Various studies in the 1950s found that between 30 and 60 percent of the residents in private nursing homes were public assistance recipients.8 A Public Health Service survey of nursing home residents in 13 states during 1953-1954 found that 51.3 percent were public assistance recipients.5 Another study of expenditures for nursing and convalescent homes found that, in 1957, even before the 1956 amendments took effect, 53 percent of the expenditures for nursing and convalescent homes were from federal, state, and local governments.9 In 1965, 60 percent of the residents of nursing and convalescent homes were supported by welfare.~° With this increasing federal financial involvement in nursing home services and construction, federal attention began to focus on quality issues. In 1956, the Commission on Chronic Illness called attention to problems with the quality of care in nursing homes.
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From page 240... ...
Many states report that strict enforcement of the regulations would close the majority of the homes." As a result of concerns about the quality of care and safety of conditions in nursing homes, the chronic disease program of the Public Health Service began to study state licensing programs in 1957. The program began to work with the states and the industry to develop federal guidelines for nursing home licensure programs.~7 The final product, the Nursing Home Standards Guide, was issued in 1963.
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From page 241... ...
THE ADVENT OF MEDICARE AND MEDICAID The next major event was the enactment of the Medicare and Medicaid programs in 1965. This greatly expanded federal funding of nursing home services and gave the U.S.
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From page 242... ...
. They were intended to care for residents who did not need the 24-hour nursing services provided in skilled nursing homes, but who needed more than custodial care.2 The committee report said that ICFs would lower the overall costs of long-term care and allow many nursing homes to participate that could not meet SNF or ECF requirements.
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From page 243... ...
General Accounting Office (GAO) audited skilled nursing homes in three states and found that half were in violation of Medicaid standards for nurse staffing, physician visits, or fire safety.22 The Senate Finance Committee staff study of Medicare and Medicaid in 1970 was very critical of Medicare certification.20 Congress forced HEW to stop using "substantial compliance" as a basis for certifying nursing homes.
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From page 244... ...
, and directed HEW to develop a single set of standards for Medicare and Medicaid SNFs. Although the Senate Finance Committee's report said the provision to unify Medicare and Medicaid standards for SNFs was "not intended to result in any dilution or weakening of standards for skilled nursing facilities," the law itself reduced some Medicare provisions, such as eliminating social workers in SNFs, reducing RN coverage in rural SNFs from 7 to 5 days a week, and extending indefinitely the grandfathering from state licensure requirements of nursing home administrators with 3 years of practical experience.
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From page 245... ...
in January 1974, just prior to the promulgation of the ICE standards, found that 59 percent of SNFs were being certified with life safety code deficiencies.26 The new standards triggered another wave of conversions from SNF to ICF.25 Finally, in 1974, "as a result of an increasing awareness on the part of the federal government that many nursing home facilities which were receiving Medicare (Title XVIII) and Medicaid (Title XIX)
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From page 246... ...
The ONHA, now called the Office of Long-Term Care, was overseeing a substantial revision of the SNF standards by an interagency work group as early as 1976. HEW began another effort to revise the nursing home survey program as part of President Carter's regulatory reform effort, "Operation Common Sense." The HCFA announced plans to revise the SNF conditions of participation and ICE standards.30 The announcement was followed by public hearings in five cities3t and numerous written comments and meetings with interested parties.
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From page 247... ...
The nursing home industry disputed the HCFA's estimates of the costs the new regulations would impose. The HCFA said, in its regulatory impact analysis, that the changes would cost about $80 million a year (revised in 1981 to $135 million)
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From page 248... ...
as sufficient evidence that facilities met federal requirements for Medicare and Medicaid participation. Taken together, these changes were viewed as another attempt to reduce federal protection of the health and safety of nursing home residents by Congress, which promptly imposed a moratorium on them.
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From page 249... ...
1957. Nursing Homes, Their Patients and Their Care: A Study of Nursing Homes and Similar Long-Term Care Facilities in 13 States.
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1958. Nursing Homes: Public and Private Financing of Care Today.
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1971. Report on the Skilled Nursing Home Certification Project.
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1974. Enforcement of Life Safety Code Requirements in Skilled Nursing Facilities.
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From page 253... ...
1980. A Critical Evaluation of the Federal Role in Nursing Home Quality Enforcement.
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