THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, August 29, 1996 TAG: 9608290004
SECTION: FRONT PAGE: A16 EDITION: FINAL
TYPE: Opinion
SOURCE: By RANDOLPH L. GORDON, M.D.
LENGTH: 79 lines
The aging of America is changing this country's business, government and family life. As the elderly live longer, more Americans have become ``sandwiched caregivers'' - raising children and also providing for their parents in their declining years. The recent flap over the loss of Medicaid certification at the Forest Hill Convalescence Center in Richmond has brought to the surface, in a pointed and emotional way, numerous issues about aging that merit discussion. The safety and health of patients and families have been the top priority of the state throughout this Forest Hill process. The following things have become abundantly clear over the past several months:
1. Americans demand high-quality convalescent care. The federal government has set strict standards in response to public concern over care for the elderly. Over the past 10 years, the federal government has developed and revised, with public input, rigorous standards for convalescent care. These revised standards have been in place since July 1, 1995, and cover food quality, facility maintenance, proper distribution of medication and procedures for care and what happens as a result of care. The federal government has anticipated the public's worry over quality care for aged loved ones, and if these standards need to be changed, they need to be changed in Washington.
2. The federal regulations are tough but fair. Federal regulations afford facilities every opportunity to comply. They provide for tiered inspections. At each step in the process, the facility manager is aware of deficiencies that require correction. Inspections are teaching and learning experiences. More than 70 percent of convalescent centers pass on the first inspection, and more than 95 percent pass by the third visit. Only one Virginia convalescent center, Forest Hill, has failed six inspections.
3. The commonwealth has a vested interest in maintaining tough standards of care. Virginia is required by the federal Health Care Financing Administration to ensure that the federal standards of care are maintained. The commonwealth has zero tolerance for a facility's lack of concern for patient health and safety. To ensure the safety and health of residents, Department of Health inspection teams with decades of experience regularly monitor convalescent centers across the state.
4. Nursing care is a business that requires well-trained staff, but a badly run business can fail. Privatized care for loved ones is an important component of the convalescent-care landscape. Compliance with federal standards often boils down to well-trained staff. Forest Hill's failure points this up. A well-managed staff should ensure that residents are kept clean and regularly shifted to prevent bedsores. A capable staff is required to ensure that soiled sheets are not placed outside the kitchen. A capable staff must ensure that medication is distributed in a timely and correct fashion. Improperly distributed medication can result in sickness or death. Families demand adequate care by convalescent staff.
5. The commonwealth has an obligation to the taxpayers to purchase only quality care. Most (70 percent to 75 percent) nursing-home care is paid for with state or local tax dollars. Department of Health inspections ensure that these tax dollars are being spent to provide high-quality care rather than resulting in inappropriate profits for the owners of the facilities.
In addition to the truths that have become clear with perspective, several lessons have also been learned in this process.
1. The state must not rely on a facility to communicate its deficiencies with families, but must proactively communicate a business failure and what action will be taken.
2. We must work in partnership with the community to ensure that there are adequate temporary nursing beds in a locality to make it easier to react when a bad business fails to meet federal standards.
3. The commonwealth must always keep a strong commitment to provide alternatives when a convalescent center fails to meet federal standards, including taking temporary control of a center, through negotiation, as with Forest Hill, or through legal action against such facilities.
The aging of this country has indeed affected every part of our lives. It is clear that our family members who are convalescent-center residents deserve the same level of care that a loving family would give. It is equally clear that tough federal standards ensure a high level of care for patients. The experience with Forest Hill Convalescent Center over the past several months has resulted in a victory for residents and their families. MEMO: Doctor Gordon is commissioner of the Virginia Department of
Health. by CNB