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Coverage, Care for the Elderly

August 28, 1993

It is important that consumers do not fall victim to those, such as the so-called California Advocates for Nursing Home Reform, who seek to capitalize upon peoples' emotions and fears to further their own agenda ("Fatal Lapses in Rest Home Care Cited," Aug. 5).

On behalf of the members of the California Assn. of Health Facilities (CAHF), who represent more than 1,000 licensed long-term care facilities providing skilled nursing intermediate and residential care for patients throughout the state, I strongly resent the overtly biased and blatantly inflammatory nature of the "report card" that intentionally distorted and misrepresented our profession.

A survey of family members of nursing facility residents indicates that an overwhelming 80% of the 500 people surveyed rated the care of their family members to be "good to excellent."

Our facilities are required to comply with myriad federal, state and local rules and regulations to ensure the quality of care. Each nursing facility in California has 200 to 300 hours of state on-site inspections each year to ensure compliance with the more than 900 separate requirements.

GARY D. MACOMBER, Executive Vice President, California Assn. of Health Facilities, West Sacramento

Is California really doing a poor job of regulating nursing facilities? No, although you could get that impression from your article. In describing the enforcement of fines for nursing home violations, the article incorrectly states, "But in keeping with the enforcement philosophy, many of the fines were forgiven once they were appealed or problems were corrected . . . " There is no such "philosophy." These procedures are governed by federal laws and regulations.

The article reports on the California Advocates for Nursing Home Reform "report card," a "report card" that contains a fundamental misunderstanding: It links the fact that California inspectors issue more deficiencies than inspectors in any other state in the country, with inadequate enforcement. More citations do not reflect a regulatory agency's lax enforcement, but rather a facility's noncompliance with state laws and regulations.

Experience with enforcement of nursing home regulations varies widely across the country. California inspectors have more experience with nursing home regulation than inspectors in many states and thus may recognize violations more readily than elsewhere.

Federal guidance varies among the 10 federal regions that oversee states' regulatory activities. The federal government and the states are addressing these variations together to interject more consistency into the process.

The report greatly overstates the size of a backlog of complaints in 1992 that were responded to by form letters. While there was a significant backlog, the most urgent complaints were investigated within 24 hours.

CANHR and similar advocacy groups fought long and hard to convince Congress and the nation that provisions enacted in 1987 would improve the health and dignity of residents in nursing homes. California is now vigorously following those tough rules. If CANHR now believes that the new rules are not adequate to improve the quality of care in nursing homes, the organization should work with Congress to change those rules.

MOLLY JOEL COYE, Director, State Dept. of Health Services, Sacramento

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