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Final Standards Issued on Care at Nation's Nursing Homes


WASHINGTON — Seven years after Congress acted to clean up abuses and substandard care in the nation's nursing homes, the Department of Health and Human Services released final regulations Thursday on how to carry out the law.

Nursing homes can be fined up to $10,000 a day for serious violations that endanger the patient.

Fines of $2,000 would be imposed on anyone who tips off a nursing home about the date of a surprise inspection.

And penalties are graduated, with minor infractions punishable by fines of $50. Previously, the main enforcement tool available to the federal government was the complete withholding of Medicare funds, which was so severe it was rarely used.

"We insist that nursing homes not only meet residents' physical needs, but must also offer a quality of life that respects their rights and humanity," HHS Secretary Donna E. Shalala said.

The 1987 law laid out health, safety and quality standards for nursing homes. These included rules on nutrition and cleanliness, assurance of a patient's right to refuse physical and chemical restraints, and guarantees against involuntary discharge.

Under the new regulations--affecting 16,700 nursing homes that care for 1.5 million Medicare and Medicaid patients at a cost to the government of $31 billion a year--surprise inspections of nursing homes are to be conducted an average of once a year but no less than once every 15 months.

"On the whole, the regulations represent a step forward in improving quality," said Paul Willging, executive vice president of the American Health Care Assn., a major trade group for the nursing home industry. He said the regulations will allow enforcement to focus on chronically faulty facilities rather than those with only minor problems.

Linda Keegan, an AHCA official, said this is an improvement over the earlier, tentative version of the regulations, published two years ago, which would have allowed an inspector to cite a home for a violation "if he saw a single cracked egg in a refrigerator," even if it did not represent a pattern or repeated occurrence.

A third major feature of the new rules is the graded system of penalties.

The rules announced Thursday are designed to match the punishment or corrective action with the severity of the violation.

Medicare-Medicaid administrator Bruce C. Vladeck said 10 different penalties start with simply giving the nursing home a detailed plan to correct violations.

More severe violations could be met with denials of payments, civil fines of $50 to $3,000 a day, state or HHS management of the facility, fines of $3,050 to $10,000 a day, exclusion from Medicare and Medicaid and shutting down the home altogether.

The new rules are to take effect July 1.

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