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Turn Back the Clock: 1998 Nursing Home Initiative

Back in the summer of 1998, President Bill Clinton announced his administration’s new initiative to further strengthen existing nursing home laws and regulations. We previously covered the 1987 Nursing Home Reform Act as one of the landmark and foundational laws that was the precursor to modern federal and state laws and enforcement mechanisms that govern nursing home standards and practices across the country. After further reforms in 1995, the Clinton Administration’s 1998 Nursing Home Initiative (NHI) aimed to further boost effectiveness of government enforcement. This came on the heels of a report by the Health Care Financing Administration that cited some deficient enforcement mechanisms in the then-current survey and certification process (though it is worth nothing the report found the prior decade’s enforcement process as overall successful in improving conditions for residents). The Initiative also came on the heels of a hearing before the Senate Committee on Aging, and a Government Accountability Office report.

What were the Fixes?

The Clinton 1998 Initiative contemplated multiple changes or reforms. One was that nursing home inspections should no longer be scheduled in regular intervals, but should rather be staggered. It also contemplated that a minimum of 10% of on-site visits occur on weekends, early mornings, as well as evenings, and not just normal weekdays when one might typically expect. The Initiative further threatened that federal funding would be pulled from states that did not properly conduct their own surveys of in-state facilities.

It also called for sanctions against a nursing home that commits a second violation of rules or regulations, whereas the prior structure allowed for a period of time for the facility to correct its problems; the Initiative contemplated immediate sanctions and penalties after the second offense. Regarding such sanctions and penalties, states were also permitted to impose penalties on their own for every distinct violation, of up to $10,000 each. The Initiative also took a tougher stance on facilities with a negative track record and which were repeat offenders by requiring more frequent inspections of those facilities with citations and sanctions until those nursing homes took satisfactory corrective action to fix their problems and raise their respective standards of care, all subject to in-person verification by authorities.

The 1998 Nursing Home Initiative furthermore focused on specific maladies that are often the result of abuse and negligence, such as bedsores and malnutrition, which can occur when residents are not fed and are left in the same position in bed, without bathing or changing sheets, for moderate or long periods of time. It also focused on reducing abuse, proposed a manual of best practices, proposed new criminal background checks for hiring nursing home staffers, and also called for a national abuse registry to keep offenders from ever working at nursing homes again. A follow-up report to the NHI discussed new minimum staffing ratios to ensure residents receive sufficient care.

The 1998 NHI serves as another marker in the recent two-decade history of improving rules, regulations, and enforcement by government in the nursing home industry. We see many familiar concerns that plagued the country in previous decades and which still do so today, yet enforcement mechanisms grow stronger with time to combat them.

See Related Blog Posts:

Looking Back: 1987 Nursing Home Reform Act (Part I)

Looking Back: 1987 Nursing Home Reform Act (Part II)