December 04, 2019

The White House Says Nursing Home Regulations Are Too Tough

By Ina Jaffe, NPR – WAMU 88.5
November 30, 2019

Heard on Weekend Edition Saturday



Rolling back federal regulations has been a cornerstone of the Trump presidency. Now the administration has proposed rolling back some Obama-era rules for nursing homes and how they care for more than 1.3 million residents. NPR’s Ina Jaffe covers aging and joins us now. Ina, thanks for being with us.


SIMON: And what’s the administration’s reasoning for this?

JAFFE: Well, they say it’ll reduce regulations that they call burdensome and inflexible. They also say that the proposed new rule will save nursing homes more than $600 million a year and that this will free up funds to improve patient care, though there’s no requirement that the nursing homes spend the savings that way.

But there could be changes before the rule is finalized. And that’s why the Centers for Medicare and Medicaid Services, which oversees nursing homes, didn’t want to do an interview.

SIMON: These are proposed changes. What might change if they’re approved?

JAFFE: Well, one proposal that’s attracted a lot of attention would change the way antipsychotic drugs can be prescribed. Now, Scott, these are drugs that are approved for treating serious mental illnesses, like schizophrenia. They also come with a black box warning that says they can raise the risk of death in older people with dementia. But in nursing homes, that’s usually who gets them. It’s a practice that’s widely criticized. So the Centers for Medicare and Medicaid Services, known as CMS, has spent years trying to get nursing homes to reduce the use of antipsychotics. But critics say the proposed new rule would actually make it easier to prescribe them.

SIMON: Why would the government make it easier to do something they’ve been discouraging?

JAFFE: Well, currently, if a nursing home resident gets a new prescription for an antipsychotic, it can’t be renewed after two weeks without a doctor’s exam. But under the proposed rule, the doctor could keep renewing the prescription without seeing the patient again for a month or two. This has been condemned by elder rights organizations like the Long Term Care Community Coalition. Their executive director, Richard Mollot, told me that the physician he’s consulted also condemns the proposal.

RICHARD MOLLOT: What he said was that no other insurance company would ever accept that a doctor didn’t have to see a patient before continuing a prescription for medicine. But CMS is saying now that that’s OK for nursing homes in this very vulnerable population. And people die from this. They’re affected so catastrophically.

SIMON: Nursing homes see it differently, Ina?

JAFFE: They do. Dr. David Gifford is the chief medical officer of the American Health Care Association. That’s a trade group representing most nursing homes. And he says that the proposal requires doctors to document their rationale for continuing an antipsychotic, and that’s actually an improvement.

DAVID GIFFORD: It requires much more guidance from the physician to the nursing staff as to when to use them and why to use them. So I think they did a nice balance to see if these medications are being used appropriately.

JAFFE: And what Gifford calls balance is the kind of thing the nursing home industry trade group has been asking for since they sent a letter to then-President-elect Trump last December.

SIMON: What are some of the other major changes in this proposal?

JAFFE: Oh, they cover everything from who runs the kitchen to controlling infection to how to file grievances. In all of those cases, you could say that standards or staff time have been reduced.

SIMON: What has made the Trump administration turn its attention to the nursing home industry right now?

JAFFE: Actually, they’ve been chipping away at Obama-era rules for a while. Here’s just one example. They’ve changed the way that fines are assessed for substandard care. The result is that the average nursing home fine has dropped by about a third. And there’s another regulation proposed in this package that could result in a further reduction of fines.

SIMON: NPR’s Ina Jaffe, thanks so much.

JAFFE: Oh, you’re welcome.


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