Quality of Nursing Home

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President Announces Actions to Improve the Quality of Nursing Home

THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release July 21, 1998

REMARKS BY THE PRESIDENT
IN HEALTH CARE ANNOUNCEMENT

The Oval Office

3:16 P.M. EDT
THE PRESIDENT: Thank you, Secretary Shalala, and NancyAnn DeParle, and the advocates who are here. I wish your mother werehere, Secretary Shalala. I have met her, and even a skeptical presscorps would believe your account of her in full if they could seeher.
The duty we owe to our parents is one of the most sacredduties we, as Americans, owe to each other. Nowhere is that dutymore important than when a family makes the choice to move a parentinto a nursing home. When that time comes, all of us need to knowthat all our parents will be well cared for.
Today, more than 1.6 million Americans live in more than16,000 nursing homes nationwide. When the baby boom generation movesinto retirement, the number will rise even higher. By 2030, thenumber of Americans over the age of 85 will double, makingcompassionate quality nursing home care even more important.
At their best, nursing homes can be a Godsend for olderAmericans and their families, providing a save haven in times ofneed. But at their worst, they can actually endanger theirresidents, subjecting them to the worst kinds of abuse and neglect.For nearly six years, as Secretary Shalala said, we've worked hard togive our most vulnerable citizens the security and health servicesthey need to live in peace and safety.
I am committed to honoring the great social compactbetween the generations, first let me say, by reserving every pennyof the budget surplus until we save Social Security first. Thehistoric balanced budget I signed last summer preserves the Medicaretrust fund into the 21st century. We've taken action to root outMedicare fraud and abuse, saving taxpayers over $20 billion.
Finally, we're fighting to meet the challenge of ourchanging health system by enacting a patients' bill of rights, toinclude access to specialists and the right to appeal health caredecisions. I have extended those rights already to Medicarebeneficiaries; they should be the rights of every American.
One of the most important way we can help our seniorcitizens is by improving the quality of care in our nursing homes.In 1995, when Congress tried to eliminate federal assurances ofnursing home quality, I said no. It was the right thing to do. Thatsame year, we put into place tough regulations to crack down on abuseand neglect in our nursing homes. Since then we have made realprogress, as Secretary Shalala said, stepping up on-site inspectionsand helping nursing homes to find and fix problems.
As the HCFA report Secretary Shalala talked about showsall too clearly, however, the job is far from over. When peopleliving in nursing homes have as much fear from dehydration and poornutrition as they do from the diseases of old age, when families must
worry as much about a loved one in a nursing home as one livingalone, then we are failing our parents and we must do more.
Today, I'm acting within my power as President to crackdown on unsafe nursing homes. Effective immediately, HCFA willrequire states to step up investigations of nursing homes, makingon-site inspections more frequent and less predictable, so there isno time to hide neglect and abuse. Whenever we find evidence that anursing home is failing to provide its residents with proper care, oreven mistreating them, we will fine that facility on the spot. Andif state enforcement agencies don't do enough to monitor nursing homequality, we will cut off their contracts and find someone else whowill do the job right.
I'll continue to do everything I can to fight nursinghome abuse and neglect, and to give more options to elderly,disabled, and chronically-ill Americans who choose to stay at home.But Congress also must act. This week I am proposing comprehensivelegislation to protect older Americans with a national registry totrack nursing home employees down known to abuse nursing homeresidents, and criminal background checks to keep potentially abusiveemployees from being hired in the first place. I ask the Congress toput progress ahead of partisanship on this issue, and pass thislegislation to improve our nation's nursing homes this year.
Choosing to move a parent or a loved one into a nursinghome is one of life's most difficult decisions. But with these stepswe can at least give families a greater sense of security in knowingwe are doing everything we possibly can to make our nursing homessafe and secure.
Thank you very much.
Q Do you think the Congress would be against theregistry, per se?
THE PRESIDENT: No, I have no reason to believe theywould be, and I hope they would pass it.
Q What do you mean by putting partisanship aside?
THE PRESIDENT: Well, we haven't had a lot of billscoming out of Congress this year, but I hope very much that they willpass this. I don't believe -- not since 1995, when there was anattempt to strip the federal authority standards has there been aserious move on this issue. And I believe there are a lot ofRepublicans, as well as Democrats, in Congress who will support this.So I'm quite hopeful that it will pass.
Q How about the patients' bill of rights; do youthink you're going to get that?
THE PRESIDENT: Well, I don't know. That's up to them.We have to have some significant amount of Republican support to geta strong bill. We have to have 60 votes to break a filibuster in theSenate, and obviously a majority in the House, sufficient to actuallymake sure the bill could come to a vote. But we're still working onit and it's terribly important.
Everywhere I go in the country -- you know, I was justhome last weekend and I was stunned at the number of people who cameup to me and just started talking about it, and talking about theirown experiences and how important they thought it was. So I'm veryhopeful we'll get it.
Q How can you parlay that, then, into a real publicresponse?
THE PRESIDENT: Well, I'm working at it. We've had alot of events on the patients' bill of rights. I'm trying to get thepublic involved in this, trying to get them to express their opinionsto their members of Congress and I will continue to do so.
Q I wanted to ask you about another issue, sir. Nowthat the Secret Service agents have testified, are you concernedabout what they might be saying, one; and, two, do you find yourselfholding them more at arm's length, sir?
THE PRESIDENT: The Secret Service has made its owndecisions about what to say and how to do it, based on theirprofessional sense of responsibility, and I'm not going to get intothis. I've refused to comment on it so far and I'm going to continueto refuse to comment.
Q Mr. President, your administration is making a newpush to end the standoff with Libya over the Lockerbie bombing,including possibly holding a trial in a neutral country, under U.S.or Scottish jurisdiction. Are you optimistic that this climate mighthelp and what has brought on this new push?
THE PRESIDENT: Well, we have always said that our firstgoal was to bring the perpetrators of Pan Am 103 murders to justice.That's our first purpose. And since I got here we've been lookingfor ways to do that. We have had conversations with representativesof the British government, as well. We've always said we thoughtthat there had to be a trial under American or Scottish law. Theremay be some possibility of standing up a Scottish court in anothercountry, but there are lots of difficulties with it as well,apparently.
All I can tell you is that it's one of the things thatwe have explored with a view toward accelerating the day -- it's beena long time now, it's been a lot of years since that terrible daywhen Pan Am 103 crashed over Lockerbie. And we're looking at it, butI don't know that it can be done. Our people have spent a lot oftime on it. We've talked to the British at great length about it.We're trying to find some way that has real integrity, that willwork. But there are all kinds of practical difficulties that I'msure our folks can explain. I don't know if we can do it, but we'reworking on it.
Q What brought it up now? I mean, what all of asudden, after so many years?
THE PRESIDENT: I don't know why it is just now cominginto the press. But it's not just being brought up now. We haveliterally been working for years; I have personally been engaged inthis for years, trying to find a way to get the suspects out ofLibya, into a court where we thought an honest and fair and adequatetrial could occur.
And in a case like this, like every other case, as theyears go by you run more and more chances that something will happento the evidence that is available, to any witnesses that might beavailable. So we've had a sense of urgency about this for some time.But my guess is that it has come to public light because asignificant number of conversations have had to be held between theAmerican and the British authorities and between others in potentialthird-party venues, like the Netherlands. And I know there's beensome discussion of that. But it has not been resolved yet.
Thank you.
Q Is there any indication that the Libyans might goon, sir?
Q Sir, can you comment on CNN's nerve gas report,that the Pentagon --
THE PRESIDENT: All I know is what Secretary Cohen hassaid to you, to the public and to me, which is that their view isthat it did not occur.
Thank you all very much.