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Sunday, October 24, 1999

New Rules Will Replace Almost No Regulation

By Thomas J. Cole
Journal Investigative Reporter
LONDON -- Andrew Turner, who heads Sun Healthcare Group of Albuquerque, was asked in 1997 whether Britain had anything like the comprehensive U.S. law on how nursing homes must care for residents.
"No," replied Turner, whose company is one of the biggest nursing-home operators in both countries. "The British are smarter than that."
But Britain is moving toward adopting national standards for nursing homes that are even tougher in some ways than those in the United States.
For example, the standards would set minimum staffing levels for nursing homes, require homes to offer private rooms and set out employee rights.
Britain also is preparing to create regional commissions to regulate and inspect nursing homes. That work is now done by 100 health authorities.
The proposed changes are in part a response to incidents of neglect and abuse in nursing homes.
There have been accounts of bedsores, sexual abuse and other problems similar to the horror stories that have become commonplace in the United States.
The goal, according to a report by the Labor government of Prime Minister Tony Blair, is to do "everything that is possible to prevent and root out the abuse and neglect of vulnerable people."
Ginny Jenkins, director of the nonprofit group Action on Elder Abuse, said Britain hasn't been as smart as the United States in protecting nursing-home residents.
"We have been very naive," Jenkins said. "There was just increasing recognition that the current system wasn't working."

No data in Britain
Turner, the founder, chairman and chief executive officer of Sun, made his comment about the British regulatory system in an interview published in August 1997 by Contemporary Long Term Care Magazine.
Turner said the quality of British nursing homes was "equal, not better or worse" than the quality of homes in the United States.
About one-fourth of U.S. homes are cited each year for deficiencies that caused actual harm to residents or put them at immediate risk for injury or death.
A Journal analysis of inspection data posted in May by the U.S. Health Care Financing Administration showed nearly 39 percent of 321 Sun nursing homes were cited for such deficiencies in recent annual inspections.
There is no such data available for British nursing homes or those run by Sun in that country.
Sun didn't respond to a request for comment on the proposed new British standards.
In addition to having homes in Britain, Sun operates long-term care facilities in Spain and Germany and hospitals in Australia.
Turner laughed and responded "exactly" when Contemporary Long Term Care Magazine compared him to international media tycoon Rupert Murdoch.

Regulation overhaul
Nursing homes in Britain currently are governed under the 1984 Registered Homes Act and its regulations.
The 100 health authorities around the country are responsible for enforcement of the law. Homes must be inspected twice a year.
But for the most part, the Registered Homes Act and its regulations include only general standards for how nursing homes must operate.
For example, the law requires a nursing home to have adequate staffing but doesn't spell out what adequate staffing is.
The general standards allow health authorities to have great discretion in determining compliance.
The report by the Labor government said:
"Although local discretion allows flexibility, it means that there is inconsistency between authorities, leaving providers uncertain about what they need to do in order to be registered, and leaving service users unclear about what standards they can expect as a minimum."
The government late last year announced its plan to implement detailed national standards.
Eight regional commissions in England and one in Wales are to be created to enforce the standards.
Scotland is expected to adopt similar standards and set up its own commission.
The Labor government in September put out for public comment a draft of the proposed standards. The areas covered include:
* What a nursing home must disclose to prospective residents;
* The rights of residents;
* How complaints are handled;
* Policies, procedures, records and protocols;
* Residents' health, personal care;
* Daily life and social activities;
* Meals and mealtimes;
* Dying and death;
* The physical characteristics of nursing homes;
* Management, administration;
* Staffing.
"Overall, it's very similar" to U.S. law and regulations, said Roy Weidner, a manager with the New Mexico Health Facility Licensing & Certification Bureau, which inspects homes for compliance.
The proposed new British standards were developed for the government by the nonprofit Centre for Policy on Ageing. An advisory group included health-care professionals, nursing-home operators, advocates for residents and nursing-home inspectors.
"One of our objectives is to promote good quality care," said Gillian Dalley, director of the Centre for Policy on Ageing. "I don't think in most homes it is very bad. That isn't to say in most homes it is very good."
Joan Morton, who is in charge of nursing-home inspections for the North Yorkshire Health Authority in northern England and served on the advisory group for the new standards, said the standards would bring consistency to nursing-home regulation in Britain.
"Any of these big companies should be able to set up their protocols, policies and procedures for all their homes across the country," Morton said.
The standards also are needed to improve care in nursing homes, she said. The incidents of bad care are now "more than I would like to see."
The nursing-home industry has raised some objections to the standards.
Sheila Scott is chief executive of the National Care Homes Association, a trade group that primarily represents small homes.
Scott said some homes would be forced out of business by standards dealing with physical characteristics, including minimum room sizes.
The size of a room doesn't necessarily affect quality of care, Scott said. She said the trade group also doesn't want all the standards to take effect at one time because of the costs homes would have to incur.
"We want the focus to be on those quality-of-care issues," Scott said.
The Independent Healthcare Association, an industry trade group that represents for-profit chains, said implementation of the standards should be accompanied by increased government payments to homes. The association also has said the majority of the standards are sensible but some would do little to improve care.
"I am not sure that government ministers really want to get involved in detailing the number of soft furnishings in people's rooms or on specifying the nitty-gritty of room sizes," said Barry Hassell, chief executive of the association.
Les Bright, deputy general manager of the nonprofit group Counsel and Care, said the industry's concerns about the mandatory-room sizes are a fraud.
The industry is actually more worried about other standards that deal with residents' quality of life, Bright said.
"It's really about what happens in the room," he said of the standards.
Bobby Aubrey-Fletcher and her husband own a home for private-pay clients in Chilton.
"I think it's going the right way," Aubrey-Fletcher said. "We didn't really have any standards before. We do need clarity."
She added, "There is nothing to fear from regulation as long as it doesn't overwhelm the industry."