Analysis

Topic: Nursing Homes
Sponsor: Representative Lockwood
Committee: Senate Health Policy
Date Passed by House: March 28, 2001
Date Introduced: March 13, 2001
Date of Analysis: April 12, 2001

Position: The Department of Consumer and Industry Services does not support the bill.

Description of Bill: The bill amends the Public Health Code to create a Nursing Home Quality of Life Review Commission in the Department of Community Health. The Commission would consist of nine members appointed by the Governor consisting of the following:

• One member from the Department of Community Health who has knowledge about the federal nursing home guidelines;

• One member from the Department of Consumer and Industry Services, representing individuals conducting nursing home surveys;

• A physician specializing in geriatric medicine;

• Two members representing nursing home reform or nursing home patient advocacy groups, or both;

• Two members representing nursing homes, one of whom is a supervisor, registered nurse, or practical nurse, but not a director of nursing;

• A nursing home resident and a family member of a nursing home resident.

The Commission is required to do all the following:

• Request and review all reports resulting from nursing home surveys,

• Establish a nursing home satisfaction survey,

• Establish review criteria for reviewing nursing home survey reports,

• Conduct quarterly meetings with survey teams,

• Present an initial written report to the Department of Community Health, Department of Consumer and Industry Services, the Governor, the Legislature, and the Attorney General within 1 year after initial appointment of members.

• Provide annual written reports of Commission activities, findings, and recommendations,

• Review survey reports for changes reflecting the latest developments in geriatric social and medical practice.

The Commission may appoint advisory committees. The Department of Community Health is required to provide office space, supplies, clerical and administrative assistance, and other staff as necessary for the Commission.

Arguments For: The Commission's work will improve the survey process and help assure that citations issued by survey teams are related to quality of care and consistent with federal guidelines. The Commission will also help reduce tensions between nursing homes and survey teams.

Arguments Against: The bill is unnecessary. Public Act 171 of 2000 created a Clarification Work Group in the Department of Consumer and Industry Services which will substantially address some of the same concerns that the current bill is attempting to address. Unlike the Commission established by House Bill 4451, the Health Care Financing Administration has been part of the Work Group. The Work Group has had several meetings and substantial progress has been made. It is expected that the Work Group will produce recommendations which improve the survey process and reduce tensions between nursing homes and surveyors.

The concept of pulling the survey teams out of the field on a quarterly basis to meet with the proposed Commission is inconsistent with resident safety and the department's regulatory obligations to the federal Health Care Financing Administration. The department is required by the federal government to conduct annual surveys of all nursing homes. The department has also substantially improved its response to complaints. The bill would make it much more difficult for the department to do surveys in a timely manner.

The proposed tasks of the Commission are unrealistic. It is not likely that a part-time advisory body will be able to review over 2,000 annual, revisit, and complaint surveys, keep current on the latest state and federal regulations, review the abundant medical literature in the geriatric area, complete a financial audit, and make annual reports to the Legislature. The staff resources to support such an effort would be enormous and would divert substantial resources from more important programs.

Establishing a nursing home resident satisfaction survey is unnecessary. Resources are available to assist consumers in selecting the best nursing home care available. Both the industry and advocacy groups have satisfaction surveys. Having a third type of survey developed by the Commission is unlikely to prove helpful.

Positions: The following positions are listed in the analysis of the House Legislative Analysis Section. The Health Care Association of Michigan supports the bill. The Michigan Association of Homes and Services to the Aging and Citizens for Better Care support the concept of the bill. The Campaign for Quality Care and the Michigan Advocacy Project want a majority of members on the Commission to be consumers.

Fiscal Information: The responsibilities of the Commission would require substantial allocations of staff from the Department of Community Health.

Administrative Rules Impact: No administrative rules are authorized in the bill.