Yes, there is a difference

When the Democrats won control of Congress in last year's elections, there were a variety of predictions about whether the institution would operate differently. Many cynics thought that the change in party control would not produce any substantive changes in policy. After all, Congress was closely divided between the two parties before the election and remains closely divided now. Observers who argue that there's “no real difference” between the Repulican and Democratic versions of congressional representatives thought that the result would be a continuation of politics as practiced over the past six years.

With the 110th Congress in place for only four months, however, the cynics already have been proven wrong. The record of the current Congress on nursing home and long-term care (LTC) issues reflects interest in the personnel, safety, and care topics that has been absent from previous congressional sessions. For example, 11 separate pieces of LTC legislation have been introduced since January of this year, compared with not one legislative proposal pertaining specifically to long-term care during the first four months of the previous Republican-controlled Congress.

The legislation relevant to nursing homes that has been introduced in the 110th Congress focuses on a handful of topics including:

  • nursing home resident safety;

  • staffing recruitment and reimbursement;

  • technological innovations; and

  • funding related to specific conditions or services.

These topics have been major priorities for both the LTC industry and its consumers.

Nursing home safety as an issue is the central concern of three pieces of legislation: the Senior Safety and Dignity Act of 2007, introduced by Rep. Ginny Brown-Waite (R-Fla.); the Elder Justice Act, championed by Rep. Rahm Emanuel (D-Ill.); and the Nurse and Patient Safety & Protection Act of 2007, sponsored by Rep. John Conyers (D-Mich.), the chairman of the House Committee responsible for healthcare legislation. Conyers's bill has punitive elements because it would require all healthcare facilities to eliminate manual lifting of patients, except in a declared state of emergency. Facilities violating the bill's “Federal Safe Patient Handling Standard” would be subject to prosecution in a federal district court.

Brown-Waite's bill is far less strident in its calls for skilled nursing facilities (SNFs) and other LTC facilities to conduct criminal background checks and establish disaster evacuation plans.

The Elder Justice Act, unlike the other safety-related legislation, is a comprehensive proposal that incorporates both incentives and penalties to influence the behavior of LTC facilities. Emanuel's bill would authorize the Department of Health and Human Services (HHS) to make a series of financial grants to LTC facilities that would pay for continuing training and varying levels of certification for employees who provide direct care to LTC facility residents, as well as for bonuses or other benefits to employees who achieve certification. Another set of proposed grants would offset SNF costs for installing clinical healthcare informatics systems designed to reduce adverse events and complications resulting from medication errors. The legislation also proposes requiring every LTC operator and employee to report any reasonable suspicion of crimes occurring in the facility to HHS as well as local law enforcement, and would require SNF owners to inform both HHS and their state concerning any impending closure, including a plan for the relocation of facility residents.

In addition to its direct proposals for grants to LTC facilities, the Elder Justice Act provides for incentives for individuals to train for, seek, and maintain employment providing direct care in an LTC facility. It also explores other solutions for reducing the staffing problems by creating an LTC facility worker employment tax credit and requiring HHS to study the possible creation of a national registry of certified nursing aides.

Staffing issues are the major focus of the Allied Health Reinvestment Act, introduced in the U.S. Senate by Maria Cantwell (D-Wash.) and eight other Democratic senators. The legislation proposes that HHS develop public service announcements to promote the allied health professions. It further requires HHS to award grants to promote such professions by supporting state and local recruitment campaigns, increasing education opportunities, and developing and implementing retention strategies. Cantwell's bill would address the cost and availability of education in the allied health professions through HHS grants to provide education through new technologies and methods and HHS-sponsored faculty loan funds.

The legislation that has been offered on technology is relatively colorless compared with the big proposals on LTC safety and staffing. One bill offered by New Orleans' Congressman William Jefferson (D-La.) would authorize SNFs, assisted living facilities, and even board-and-care homes to serve as the originator of a telehealth network. A somewhat more inclusive bill introduced by Sen. Norm Coleman (R-Minn.) would establish a national Consortium on the Impact of Technology in Aging Health Services. Coleman's proposed consortium would be required to recommend a national policy to address issues concerning technology and assistive health services for seniors. Specifically, the consortium would identify changes to federal laws and programs that encourage the private sector to increase the availability of technology that empowers elderly consumers.

Coleman's bill illustrates another difference between the current Congress and previous congressional sessions: Roughly half of the sponsors of the Republican senator's legislation are Democratic senators. Similarly, the cosponsors of legislation by Sen. Barbara Mikulski (D-Md.) to foster breakthroughs on Alzheimer's disease care are evenly divided between members of both political parties. Bipartisanship may not have been restored to full health in the 110th Congress, but it's more alive than it has been in years.

Not all legislation related to long-term care should be taken seriously. Congressman Christopher H. Smith (R-N.J.), for example, has introduced an unlikely bill to establish an independent Veterans Health Care Funding Review Board that would chip away at the power of the President to establish an arbitrary funding level for veterans' care, including LTC services. On the other side of the aisle, Democratic congressmen have continued their decades-long tradition of offering doomed legislation to establish national health insurance.

Those prospects may change, but one thing is sure: After many years of a legislative drought, the Democratic majority in Congress appears willing to seriously consider solutions to long-term care's problems and may even be willing to share the credit with at least some of their Republican colleagues.

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