An "informed" public
(2/22/02 Gainesville Sun, FL) Editorial

Florida's record with nursing homes is not a good one when compared with the rest of the nation.

In 2000, 30 percent of Florida nursing homes were cited for food-sanitation problems and 15 percent were written up for improper use of physical restraints. One in five residents had pressure sores, caused from being too long in one position. The rates were all above the national average.

In a more recent finding, more than 90 percent of the nation's nursing homes don't have enough workers to take proper care of patients.

The report, prepared by the U. S. Department of Health and Human Services, found "strong and compelling" evidence that substandard care in nursing homes was closely associated with low levels of staffing.

Reaching adequate staffing levels would not be cheap -- $7. 6 billion a year more, the report estimates, or about 8 percent above current levels. And that's one reason President George W. Bush wants to make what he calls an "informed public" by publishing data on the number of patients and workers at each nursing home.

The "informed public" idea hits a snag in Florida, however. The Legislature doesn't want to keep the public informed. Last year, the Legislature, while providing for increased staffing and inspections at nursing homes, also closed access to records of possible abuse and neglect at nursing homes, saying the facilities are more likely to report unconfirmed incidents if they are guaranteed confidentiality.

Closing the records didn't just squeak by either. It passed the Senate 39-0 and the House, 99-21. Legislators said opening the records would only provide a feeding ground for attorneys to sue nursing homes.

The federal report offers no sign of relief from the growing demand for nursing homes. The 85-and-older group most likely to need nursing home care will double to nearly 9 million Americans within the next 30 years.

Dr. John F. Schnelle, a co-author of the report, told The New York Times that, under the report's recommendations, one nurse's aide would be needed for every five or six residents during morning-to-midnight shifts. Currently, it is common for nursing homes to have one nurse for every eight to 14 residents.

Even with the present occupancy rate, nursing homes would be faced with heavy increases in staffing levels to meet recommendations for Medicaid patients, who make up about two-thirds of nursing home residents. The report noted demand for nurse's aides would increase 13 percent to 21 percent, and said standards must be "phased in over a multiyear period to give providers an opportunity to recruit and train the required additional staff."

The Bush administration responds that there is not "sufficient information upon which to base a federal requirement" for minimum staffing need. But the "informed public" knows that poorly staffed nursing homes seldom provide quality care. Perhaps one day the informed public will draw a connection between nursing homes with high staff-to-patient ratios and politicians who don't want to pay to lower them.