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Senate OKs Stricter Nursing Home Rules

May 1, 2003 | St. Louis Dispatch At 1:25 a.m. on April 8, 2001, paramedics found a woman dead in her stuffy, third-floor room at the Leland Health Care Center in University City.

The next day, three more residents died, one in the morning and two in the evening. The temperature in the rooms reached 95 degrees, and a police officer responding to the third death called the room an oven. But until late that night, the nursing home staff resisted requests to fix the air conditioning, move residents or bring in extra fans.

The home escaped state fines for its actions, but that won't happen in the future under legislation sent to Gov. Bob Holden on Wednesday.

The state could fine operators up to $10,000 a day for life-threatening violations and could make the punishment stick. Under current law, fines are forgiven if a home files a correction plan by the time of reinspection. In the University City case, that meant fixing the air conditioning and developing a plan for handling excess heat.

The deaths, which mobilized groups of older Missourians and generated media attention, helped propel the Legislature to pass the Senior Care and Protection Act of 2003.

The Senate sent the bill to the governor on Wednesday on a vote of 32-0. Earlier, the House passed it 144-1.

"I hope it means we'll have no more Leland nursing home events, where you have multiple deaths from neglect," said the bill's sponsor, Senate President Pro Tem Peter Kinder, R-Cape Girardeau.

Last year, a Post-Dispatch investigation found that thousands of America's nursing home residents are dying from preventable causes and that those who allow the neglect to go on often face little or no penalty.

In addition to increasing fines, the bill requires that homes report all deaths to the local coroner or medical examiner before moving a body to a funeral home. Administrators who conceal abuse or neglect could be charged with a felony, punishable by up to five years in prison.

Bills strengthening enforcement of Missouri's nursing home laws have failed in the Legislature three years in a row. Kinder killed last year's version because it would have given injured nursing home residents more time to sue for damages, a change Kinder said would have driven up insurance rates for the homes.

This year, Kinder worked with Lt. Gov. Joe Maxwell, a Democrat, to craft a compromise bill. After it passed, the two stood together, along with other elected officials, on the Capitol steps to address older Missourians in town for a lobby day.

In an unusual display of bipartisanship, House Speaker Catherine Hanaway, R-Warson Woods, praised Maxwell for his dogged work. She singled him out as the one "who stalked the halls, was in everyone's office, who worked very hard to make this happen."

Joining the rally late, Gov. Bob Holden sounded a more partisan note, proclaiming the legislation the "Holden-Maxwell" bill. Holden, a Democrat, also congratulated the activists for the elderly on their work.

"It's a great victory for better quality of care" in nursing homes, the governor said. "It's about time they be held accountable."

The bill had been in jeopardy last week, when House Republican leaders attached an amendment to raise nursing homes' Medicaid rates by $72 million a year. The Republicans backed off on Tuesday, saying they could not generate enough support for the idea when the state budget is in the hole.

The amendment would have updated homes' rates to reflect their current costs and required that they be adjusted annually for inflation. Speaker Pro Tem Rod Jetton, R-Marble Hill, said everyone "thought it was needed. But they all just said the money is not there right now."

Both Hanaway and Kinder promised to appoint interim committees to study nursing home financing this summer and fall. Lobbyists for the nursing home industry were unhappy that the rate increase was removed but said they would try to make the bill work.

Earl Carlson, a lobbyist for the Missouri Health Care Association, said he also hopes the Legislature works on making inspections more consistent. The bill throws the industry a bone by promising fewer inspections of nursing homes with good records. Regulators can visit them once a year instead of twice. Also, the state will have to act on Medicaid applications from nursing home residents within 60 days.

AARP lobbyist Norma J. Collins was delighted with the bill.

"We got pretty much everything restored," she said.

The AARP gave up one provision. The group wanted to allow videotaped statements of people 60 and older to be used in some civil court proceedings, if the witness had died or was later adjudged incompetent. Republicans removed that provision, citing the right to face one's accuser.

Holden said he expects to sign the bill as soon as his staff completes a detailed review.

In the crowd at the rally Wednesday was Gerald Randall, 71, of Kansas City. He said "there needs to be teeth" in the law. "The people who get mistreated are people who don't have families" to visit them, he said.

Brian Fellows, an attorney who represents relatives of two of the women who died in University City, said his clients had a policy of not talking to the media. But he said the changes in the law sounded positive.

"You shouldn't have been able to avoid a fine by saying, 'We promise not to do this again,'" Fellows said.

Sen. Pat Dougherty, D-St. Louis, said the new law would make a big difference in how nursing homes operate.

"They're either going to clean up their act or they're going to get out of the business," he said.

Major provisions of Senior Care and Protection Act

Fines would be increased and could range from $50 to $10,000 a day, depending on the severity of the violation.

Administrators who knowingly concealed abuse or neglect could be charged with a felony.

Homes would be required to notify the local coroner or medical examiner before moving the body of a deceased resident to a funeral home.

Nursing homes with good records could be inspected once a year instead of twice.

A home's license could be revoked if the operator refused to let regulators talk to staff and residents.

State employees who tipped nursing homes about a coming inspection would be fired and charged with a misdemeanor.

The state would continue to post inspection reports on its Internet site but would delay posting reports that were in dispute and would also post homes' correction plans.

The fines would stick for the most serious violations instead of being wiped out when a home files a correction plan.

If the state failed to act in 60 days on a Medicaid application for a nursing home resident, the person would begin drawing benefits.

Complaints of neglect or abuse at unlicensed senior housing centers would be investigated within 24 hours.

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