An Evaluation of Changing Patterns of Control of Nursing Homes

摘要

Consumer groups successfully spurred regulatory reforms of New York's nursing home industry in the mid-1970s. Those initiatives had the greatest impact on professional standards, reimbursement mechanisms, and criminal enforcement. For example, the reforms intensified the use of such techniques as management assessment, which more closely linked reimbursement to the standard setting and surveillance. This capped the rapidly expanding growth of licensed nursing homes, and kept relatively constant the number of beds between 1975 and 1980. The reforms also affected reimbursement. Restrictions in capital cost reimbursement eliminated incentives for real estate speculation in nursing homes, while other kinds of controls dampened Medicaid cost increases. Criminal enforcement was an important feature of the new regulations. An independent, well-financed enforcement unit was set up, and fines and jail sentences were imposed. This created fear of prosecution as a new form of control. Attempts to enhance consumer controls in nursing homes were instituted, and included such measures as legislative and administrative mechanisms for protecting patients' rights. However, changes resulting from increased consumer input had relatively little impact compared to reforms in other areas. Current concerns include preventing erosion of the consumer controls that had been so hard to obtain, and assuring the responsiveness of nursing homes and regulatory agencies.