Sunday, April 21, 2002

Nursing proposals languish

Advocates for disabled had sought stronger bill

By Spencer Hunt
Enquirer Columbus Bureau

        COLUMBUS — Some new proposals intended to combat abuse and neglect in homes for the mentally retarded are already on a political scrap heap in the Ohio General Assembly.

        State officials responding to a Cincinnati Enquirer investigation of Ohio's troubled mental retardation system had sought new powers to fine poorly run nursing homes for the mentally retarded. They also wanted broader authority to keep bad homes from taking in new residents.

        Those proposals and others are nowhere to be found in a bill lawmakers plan to pass. The reforms fell victim to a lobbying effort by group home and nursing home owners who call the sanctions unfair.

        State mental retardation officials say the bill still lets them crack down on abuse through a new licensing scheme and report cards on homes. While advocates for the mentally retarded sup port these changes, they say the bill could have been stronger.

        “Some of the teeth have been taken out,” said Stuart Warshauer, former chairman and current adviser to the Ohio Developmental Disabilities Council.

        At the center of the issue is a state enforcement system that fails to close or clean up mismanaged homes. There are 400 nursing homes and 900 group homes that care for 9,000 mentally retarded Ohioans.

        An Enquirer investigation found conditions were so bad at 65 nursing homes over the past three years that state officials threatened to take away vital Medicaid


        A database built from state health inspection reports between 1999 and 2001 revealed 524 incidents of abuse and neglect ranging from cruel language to sodomy. There were 590 injuries, from bruises to skull fractures, and 205 incidents in which people weren't given their medicine or got the wrong doses.

        The newspaper also identified 12 people who died under questionable circumstances, eight of whom lived in nursing homes.

        In every case, state officials issued threats but then let the homes stay open after they promised to do better jobs. Thirteen homes were threatened more than once.

        Ken Ritchey, the director of the mental retardation department, told the newspaper he needed to change the way homes were licensed and inspected. He also wanted to bar new residents from moving into any home a company owns if there were serious problems at one or two.

        Dr. Nick Baird, the Health Department director, wanted to fine nursing homes for the mentally retarded. Rebecca Maust, the agency's quality assurance chief, also asked lawmakers for powers to deny payments for new residents, to demand specific corrections, and to put temporary managers in troubled homes.

        Department of Health officials said fines, in particular, would go a long way toward persuading home operators to crack down on abuse. Homes for the elderly are already fined for incidents of abuse, and officials say such incidents have dramatically declined.

        Aside from changing the way homes are licensed, none of these proposals is part of the bill the Ohio Senate passed March 20.

        Marti Estep, program director for Advocacy and Protective Services Inc., a state-funded agency that provides guardians for 3,400 mentally retarded Ohioans, said the lack of fines was a big disappointment.

        “The money is what makes the difference (for homes,)” Ms. Estep said. “If they have to one time lose money, it could be enough to make them pay closer attention to what's happening and make sure no one is lying in wet sheets for hours.”

        The bill sponsor, Sen. Robert Spada, R-Parma Heights, said fellow lawmakers balked at these sanctions after special interests representing nursing homes and group homes objected.

        “I have to gain support from (lawmakers) and sometimes they have been lobbied or talked to by these advocates, parties or other interests,” Mr. Spada said. “You have to deal with these other folks to get this legislation passed.”

        These “other folks” were the Ohio Health Care Association, which represents nursing homes, and the Ohio Provider Resource Association (OPRA), which lobbies for companies that provide services for mentally retarded Ohioans.

        Both groups argue the state has more than enough power now to punish homes.

        “They can revoke licenses. They can suspend admissions. They can put in a monitor,” OPRA director Maureen Corcoran said about mental retardation officials.

        “If they are not using those tools now, why should they get more?” Ms. Corcoran said.

        Pete Van Runkle, president of the Ohio Health Care Association, said fines were a bad idea because homes often need more money to turn bad situations around.

        Health Department spokeswoman Mari-jean Siehl said officials there are satisfied with the bill, even though not one of their reform proposals is in it.

        “(Mental Retardation) is really the lead agency on the bill. If they're pleased, we're pleased,” Ms. Siehl said.

        Mr. Ritchey was conciliatory, saying good compromises were won.

        Instead of a broader ban on new residents, the bill requires agency officials to quickly investigate all homes a company runs if inspectors find problems at one or two. If those inspections reveal similar problems the agency can suspend new admissions at those homes.

        The state also will try to shame homes that have repeated problems. The bill lets officials make a “public notice” about a home, which could be posted on the state agency's Web site.

        Mr. Ritchey also acknowledged his agency could simply have changed its policies to enact these reforms. He said having a law would protect the agency from a lawsuit.

        Mr. Ritchey said two other provisions would improve the health and safety of thousands of mentally retarded Ohioans.

        Instead of a lifetime permit to operate homes, the bill would put one- to three-year limits on their state licenses. The department of mental retardation would inspect each home at least once before its license expires to see whether they should be renewed.

        That means problem homes would be inspected more often. However, other homes that have better records could go without inspections for as long as three years.

        Agency officials say they also will move forward with a proposal to create a consumer guide for homes and companies. This would let customers, parents and legal guardians view a home's record and past problems before choosing where someone should live.

        Advocates for the mentally retarded support the bill for these two reasons. Even as they call it a good step forward, they're also critical about what's missing.

        “The providers and the nursing home lobby were real effective at working with the committee in the Senate,” said Tom Eamoe, director of Arc Hamilton County. “They unfortunately managed to get the most potent of the methods for reform removed.”

        Mr. Warshauer said the political playing field in the General Assembly favors group home and nursing home owners over the mentally retarded people who live in them.

        The advocates say they still support the bill and that it could help improve conditions.

        “There's still stuff in there that is useful,” Mr. Eamoe said.

        Ms. Corcoran said she does not think nursing home owners or group home owners have too much influence. She said they worked to compromise.

        “Otherwise, I assume the thing wouldn't be going anywhere.”


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