Such questions intrude even when the best of care is given. In other settings, however, scandal and calamity enter the picture; and dark new questions emerge. The subcommittee, in this report and succeeding Supporting Papers, recognizes the importance of the nursing home industry; and it pledges every effort to continue communication with representatives of the industry and with members of the executive branch. For these reasons, the subcommittee has devised an unusual format: After publication of the Introductory Report, a series of follow-up papers on individual issues will follow; then we will publish a compendium of statements invited from outside observers; after this will come our final report. In this way, the subcommittee can deal with the many parts needed to view long-term care as a whole. Testimony from many, many days of hearings and other research have been tapped for this report, which is extensive and heartfelt. Concern about people has been at the heart of this effort. The subcommittee has, therefore, been especially dependent upon responsive staff effort. Mr. Val Halamandaris, associate counsel for the Senate Special Committee on Aging, deserves specific mention for his role in assuring that subcommittee inquiries remained directed at their real target: to wit, people in need of good care. Mr. Halamandaris has had the primary responsibility for directing the subcommittee's hearings; he is responsible for the excellent research on data and for writing this report. He is more than a skilled and attentive attorney; his investigatory skills are rooted in concern and, when necessary, outrage. He has made it possible for this subcommittee to compile and offer more information and insights into the nursing home industry than the Congress has ever had before. He has been helped considerably by other committee personnel. Staff Director William Oriol has provided guidance and consultation leading to the design and special points of emphasis in this report. Committee Counsel David Affeldt has given generously of his legislative expertise, as well as painstaking attention to detail. Particularly fortunate for the subcommittee was the fact that a professional staff member, John Edie, had special qualifications for making a substantial contribution to this effort. Mr. Edie, an attorney, formerly served as counsel to a program on aging in Minneapolis, Minn. When the subcommittee went to that city for intensive hearings on scandalous shortcomings in nursing home care there, Mr. Edie testified and then continued his efforts on behalf of reform. In the preparation of this report, he has worked closely and at length with Mr. Halamandaris and his associates. The subcommittee also stands in debt to a select group in the nursing home industry and within the executive branch. Usually without much attention or encouragement, these public servants have stubbornly refused to compromise their goal, seeking high, but reasonable, standards of care. With the publication of the Introductory Report, the subcommittee begins a final exploration of issues. We will publish responsible comments on findings expressed in this document and the Supporting Papers which will follow. And we will, in our final report, perhaps 8 to 10 months from now, make every effort to absorb new ideas or chal lenges to our findings. The care of chronically ill older Americans is too serious a topic for stubborn insistence upon fixed positions. Obviously, changes are needed. Obviously, those changes will occur only when public understanding and private conscience are stirred far more than is now the case. FRANK E. Moss, Chairman, Subcommittee on Long-Term Care. Major points of Supporting Paper No. 1 Page III IX IX X X XII XIII Major points of forthcoming supporting papers: Supporting Paper No. 3: Doctors in nursing homes: The shunned Supporting Paper No. 4: Nurses in nursing homes: The heavy burden fires.. Supporting Paper No. 6: What can be done in nursing homes: Positive aspects in long-term care Supporting Paper No. 7: The role of nursing homes in caring for discharged mental patients.. Supporting Paper No. 8: Access to nursing homes by U.S. minorities. Supporting Paper No. 9: Profits and the nursing home: Incentives in favor of poor care Introduction_.. XV XV XV XVI XVI XVII XVII 243 ᏢᎪᎡᎢ 1 The elderly and drugs.. 245 I. How do drugs get into nursing homes? II. Consequence of poorly controlled drug distribution A. Errors in medication.......... Other evidence of the lack of controls and drug errors_ C. The high incidence of adverse drug reactions. 259 262 262 Antianxiety agents (examples: valium, librium, miltown). 262 262 Drugs which influence behavior in the elderly: promises, Appendix 1. Penalties for fraudulent acts and false reporting under medi care and medicaid-Public Law 92-603, section 242Appendix 2. General definition of drug categories_ - Appendix 3. Implications of medical review in long term care facilities... Appendix 5. Relationship between nursing home facilities and pharmacists: pharmaceutical services, April 1973. Appendix 6. Articles from "Modern Nursing Home," April 1971.. Appendix 7. Letter from F. J. McQuillan, associate director of research, to Senator Frank Moss, transmitting: Fact Sheets, pharmaceuticals and the nursing home market; dated September 8, 1971 297 300 302 309 310 312 315 NURSING HOME CARE IN THE UNITED STATES: FAILURE IN PUBLIC POLICY SUPPORTING PAPER NO. 2 DRUGS IN NURSING HOMES: MISUSE, HIGH COSTS, AND KICKBACKS ABOUT THIS REPORT To deal with the intricate circumstances and governmental actions associated with nursing home care in this Nation, the Subcommittee on Long-Term Care of the U.S. Senate Special Committee on Aging is issuing several documents under the general title of Nursing Home Care in the United States: Failure in Public Policy. An Introductory Report, published in November, declared that a coherent, constructive, and progressive policy on long-term care has not yet been shaped by the Congress and by the executive branch of this Nation. Examining the role of Medicare and Medicaid in meeting the need for such care, the report found that both programs are deficient. Further, it raised questions about current administration initiatives originally launched personally by President Nixon in 1971. These shortcomings of public policy, declared the report, are made even more unfortunate by the clear and growing need for good quality care for persons in need of sustained care for chronic illness. It called for good institutions and, where appropriate, equally good alternatives, such as home health services. (A more detailed summary of major findings from the Introductory Report appears later in this section of this report.) Supporting Paper No. 2, "Drugs in Nursing Homes: Misuse, High Costs, and Kickbacks," analyzes drug distribution in America's 23,000 nursing homes. It gives specific examples of loose controls and the dire consequences to nursing home patients and the taxpayer. THE FACTUAL UNDERPINNING OF THIS STUDY Fifteen years of fact-gathering preceded publication of this report. In 1959, the Senate Committee on Labor and Public Welfare established a Subcommittee on Problems of the Aged and Aging. Findings from subcommittee reports and hearings have been evaluated. That subcommittee acknowledged in 1960, as this report acknowledges in 1974, that nursing homes providing excellent care with a wide range of supportive services are in the minority. 41-557 - 75 - 2 |