Fact Sheet: President Clinton's Radio Address to the Nation: President Clinton Announces New $1 Billion Investment in Nursing Home Quality (9/16/00)
 Takes Additional Steps to Increase Staffing and Accountability in Nursing
                            September 16, 2000

Today, in a live radio address broadcast from The Washington Home in
Washington, DC, President Clinton will announce that he will be sending
legislation to the Congress next week to improve nursing home quality
nationwide.  This initiative: (1) invests $1 billion over 5 years in a new
grant program to increase staffing levels nationwide and improve quality of
nursing home care; (2) imposes immediate penalties on nursing facilities
placing residents at risk and reinvests these funds in the new grant
program; (3) directs the Health Care Financing Administration to establish
national minimum staffing requirements and complete recommendations for
appropriate reimbursement within two years; (4) helps families make
informed decisions by providing accurate information on staffing levels;
and (5) launches a new campaign to identify and prevent unintended weight
loss and dehydration among nursing home residents.   He will state that
these proposals can and should be included in any legislation that
increases funding for health care providers being considered by the
Congress.  The President will praise Senators Grassley and Breaux, as well
as Congressmen Gephardt, Waxman, and Stark, for their leadership on this
issue and encourage the Congress to act quickly on this new initiative.

million older Americans and people with disabilities receive care in
approximately 17,000 nursing homes. The Clinton-Gore Administration has
made the health and safety of nursing home residents a top priority ?
implementing the toughest nursing home regulations in the history of the
Medicare and Medicaid programs.  Many nursing homes provide high quality
care to the frail and vulnerable elderly individuals they serve.  However,
recent reports have demonstrated a strong correlation between inadequate
staffing and poor quality of care.  Specific findings include:

?    Over fifty percent of nursing homes do not maintain the minimum
staffing levels necessary to ensure the delivery of quality care.  The
Health Care Financing Administration (HCFA) recently released a report
demonstrating that patients are significantly more likely to develop
pressure sores, lose weight, and undergo unnecessary hospitalizations once
staffing ratios fall below the level of two hours per resident for
certified nurse aides daily.  That amount of time is the minimum necessary
for nursing staff to reposition residents and change wet clothes; assist
residents with toileting; provide feeding assistance; provide morning care;
and encourage or assist residents with exercise as appropriate.

?    Poor staffing results in many nursing home residents becoming
malnourished or dehydrated, unnecessarily increasing their risk of
infection and impaired mental function.  Certified nursing assistants
(CNAs) typically help seven to nine residents with their daytime meals, and
as many as 12 to 15 residents with their evening meals.  A recent study by
the Commonwealth Fund estimates that over 30 percent of nursing home
residents are malnourished, placing them at risk for infections, pressure
sores, depression, confusion and impaired cognition, and hip fractures.
Compared with well hydrated and nourished residents, these nursing home
patients have a five-fold increase in mortality when admitted to the

?    Nursing home staff often need additional training to carry out their
assigned duties adequately.  A 93 percent turnover rate in CNAs compounds
the problems caused by inadequate numbers of nursing home staff.  A
shortage of nursing supervisors leaves CNAs to do the best they can without
assistance from registered nurses or physicians.
PROVIDED IN NURSING HOMES.  Today?s initiative will:

?    Invest $1 billion over 5 years in a new grant program to improve
quality of nursing home care.  This portion of the initiative, which is
financed through the undedicated portion of the President?s $40 billion
provider restoration initiative and should be included in any such
initiative being considered by the Congress, will:

?    Create a competitive grant program to increase staffing levels in
nursing homes nationwide.  States would be able to receive funds to provide
financial and technical assistance to nursing facilities, unions,
non-profit organizations, or community colleges.  States applying for funds
would be required to develop, through an open public process, a proposal to
enhance staff recruitment and retention efforts; establish career ladders
for CNAs; provide increased training for staff; or conduct other staffing
initiatives to assure improved patient outcomes as approved by the
Secretary of Health and Human Services.  States may also use a portion of
the funds to reward nursing facilities with exemplary quality of care
records.  At least 75 percent of funds are to be awarded to states whose
current staffing levels are below two hours per resident for certified
nurse aides daily, but who commit to raising their staffing levels to the
two hour level within two years.  Up to 25 percent of the funds are
reserved for states whose staffing levels are currently at or above the two
hour threshold.  This legislation requires the Secretary to increase the
staffing thresholds as recommended by the upcoming HCFA report on staffing
levels with the goal of reaching the staffing level necessary to provide
optimum care.

?    Imposes immediate penalties on nursing homes endangering patient
safety.   Currently, if a nursing home appeals the imposition of a fine for
endangering patient safety (G level violation), the Federal government does
not collect the fine until after the appeal is settled, allowing many
facilities to avoid paying fines for years after the violation was
committed.  This initiative would require civil money penalties to be
immediately withheld from future payments to the nursing home.  If a
nursing home appealed the imposition of the fine and won, the Federal
government would return the funds with interest.

?    Invests Federal financial penalties levied against nursing homes
endangering patients in the new grant program.  Any civil money penalties
collected by the Federal government will be automatically reinvested in the
new $1 billion grant program and used to improve the quality of care
provided to nursing home residents rather than returned to the Medicare
Trust Fund.

?    Providing the public with accurate information on staffing levels.
Nursing homes participating in the Medicaid and Medicare programs will be
required to provide HCFA with detailed information on their current
staffing levels, including the total number of hours; coverage levels per
shift; identifying staff as CNAs, LPNs or RNs; and the average wage rate
for each class of employees.  This information will be posted for the
public to review in individual facilities as well as on HCFA?s Nursing Home
Compare website.

?    Direct HCFA to establish national minimum staffing requirements within
two years.  Today, the President will direct HCFA to complete its
comprehensive study on staffing ratios within 12 months and develop and
publish Federal regulations establishing minimum staffing levels no later
than September 1, 2002.  As part of this process, HCFA will concurrently
evaluate whether any changes in Federal reimbursement are necessary to
implement the new staffing standards established by the report.  In
addition, HCFA will include a recommendation on the feasibility and
advisability of increasing training requirements for CNAs from 75 to 160
?    Launch a new campaign to prevent unintended weight loss and
dehydration among nursing home residents.  This week, HCFA launched a new
education campaign that is sending all 17,000 nursing homes in the country
a new set of training materials to identify and prevent malnutrition and
dehydration.  These materials will help CNA and other caregivers identify
residents at risk for unintended weight loss and dehydration and then take
the necessary action to prevent it.

IMPROVING NURSING HOME QUALITY.   Senators Grassley, Breaux, Reid, and
Kohl, as well as Congressmen Gephardt, Waxman, and Stark, have shown
exemplary leadership on this issue and their efforts to improve nursing
home quality nationwide.

NURSING HOME QUALITY.  Protecting patients in nursing homes has been and
will continue to be a priority of the Clinton-Gore Administration. In 1995,
the President threatened to veto legislation pending before the Congress
that would eliminate Federal enforcement of nursing home quality standards,
and issued the toughest nursing home regulations in the history of the
Medicare and Medicaid programs, leading to measurable improvements in
quality of care for nursing home residents. In July of 1998, the
Clinton-Gore Administration initiated a new nursing home quality initiative
that ensures swift and strong penalties for nursing homes failing to comply
with standards, strengthened oversight of state enforcement mechanisms, and
implemented unprecedented efforts to improve nutrition and prevent bed
sores.  Finally, the Administration recently instructed states to eliminate
corrective periods during which nursing homes could avoid the imposition of
sanctions, such as fines, when a nursing home is found to have caused harm
to a resident on consecutive surveys, in order to put additional pressure
on nursing homes to meet all health and safety standards.

                                   # # #

President and First Lady | Vice President and Mrs. Gore
Record of Progress | The Briefing Room
Gateway to Government | Contacting the White House | White House for Kids
White House History | White House Tours | Help
Privacy Statement


Site Map

Graphic Version

T H E   W H I T E   H O U S E