01:00 AM EDT on Thursday, June 9, 2005

BY LIZ ANDERSON
Journal State House Bureau

PROVIDENCE -- Lawmakers have altered pending nursing-home bills to allow the public to know when a facility has demonstrated what the state believes is a "substandard quality of care."

Both the Senate Health and Human Services Committee and the House Health, Education and Welfare Committee approved that change last night in passing legislation known as the Germaine Morsilli Act, in memory of a former nursing-home patient who suffered serious bedsores under the care of the now-defunct Hillside Health Center in Providence.

The changes came after the American Civil Liberties Union, and advocates for senior citizens, complained that original drafts of the bills did not contain enough provisions for the public to learn when a facility is struggling.

If a nursing home has been cited for substandard care, that fact would become a public record after no more than 10 days. The public-notice provisions would kick in sooner if the state approves a correction plan from the facility before the 10 days are up.

Under revisions to another bill in the five-bill package, considered last night in the Senate committee, the public would also be informed when a nursing home fails to respond satisfactorily to a state finding that its "financial status is of concern" and that "incident[s], event[s] or patterns of care exist that harm or have the potential to result in harm or danger to the residents of the facility."

In those circumstances, state officials have the right to summon the home's managers to a meeting to explain the situation. If the officials are not reassured, the home's operators get 10 days to return with a plan of correction, then the state has 10 days to decide what to do with it. (Each side can get a 10-day extension for good cause.)

Once the state makes its ruling, even if the plan is rejected, the document would become a public record, and would also be provided to patients and their families; other information collected by the state during its investigation would remain confidential.

"You won't see something potentially going hidden for months," Senate Health and Human Services Committee Chairwoman Elizabeth Roberts, D-Cranston, said before the hearing.

Steven Brown, director of the Rhode Island Affiliate of the American Civil Liberties Union, agreed the changes would help "ensure prompt access to what could be very important information for the public to know."

But Brown said the two sides should seek time extensions only when necessary, because "forty days is a long time to keep everyone in the dark."

While some state officials had originally called for the state to notify families when inspectors find that patients have been harmed, the bills, even in their revised form, leave such communications to nursing homes.

But the changes do call on the state to echo, on its own books, the federal rules for when nursing homes must make such notices, including an injury to a resident or any other "significant change" in the resident's condition.

Roberta Hawkins, the state's nursing-home ombudswoman and a representative of the Alliance for Better Long Term Care, praised the bills in testimony before the Senate committee.

"This is the best reform I have seen in 27 years," she said. For residents and their families, she said, "I'm here to say thank you."

Representatives of the nursing-home industry said the bills had improved as they had evolved, but still expressed concerns.

Lobbyists from the Rhode Island Health Care Association and the Rhode Island Association of Facilities and Services for the Aging said the bills point to high rates of staff turnover as one potential sign of problems, but that the issue has proved hard to avoid in the nursing-home field, even at well-functioning facilities.

They also said a requirement they provide staffing reports on a shift-by-shift basis would add significantly to their paperwork, and that new language spelling out the responsibilities of facility medical directors could scare people away from those jobs.

Rod Gauvin, owner of Alpine Nursing Home in Coventry, said adding regulations to his industry, "year after year after year" only makes it more difficult for legitimate nursing-home operators struggling to make ends meet.

"You can't legislate morality," he said. "If someone doesn't have a conscience, it's not going to matter."

But Roberts said that the legislation strives to give a break, when possible, to well-functioning homes, while stepping up scrutiny of problem ones.

The Senate committee ultimately approved four of the five bills in the package, sending them to the floor for a vote that could come sometime next week. The committee held onto a final measure that would give the attorney general more tools to use to put failing nursing homes into receivership, after members said the language needed more work.

The House version of the Germaine Morsilli Act heads to that chamber's floor too, although last night Deputy Majority Whip Paul Moura, D-Providence, left the door open for further negotiations, calling it "a work in progress."

Moura did not elaborate, but said lawmakers should be careful not to overreach, as, he suggested, they had done with other high-publicity legislation adopted in the wake of scandals or tragedies, such as the Station nightclub fire.

With reports from State House reporter Katherine Gregg.