Academic journal article Generations

Nursing Home Politics at the State Level and Implications for Quality: The Minnesota Example

Academic journal article Generations

Nursing Home Politics at the State Level and Implications for Quality: The Minnesota Example

Article excerpt

Nursing home politics encompasses connections among elected officials, officials of regulatory agencies, provider industry representatives, and consumer advocates. These connections involve a spectrum of issues, actions, and decisions-and, as Bruce Vladeck (I980) describes below, heavy doses of image-making.

The manipulation of political imagery is central to much of nursing home politics. Industry spokesmen seek to establish themselves as representatives of their helpless residents, who deserve a slightly larger pittance from penurious state officials. Those officials, in turn, pose as vigilant guardians of the public purse against raids by avaricious and unprincipled nursing home owners. Consumer groups portray owners as vicious abusers of resident welfare and state officials as cowardly bureaucrats secretly in league with the enemy.

Of course, the interworkings of nursing home politics are neither so generalizable nor so categorically simple as this unvarnished sketch. The elected officials include proponents of liberal and conservative approaches at varying levels of influence. Among regulators, poorly veiled struggles for dominance occur between the public health and payment agency officials. The longterm-care industry representatives for proprietary and not-for-profit operators, while united on many points, are just as likely to be carrying opposing agendas on others. Quite similarly, senior membership organizations have priorities, personalities, and histories that divide as well as unite. What exists is a recipe for chaos, yielding decisions that look appalling to the purist and impressive to those who are aware of the chaos from which the decisions have emerged.

This essay assesses, from a consumer advocacy perspective, how the political backdrop for nursing home care has changed in Minnesota over the past two decades and suggests implications for quality services and consumer empowerment. The discussion begins with a snapshot of the terrain in the I970s, then turns to the evolution of political issues, and then identifies elements of consistency and change and their ramifications for the safety and quality of life of nursing home residents in the future.

1970S: EARLY REFORMS

Two forces altered the political landscape in Minnesota during the 1970s. First, a number of scandals raised public awareness of nursing home issues and led to a series of statutory reforms to the way nursing homes were regulated. Second, a grassroots consumer organization emerged and became a steady presence in the debate over public policy in long-term care. The rudimentary nursing home reform laws and the nascent consumer organization were two vehicles that changed the face of nursing home politics in Minnesota and paved the way for consumer empowerment and improved quality of care.

Nursing home consumer advocacy in Minnesota originated on July 12, 1972, when fifty residents from six Twin Cities facilities met and voted to form an independent self-help organization called the Nursing Home Residents' Advisory Council (NHRAC), which became a statewide organization later known as the Minnesota Alliance for Health Care Consumers and now the Advocacy Center for LongTerm Care. Its purposes were to establish resident councils in nursing homes, to inform the public and the legislature, and to improve the quality of life for nursing home residents. The grassroots NHRAC won an early victory in 1973 when members rallied in the office of the State Commissioner of Public Welfare and prompted state legislation to increase the personal needs allowance for nursing home residents from $14 to $25 a month. In 1975, NHRAC cemented operations with a small office in donated space and attracted enough shoestring community support to hire staff. The NHRAC board was established as a nursing home residents' governing council with an advisory group of community leaders and professionals. A membership system sought support from resident councils, and a monthly newsletter, painstakingly typed and mimeographed, was mailed to resident councils across the state. …

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