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Nursing Home Rule on Feeding Draws Praise and Fire

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WASHINGTON _ A Bush administration decision to allow nursing homes to hire workers specifically to feed residents has drawn praise from the industry and condemnation from some members of Congress and nursing home advocates.

The decision by the Centers for Medicare and Medicaid Services (CMS) was published Friday in the Federal Register and will take effect Oct. 27 unless rescinded or overruled by Congress.

Until now, federal regulations have required that anyone providing nursing services _ including helping residents to eat or be transported _ must be at least a certified nursing assistant with 75 hours of training.

The new rule will allow nursing homes to hire workers with a minimum of eight hours of state-approved training to help feed residents "who do not have a clinical condition that would require the training of a nurse or nurse aide."

The rule applies to about 17,000 nursing homes nationwide that receive either Medicare or Medicaid money. The agency estimates that 20 percent of the homes, or about 3,400 facilities, will take advantage of it.

Two states _ Wisconsin and North Dakota _ have allowed paid feeding assistants to supplement nursing staff. Florida and Illinois have passed laws permitting single-task workers in nursing homes but have not implemented them, according to the CMS findings. Several other states have expressed interest in allowing feeding assistants, but have been waiting for a federal decision.

Getting federal permission for feeding assistants has been a top priority of the nursing home industry for several years. Industry officials have argued that hiring feeding assistants will allow skilled nurses, who are in short supply, to concentrate on those patients who need extra care.

"Facilities will be able to offer residents more one-on-one interaction during mealtimes, while freeing up nurses and nurse assistants to focus on more complex tasks," said Suzanne M. Weiss, senior vice president of the American Association of Homes and Services for the Aging, in a statement issued after the regulation was published.

Weiss noted that the rule requires feeding assistants to work under the supervision of a registered or licensed nurse and to be monitored frequently, "even daily in some cases."

But Donna R. Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform, called the regulations a "cynical attempt to avoid the nation's nursing home staffing crisis.

"These regulations will allow workers who are virtually untrained to work virtually unsupervised with people who are frail, suffering from multiple medical conditions, and unable to feed themselves," Lenhoff said in a statement.

"They would permit a 16-year-old on a wing without a single licensed nurse to perform the Heimlich maneuver on your 90-year-old grandmother if she choked," Lenhoff said. "If she continued to choke or went into cardiac arrest? These regulations say this 16-year-old with eight hours of training in nursing care should ring the call bell for a nurse."

Two senior members of Congress fired off a letter to Health and Human Services Secretary Tommy G. Thompson expressing opposition to the new rules and urging him to reconsider.

Sen. Chuck Grassley, R-Iowa, chairman of the Senate Finance Committee, which oversees the Medicare and Medicaid programs, and Rep. Henry Waxman, D-Calif., a senior member of the House Energy and Commerce health subcommittee, called the regulation "a dangerous proposal that runs the risk of further endangering the health of the nation's 1.5 million nursing home residents."

Grassley and Waxman said the regulation "does nothing to solve the problem of understaffing in nursing homes ... (and) may actually worsen the staffing problem by encouraging nursing homes to hire low-wage feeding assistants, instead of certified nurse aides."

The lawmakers said in the letter they were particularly concerned that eight hours training was too little to deal with complex issues related to feeding and that there was no role for the government to determine whether the training requirements in each state were adequate.

In an important change, the final rule dropped a requirement that feeding assistants be under the "direct supervision" of a registered nurse. Instead, the supervising nurse must be on the same floor as the assistant and be reachable by a call light or call bell. But the lawmakers noted that such lights and bells "are not answered promptly at many nursing homes, resulting in waits of as long as two hours."

"Such delays in responding to an emergency call from a feeding assistant could have fatal consequences for a choking resident," they said.

A spokeswoman for Grassley said that if the rules are implemented, he will ask the General Accounting Office to monitor them.

On the Web:

Centers for Medicare and Medicaid Services:

American Association of Homes and Services for the Aging:

National Citizens' Coalition for Nursing Home Reform:

Larry Lipman's e-mail address is


Cox News Service

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