Interview with Anna Spinella, Tom Skully
ERIC OSBORN, CNN ANCHOR: Picking a nursing home for an elderly loved one may be one of the toughest decisions a person can face. Help may soon be on the way to make the choice just a little bit easier. A pilot program in six states now offers inside information about the care being offered at area residences. To learn more about this, we are joined by Anna Spinela who is with action advocates committed to improving our nursing homes. She is in Tampa. And in Washington, we are also joined by Tom Skully. He heads the centers for Medicare and Medicaid services. Thank you to both of you. Let me begin with you, Anna. Some of the experiences you talk about which motivated the pilot program are, to say the least, very disturbing.</s>ANNA SPINELLA, ACTION: Yes, the funny thing about this, I never intended to do this kind of work when I retired. But I became my family's designated caregiver a number of years ago. And for the last eight years have cared for three different family members at the same time in several different nursing homes in the Bay area. My eyes opened very wide during those experiences. I have seen it all, heard it all smelled it all, tasted it all and determined that something had to be done but I couldn't really complain about it if I didn't try to do something. And so that's why I'm here.</s>OSBORN: Anna, give us an instance of some of the treatment that rose concerns for you and what your sense is of how this pilot program is in terms of how it might help.</s>SPINELLA: One of the earliest things that started to open my eyes was when my brother-in-law, who was a purple heart veteran, was in a nursing home here in Tampa and he was due to have a rehabilitation therapy beginning at 9:00 in the morning. And I would come into his room at 8:00 in the morning and find him ice cold, sopping wet, with the remnants of breakfast over him, covered with dried and spilt milk and dried food on the bed, and the sheets laying on the floor and arrive at the doorway to find him naked in his bed, visible from the door. If he was to be up and ready for rehab, which was on another floor, I had to get him up and get him ready to do that. And I was glad to do that. But that was not the right thing. That was not the way he should have been treated. I eventually took him out of that nursing home before his Medicare days were up because I could no longer go in there with my sister in the morning and see him like that. It just wasn't right. And I did move him -- actually I took him home. Took care of him at home for about four years before it became necessary to place him again in a nursing home. And from that point -- I used to try and go in there with blinders on -- I'm just going to take care of my person, that's all I'm going to do, I'm not going to look at the person in the next bed or the person down the hall -- even though I knew there were problems. I somehow didn't want to deal with it. But at some point I couldn't do that anymore and I really had to bite the bullet and say, OK, this is everybody's problem and so it's my problem, too and I need to be part of the solution. It's been an experience.</s>OSBORN: About that solution, I wanted to ask Mr. Skully, bring him in here, among many things this program does include greater accountability, to say the least. Your sense of its impact?</s>TOM SKULLY, ADMINISTRATOR, CMS: Well, we have -- the whole point is to solve our problems. There are good nursing homes and bad ones. Seniors and families have a right to know which are the good ones and which are the bad ones. If we are going to fix it, we are all in this together. Our view is have to measure the quality and let people know which are the best nursing homes and try to raise the bar for everybody and make all of the nursing homes better. In six states we published the quality results of all the nursing homes in those states in the biggest newspapers in the states, including Florida. Some people weren't happy about it but the fact is, we believe measurement and public disclosure focuses everybody on the best nursing homes, and the ones that have problems have to fix them. The government is paying for 80 percent of the nursing home beds in the country between the two programs that I run, and we think patients have a right to know which ones are good and which ones aren't.</s>OSBORN: Now does this sense of greater accountability, is it something you could envision or prescribe for the entire country?</s>SKULLY: Yes, we're planning, Secretary Thompson and President Bush wear every supportive of this. is a six-day demo to make sure it worked. And we had great support from nursing homes, the patient groups, the AARP, and our plan right now is to roll it out nationwide in October.</s>OSBORN: Anna, is that something you'd like to see, a national accountability?</s>SPINELLA: Definitely. I think corporate accountability is very important. What I fear about this program is that it is kind of a band-aid approach and it does not really focus on the main thing that creates adequate care in the nursing home and that is a sufficient number of adequate staff. The staffing numbers are not at all in the paper. The items that are in the paper are negative outcomes in effect. I found them hard to really explain. In three cases there were nursing homes that I've had personal dealings with. One of them is one of the top two or three nursing homes in the entire state of Florida. But if you looked at those criteria that were there, you would not get that impression at all.</s>SKULLY: We have the best academics in the country do it. We didn't pick them. We commissioned the national quality forum to do it. You can complain about the outcomes. It's the first time anybody's done it. We have been pretty aggressive. We do on our Website and the states that collect that have staffing information, we are trying to start collecting and disclosing that. We'd love to work with Anna and anybody else to make these things better. But it's the first time anybody's done any public disclosure of this and we think it's a big help.</s>OSBORN: Mr. Skully, I wanted to ask you about your sense, we hear a lot about public versus private in this kind of thing. Some have suggested that in the absence of incentives, or private sector involvement, you might not see the kind of progress you might otherwise expect. Your sense of that balance?</s>SKULLY: Most nursing homes in this country are privately owned and there are a lot of good nursing homes. There are a lot of bad ones. My attitude is, it is easy to complain. We have to fix them and the government's role is to work, cooperate with the nursing homes, to raise the quality, talk about quality, measure quality, tell patients what is available. If you're picking a nursing home for your mom, your spouse, your dad, you have a right to know which ones are good. We have the best measurements we can. They may not always fair or perfect, but we believe it is a lot better than nothing. What we had until two weeks ago was nothing. So we're going to aggressively push forward on this.</s>OSBORN: Anna, I would expect it is something you'd be very enthusiastic to see, not only your loved one ones but others as well.</s>SPINELLA: Yes, I really welcome this extra pair of eyes. It's important that people be focused on what they are doing. A lot of times you can't make a choice. You come out of a hospital and the discharge planner has told you you have 24 hours to find a nursing home. You really can't make a choice quite that way. But nevertheless, everything that focuses on the nursing home and the inadequacy of care that presently exists is very important. I look at this at a small drop in the bucket, but we want to get the bucket filled and we want to have adequate care. There are almost 3 million people in nursing homes here in America; 9 out of 10 of the nursing homes we have been told by the government do not provide adequate care. We need to bite the bullet and make the care there. Corporate accountability is very important. I'm very, very stressed to find that a number of the corporate chains have been found by our justice department to have produced many, many fraudulent claims up into the millions, hundreds of millions of dollars. That has to stop and that money could be better...</s>SKULLY: We have pretty aggressively gone after a couple of the big chains. We have collected a lot of money from them as well. The point is, the nursing homes do have quality problems, many of them. We have to fix them. Anna is totally right, it is easy to talk about them. My view is, we have to start plugging away and fixing them. Public disclosure and discussion is a big part of that.</s>SPINELLA: I agree with that.</s>OSBORN: Anna Spinella, Tom Skully, thank you both for your time and both discussing a serious group of problems as well as some potential solutions. We appreciate your time.</s>SKULLY: Thanks.</s>SPINELLA: Thank you for giving us the opportunity, Kris. You, too, Mr. Skully. Pleasure to meet you and to look forward at what you're going to be doing.</s>OSBORN: Thank you very much. TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com