BACK TO THE DARK AGES

By MARGARET CARLSON

ANYONE PONDERING HIS OR HER SUNSET YEARS WILL REMEMBER THE expose of the shocking conditions in nursing homes circa 1970. Woefully undertrained workers strapped patients to hard-backed chairs, fed them cheap diets and kept them in a whimpering state of sedation. There were tales of urine-soaked hospital gowns and of false teeth collected at night and thrown into a communal vessel that patients had to fish through in the morning. All this and more was documented by the National Academy of Sciences in 1986. The next year Congress passed legislation to address decades of abuse of the elderly by profiteering nursing-home operators.

But in the blink of an eye these days, a carefully built construct of regulations can be blown away without so much as a formal hearing. As part of a crusade to curb federal authority, and with only a simple assertion that the regulations are burdensome, two congressional committees have sent to the floor for a vote this week legislation that would repeal federal standards. There would be no protection against patients' being restrained, no standards on staffing or when someone could be discharged after using up all his or her money. Niceties like nurses would be optional, since there is no requirement in the new legislation that a licensed nurse be present. Instead there would be so-called patient rights--to receive mail, keep personal belongings and be free from abuse and forced labor--rights that may duplicate, but do not exceed, the Geneva Conventions for prisoners of war.

Republicans justify the changes by saying the states know best how to run nursing homes. Of course, it was the failure of state regulation that got the reforms passed in the first place. It is unlikely that with $182 billion less in federal Medicaid money over seven years the states will embrace high-quality care. The market solution would be to replace that nurse's aide at $10 an hour with an unskilled worker at $5 and to substitute thin soup and macaroni for meat and vegetables.

In fact, it turns out that being humane actually saves money. Catherine Hawes of the nonprofit Research Triangle Institute estimated that after the 1987 reform legislation was passed, $2 billion was saved by 269 nursing homes from fewer emergency hospitalizations, less malnutrition, a 30% decrease in the use of catheters and a 25% reduction in the use of restraints. Says Sarah Burger of the National Citizens Coalition for Nursing Home Reform: "Operators didn't know until they were forced to stop doing it that the main cause of incontinence and bedsores is being restrained and not being able to get to the bathroom." But wholesale budget slashing will no doubt pressure some facilities to cut corners. Senator William Cohen of Maine, one of the few Republicans to oppose the rollback, warns, "If we weaken federal enforcement, we will be sent back to the dark days of substandard nursing homes, with millions of elderly at risk."

Republicans may have entered the slaphappy phase of their revolution, killing regulations simply because they can. Indeed, the nursing-home industry has not even asked for regulatory relief, in part because it would allow unscrupulous operators to flourish and bring shame on all of them. But Speaker Gingrich is hurtling along, fearless about sending Mom and Dad back to the future, to the day of nursing homes that lack nurses and feel nothing like home.