Remarks of Eric H. Holder, Jr.

Deputy Attorney General

Nursing Home Abuse and Neglect Prevention Conference

Philadelphia, PA

October 26, 1999


I would like to welcome everyone to this important conference. This is the second of four conferences being held around the nation that are looking for concrete strategies and actions to bolster our efforts against fraud, abuse and neglect in nursing homes.

This conference would not have been possible without the exceptional commitment from a number of people. I would like to thank Mike Stiles for agreeing to host this conference and for his personal commitment to protecting our nation's elderly against abuse and neglect. I also want to recognize the efforts of Assistant United States Attorney David Hoffman and Kim Heinz, also of the U.S. Attorney's office, for their countless hours of hard work in putting together this conference. I also would like to thank MT Connolly and Carol Cribbs, from Main Justice, for their dedication to making these conferences a reality.

Launch of the Nursing Home Initiative

Exactly one year ago, the Department of Justice, along with the HHS Office of Inspector General, the Health Care Financing Administration, and our partners in other federal, state and local agencies, gathered outside Washington, D.C., to launch an ambitious and important effort - a plan of action for combating fraud, abuse, and neglect in nursing homes. That conference was a seminal event [in our efforts and resolve] to protect the residents in nursing homes and other residential care facilities.

The need for rigorous enforcement of all laws protecting our nation's elderly nursing home residents is clear. As a nation, we have a special responsibility - a special duty - to protect the most vulnerable members of society's. And in the government, we have a special responsibility - backed up with the force of law - to protect the residents of nursing homes that are funded with federal and state tax dollars.

As many of you have seen firsthand from your work in this industry, many nursing home residents are not able to protect themselves from acts of violence or other inappropriate physical contact, not able to get out of bed and go look for a new health care provider who will treat them more appropriately, not able to discern that the appropriate number of floor nurses are not on duty because the facility's owners cut staff levels in order to save money; many of them are not able to even make a verbal complaint about their care or make the degree of their suffering known.

That is what makes abuse and neglect in the nursing home setting particularly heinous -- the fact that many victims cannot defend themselves or express their outrage. They rely totally on their care givers for the most basic of needs. And they rely on us to ensure that safeguards are in place to oversee the performance of their care givers and to take timely, effective enforcement action against those who do not provide quality health care.

Although many nursing homes provide top-quality care to their residents, the conditions in far too many homes are down right horrific. As many of you know, the U.S. Attorney's Office in Philadelphia took action against a nursing home in which a resident was scalded to death after she was placed in a bathtub full of extremely hot water. This was not an isolated incident, but rather the result of a pattern of problems that exposed residents to abuse and neglect. Later this morning, you'll hear a first-hand account from the family member of a victim. I urge you to pay careful attention to her words, to close your eyes and reflect on how you would feel if this had occurred to your mother or father, and to steel your resolve to take every possible step within your power - as a law enforcement official, regulator, patient advocate, or member of the public - to protect nursing home residents.

Unfortunately, this will be a difficult and demanding job. According to a survey of DOJ enforcement efforts, the number of new investigations opened each year involving fraud and abuse in nursing homes has jumped substantially. In 1994, we opened 5 new investigations; in 1997, we opened 54 new cases - a 10-fold increase. More than one-third of these cases involved instances where the fraudulent activity resulted in substandard care that could pose a risk to individual patients. We are receiving a steady stream of qui tam complaints alleging fraud and abuse in nursing homes - and we have every reason to believe that this problem will not go away.

Historically, nursing home enforcement was the province of the state and local prosecutors. Of late, however, it is increasingly an issue for federal law enforcement given the proliferation of cases and insolvencies involving multi-state and multi-national chains, and the stubborn fact that abuse and neglect are still all too common.

Today, approximately 33 million Americans are over the age of 65. This number is expected to double by the year 2030. While advances in the health field are making it possible for elderly Americans to live longer and fuller lives, the number of Americans residing in nursing homes and other residential care facilities will increase significantly in the coming years.

Priority within the Administration and DOJ

Despite the daunting nature of this challenge, there is reason for optimism. President Clinton and Secretary Shalala have implemented tough new measures in our regulatory enforcement program designed to improve quality of care and, where care falls short, to impose appropriate regulatory penalties.

Similarly, the Department of Justice has launched a Nursing Home Initiative to enhance and expand our enforcement efforts.

Let me tell you about it:

First, to ensure appropriate day-to-day focus on this initiative, we have tapped MT Connolly - an experienced attorney in the Civil Division - to serve as the Department's Nursing Home Initiative Coordinator. MT is responsible for coordinating all of our enforcement, prevention, and compliance efforts - from involvement in major multi-district investigations, to policy coordination with HCFA, OIG and state and local agencies, to efforts that are looking at expanding support and assistance to victims of nursing home fraud, abuse and neglect.

Second, we are working with our partners in the HHS Office of Inspector General and Health Care Financing Administration, the VA, as well as with the Medicaid Fraud Control Units, the state Attorneys General offices, local District Attorneys, state licensure and survey, patient ombudsman programs and Adult Protective Services to ensure that potential incidents of fraud, abuse or neglect are promptly referred to - and aggressively pursued by - law enforcement agencies.

Third, we are working to increase communication and information sharing between law enforcement and regulatory agencies. In the past, the nature of our system - involving a diverse array of law enforcement and regulatory agencies at the federal, state and local level - has been an impediment to effective enforcement efforts. Today, we must look for ways to leverage our resources so that information about potential abuse or neglect is quickly shared and acted upon.

Fourth, we are working on a review of state laws to identify those states that have the most effective abuse and neglect statutes and enforcement mechanisms, and to encourage other states to update their laws or enhance their enforcement efforts as necessary.

Fifth, we are conducting outreach to industry. A key component of this efforts involves working with the HHS Office of Inspector General to bolster compliance initiatives within the industry.

Sixth and finally, we have proposed legislation to address gaps in current federal law. Specifically, the Administration has proposed legislation to establish new criminal and civil penalties against individuals and organizations that engage in a pattern of abuse or neglect that result in patient harm. This legislation is particularly important because the federal government is in a unique position to investigative and punish offenses by multi-state companies.

The Purpose and Goal of the Conference

This bring us to today's conference. I have outlined what we are doing at the national level to combat abuse and neglect in nursing homes. Today - and for the next three days - you will be discussing how to implementing these initiatives on the ground. You will learn more about the enforcement process, including ways to increase information sharing and coordination. You will hear experts describe how to more effectively investigate and prosecute nursing home abuse and neglect cases, and how law enforcement can and should work closely with regulators, patient advocates and others in the system.

Perhaps most important, you will break into state working groups. These groups will provide a unique opportunity in this very interdisciplinary field, for all of the key players in various states to identify how to work together. Experience has demonstrated that no one person or agency has all the answers, and that no one approach will work in every instance. Rather, we need to pursue new approaches - through increased coordination, better information sharing, more aggressive enforcement, and better outreach to advocates, patients, and their families.

We know that law enforcement is part of the puzzle and not the only answer. But it can provide an important back-stop to all of your efforts on the front lines. If a nursing home knows that it will be prosecuted it if lies to you or conceals records when you conduct a survey; if it knows that it will be prosecuted for abusing or neglecting those who have been entrusted to its care, it will think twice about such conduct. And if facilities know that you are meeting regularly with regulators and law enforcement officials to discuss issues of inadequate care in nursing homes, that coordination alone can be a very powerful incentive for problem facilities to improve the care they provide.

It is our goal that your meetings tomorrow will be just a beginning. After the conference, I urge the state working groups to convene on a regular basis - to discuss challenges and identify solutions. And please let us know how you progress so that the other state working groups can benefit from the lessons you learn; from your successes.


Again, I want to welcome everyone to this conference. I urge you to reflect upon our responsibility - as government officials or members of the public - our duty - to do everything in our power to protect nursing home residents against abuse and neglect. And I challenge you to look for new approaches and new opportunities that enhance our ability to do so. Working together, we can - we must - make a difference.

Thank you.