Arkansas: politics & reform. (nursing homes) (column)

The long-term care industry has come to expect assaults by politicians. Sometimes they are justified, other times they are purely political. In Arkansas, things went to extremes. Arkansas' attorney general declared war on the Arkansas Nursing Homes Association (ANHA) this past May.

"The war is on!" fumed A.G. Steve Clark after months of acrimonious negotiation with the ANHA over inspection, certification, and various reforms broke down.

Clark once served as administrative assistant to U.S. Senator David Pryor (D-AK). Pryor's reputation as a nursing home reformer started when he placed undercover investigators in nursing homes. Clark did the same. Secret agents in four nursing homes produced information leading to disciplinary action against them, while typical horror stories surfaced elsewhere. The media in Arkansas, including Little Rock's Arkansas Democrat and the Gazette, published in-depth stories.

Clark's detractors contended that he had less interest in substantive reform than in stirring up publicity and aiding his own political ambitions. He is looking toward the 1989 gubernatorial election.

Before his declaration, negotiations between combatants nearly produced new statewide machinery to oversee and certify nursing homes. There would have been two "peer review" committees: "One to identify homes providing quality care and the other to help close those that do not;' as the Democrat paraphrased Clark. The ANHA, at a general meeting, selected six negotiators to work out details with him. The sides were unable to agree along original lines, but signed a five-page agreement on a somewhat less ambitious peer-review plan. Both sides also agreed to support a 14-part legislative reform package.

Clark anticipated a May 1 start for the inspection/review plan: The six nursing home representatives were to take the treaty to the ANHA board, then prepare to sign up nonmembers. Sadly for detente, according to the Gazette, "only 13 out of 100 nursing home owners . . . responded to his written request" for support of the peer-review and legislative programs. General Clark ("general" actually is what an attorney general is called) blamed ANHA President Earnest Allen's letter urging owners not to support the plan. Clark called for new leadership within the industry.

Despite the acrimony, the combatants reached settlement: Six new laws were enacted in a special legislative session with the ANHA:s assent. Three embody Clark's positions, three ...