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Moratorium on nursing home expansion may be lifted

February 23, 1999
By: David Grebe
State Capital Bureau
Links: HB 826

JEFFERSON CITY - Some lawmakers are saying Missouri's moratorium blocking many nursing homes from adding new beds is causing tragedy for the elderly. Rep. Tim Harlan, D-Columbia, said loosening the reins of regulation will lead to better care.

In an effort to avoid excess bed space and the resulting financial problems, lawmakers imposed in the early 1980s tight restrictions on nursing home expansion.

While there still is a surplus of beds statewide, some homes a filled to capacity. Linda Hagler, executive director of the Rolla Presbyterian Manor, said that situation has forced some elderly spouses to separate.

J.W., an assisted living patient at the Rolla facility, came to need a skilled nursing facility - but their skilled nursing beds were full. J.W., whom Hagler refused to identify, had to be separated from his spouse, G.W.

Shortly thereafter, G.W. got pneumonia - and also was forced to move out. Her family decided to care for here at home - during that time she broke her hip. After her surgery, she was moved to yet another nursing home since Rolla Presybterian was remained full. During this time her husband died.

Hagler said there are two other facilities nearby - and they're not full. Since they have plenty of space, the state won't let Rolla Presbyterian expand.

The present moratorium prevents some nursing homes from expanding - even though they're full - if there is a partially-full facility in the area.

"People are being forced to go to homes that are their second, third, or fourth choice," said Jan Sonnenberg, executive director of the Heisinger Lutheran Home in Jefferson City.

But not everyone in the industry agreed. "By building a new home, you often put patients in the older home at risk," said David Duncan, owner of the Tiffany Care Centers.

Some lawmakers took a dim view of Duncan's position.

"What I'm hearing is that I want you to protect my business because I'm not competitive," said Rep. Todd Akin, R-St. Louis County. Akin said he supports relaxing regulations. "We should just let it roll...I'm for the free market," he said.

Many older people may want to reside in facilities where they can stay if their condition decline - but the moratorium on new nursing home beds prevent many nursing homes from offering "continuing care."

"The moratorium has stifled the whole process," said Shawn Bloom, executive director of the Missourian Association of Homes for the Aging.

Bloom said the problem is more acute in rural areas - since the state sets limits on a county-by-county basis. If one facility is only two-thirds full, he said, that facility limits the expansion desirable nursing homes.

Harlan's bill also includes a provision that would allow for free-standing Alzheimer's facilities. These facilities are presently hobbled by a requirement that "pathways to safety," be made available to all patients.

While Duncan said that "pathways to safety" are important in the prevention of tragedy, Bloom said modern, fire resistant facilities render the requirement is "totally out of date."

The prospect of losing elderly to neighboring states is one motivating factor behind the bill, said Mike Durham, owner of the Kingwoods nursing home in Kansas City.

"They can build anything they want - and more," he said. Durham said that despite Missouri's limits on new beds, Kansas has a higher occupancy rate.