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Nursing home patience

The panel working to help Florida's troubled nursing homes should avoid quick and simple fixes and make protection of our vulnerable elderly its top priority.

Everyone agrees Florida's nursing-home industry is suffering through a crisis. One of every five nursing-home beds is managed by a bankrupt company, and insurers once willing to cover the homes' liability are fleeing the state.

What people can't agree on is why. Nursing-home lobbyists say frivolous lawsuits, brought by malpractice lawyers out for a quick buck, deserve most of the blame. But recent hearings in Washington suggest that the causes of the crisis are more numerous. While lawsuit fever may be part of the equation, no one should ignore the industry's own complicity in the financial and human mess now threatening the state.

Republican lawmakers are generally sympathetic to the industry, but even Republicans on the U.S. Special Committee on Aging last week chastised nursing-home representatives for pointing accusatory fingers at everyone but themselves. During the early 1990s, the senators reminded lobbyists, many nursing homes took advantage of overly generous Medicare reimbursement formulas _ which were themselves too often subject to inflated or fraudulent accounting by the homes _ to expand rapidly, incurring heavy debt along the way. When Congress reined in reimbursements in 1997, the industry's projections came crashing down.

"They gambled on a vision of ever-growing government largesse. They got hurt because this vision wasn't based on reality," said Committee Chairman Charles Grassley, R-Iowa, explaining why he didn't think the companies deserved more Medicare money.

Members of a legislative task force now studying the problem in Florida should be equally skeptical of the easy diagnoses and quick fixes offered by the industry. To their credit, Gov. Jeb Bush and key lawmakers seem to appreciate the complexity of the issue. They chose to empanel a study group instead of rushing to make changes they might later regret, such as curtailing the right of nursing-home residents to sue. As it works to complete its report by January, the task force should heed Grassley's admonition to "keep the complete picture in mind."

The big picture includes these considerations:

Financial mismanagement: How much taxpayer funding should Florida use to bail out those homes that made financially reckless calculations in the 1990s?

Lawsuits: Are nursing homes sued more frequently in Florida than elsewhere because lax state laws encourage such suits or because too many homes provide inadequate care and invite them?

Disappearing insurers: Are insurance companies refusing to cover the homes' liability costs because they are afraid of frivolous lawsuits or merely to avoid the unpredictability that comes with even meritorious litigation?

In the end, state leaders will need to craft a solution as creative as the causes of the crisis are complex. Part of that solution may be to raise reimbursement; state Medicaid payments have always been too low, and Congress' 1997 Medicare rollback cut deeper than it should have. But any taxpayer money should come with guarantees that the state's vulnerable elders _ not corporate executives and private investors _ are the ones ultimately protected.