Although there has been some progress, it has been very slow and minimal at best, with pain rates still far too high (47). Often, bureaucrats, health policymakers, and legislators try to resolve issues with even more regulations or laws. Additional regulation does not seem to be the answer, and more government oversight also will probably not prove beneficial. Although the intent of additional regulation is often admirable, it is important to assess the impact of regulations. In a study of the impact of the Omnibus Budget Reconciliation Act of 1987 on the tangible measurement of pressure sores in nursing home residents, Coleman et al. (48) showed no change in the prevalence of pressure sores from the early 1990s compared to the late 1990s. In the nursing home, where there is an unparalleled onus of regulations, additional regulation is more likely to affect patient care negatively rather than accomplish the goal of improved pain management (49).
Nursing homes must maintain above 80% occupancy to have a positive balance sheet. Close economic margins have limited the ability to hire new staff as nursing homes struggle to remain solvent. Regulations are costly and time consuming. Rarely is there a mechanism in place to evaluate the efficacy and burden of regulations once implemented. If ineffective, a mechanism should be in place to drop such regulations subsequently.
Nursing homes continue to see costs escalate (in part because of a continual onslaught of new regulatory requirements and surveys) without funding to accommodate the additional financial burden. Genesis Health Ventures Inc. initially filed for Chapter 11 bankruptcy in U.S. Court on June 22, 2002. Shortly after emerging from bankruptcy, the company's chief executive officer resigned in mid-2002, indicating the need for work to reform nursing home reimbursement. The former chief reportedly remarked: "We need a permanent stable funding source for this industry to continue to exist. If Congress does nothing, the industry will collapse" (50). The significance of these words was amplified later that year as Genesis again experienced familiar financial difficulties and reportedly sought to sell off much of its nursing home business.
In the pain field, the damage from overregulation has been impressive. The money wasted in association with state, federal, and system regulatory requirements consists not only of taxes and revenue taken directly from the citizens and consumers to pay bureaucrats who oversee the regulations, but also of indirect costs associated with lost energy that goes into filling out forms and the costs related to the distraction of creative power and diversion from pain evaluation (51).
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