More than 40 percent of the nearly $2.6 million the nursing home industry contributed nationwide in state elections in 2000 flowed into Missouri and Illinois.

Candidates in Illinois got $596,991, while their Missouri counterparts took in $510,412, according to the National Institute on Money in State Politics.

To put the numbers in perspective, consider that candidates in California received only $82,000 during the same period, while those in Texas got $28,450, according to the nonpartisan, nonprofit research organization.

"Many industries routinely give to campaigns, but when you see disproportionately high contributions, you can bet that, as in this case, there was major nursing homes legislation on the agenda," said Samantha Sanchez, the institute's executive director. She was correct.

In Illinois, the industry hoped to persuade lawmakers to pass a bill that would have increased Medicaid payment to nursing homes by $80 million annually, said Bill Kempiners, the executive director of the Illinois Health Care Association.

"That would have been the issue," that prompted campaign giving, Kempiners said. "We wound up getting $70 million."

In Missouri, a tight gubernatorial race between Democrat Bob Holden and Republican Jim Talent may have led to the contributions, said Earl Carlson, head of the Missouri Health Care Association.

"Anybody who could reach out to folks, I'm sure reached out," Carlson said.

The institute's figures represent only contributions that could be readily identified as coming from the industry and are generally considered conservative, according to the institute. The true amounts of money could be considerably higher.

The political contributions provide only a glimpse of the influence wielded by the industry.

"The nursing home industry has gotten their version of law adopted by legislatures, not only in Missouri, but throughout the country," said Missouri Attorney General Jay Nixon. "Whole areas of law which could improve enforcement of nursing home violations have been weakened over the last 10 or 15 years."

Hosmer v. Carlson: an ongoing battle

For the past three years, Missouri state Rep. Craig Hosmer has been the House point man for nursing home reformers. He has co-sponsored bills aimed at making it easier to fine and revoke the licenses of problem homes.

In 1998, Hosmer, a Democrat from Springfield, was appointed to help lead a legislative task force that examined elder abuse and neglect in nursing homes and found the state sadly wanting.

The task force's report led Hosmer to introduce his first nursing home bill.

It also marked the first of many contacts Hosmer would have with a nemesis, Earl Carlson.

As executive director of the Missouri Health Care Association, Carlson represents what is considered one of the loudest voices among Missouri interest groups.

Employing a small squad of lobbyists, directing money from a large campaign war chest and representing the state's hospitals and long-term care facilities, Carlson is among the most effective political arm twisters in the state.

The industry killed Hosmer's first bill, which included a provision that police be called on every allegation of abuse in a nursing home.

"We lobbied hard to have it defeated," said Carlson, explaining that it would be difficult for most police officers to discern the validity of such allegations from residents who often are confused or have dementia.

"You can't have just anybody investigate," Carlson said. "They're going to require special training."

The bill died on the last day of the 2000 legislative session.

The next year, Hosmer said, industry representatives worked with him to craft a bill, only to then testify against it in committee. Carlson said the association testified against the bill only after the Senate made substantial changes.

Stronger effort, same result

This year, Hosmer enlisted some powerful allies, including Nixon, Lt. Gov. Joe Maxwell and state Auditor Claire McCaskill. They endorsed his bill, which would have penalized homes that experienced a pattern of violations, even if they later corrected the problems.

But some provisions were watered down. One would have cut the number of surveys each year to one from two in the best performing homes. Another would have disallowed anonymous complaints to the state's elder abuse and neglect hot line, a move that advocates and others said would render it useless.

Watered down or not, the bill died in a House-Senate conference committee.

"The industry killed them," Hosmer said. "They see it as government getting involved in their business. It is our business when the state is paying a big percentage of the costs. Right now, they do business pretty much as they please.

"The industry's only concerns they've ever voiced to me is money," Hosmer said. "They don't ever worry about how they can improve the quality of care. They've got the position that any regulation of the industry is bad."

Carlson termed Hosmer's comments "absolutely, unequivocally incorrect," stressing, "The Missouri Health Care Association does not condone negative care in any way."

Carlson, in turn, criticized the state, saying it fails to come up with the money needed to provide required care.

"It's not about the dollar, but the dollars have to be there to provide the care," Carlson said. "A promise to provide care to the poor and sick is being abandoned by the state. The art of dodging responsibility by making accusations that this industry as a whole doesn't provide quality care is not fair and inappropriate."

Industry opposes legislative activists

Hosmer is running for the Missouri Senate, after term limits ended his 12-year House career. The industry is backing Hosmer's Republican opponent, Norma Champion, in the Senate race, he said.

"They're going after me," Hosmer said.

Carlson acknowledged contributing to Hosmer's opponent but said the association issues no endorsements.

"We don't go search for people to contribute to," Carlson said. "When people ask us for consideration of their campaign, we consider them."

When state Rep. Glenda Kelly cast a vote against the interest of the nursing home lobby in the last session of the Legislature, the industry responded in March by placing a full-page ad in her hometown newspaper that accused her of abandoning seniors.

"It was misleading and didn't give any facts," said Kelly, a St. Joseph Democrat. "I was pretty indignant when it came out. It was totally inappropriate."

Especially given that Kelly believes her mother-in-law had been the victim of poor care in a nursing home that led to her leg being amputated. A lawsuit against the home was settled. "I would think this industry would be spending the money that went for those ads on care," Kelly said. Carlson defended the ad.

"The purpose of the ad was to inform her constituents of her position," Carlson said. "It was very clear she voted against the interest of her constituents."

A powerful lobby in Illinois

In Illinois, Chicago Democrat Tom Dart introduced the last major bill aimed at reforming the state's nursing home industry in 1997. The bill, among other things, would have increased minimum staffing levels.

"I put two years of my life into it and it was pretty much all for naught," Dart said. "I didn't move the ball at all."

He credited the nursing home lobby for the bill's defeat.

"It was made clear to me from the beginning that the group I was going up against was one of the most powerful in Springfield," Dart said. "The results speak for themselves. Everybody is aware that some major changes are needed in the industry, but the fact that the bill never even got out of the House speaks volumes in terms of their influence."

Kempiners, of the Illinois Health Care Association, said the industry opposed Dart's bill because the state lacked the money and health care workers to meet the staffing standards Dart sought.

"Did we defeat it? I think we probably helped," said Kempiners, who once headed the Illinois Department of Public Health, which regulates nursing homes. "But when the Legislature looked at that issue, they said they didn't have the money to put into it."

The association raises about $200,000 every two years for its political action committee, he said.

"People like to think because you contribute to a legislator you're buying their vote, and that's very naive," Kempiners said. "What you're trying to do is make sure you have access to the legislator in the future."

Dart is running for state treasurer after serving 10 years in the House. He said the nursing home industry is contributing to his opponent.

Kempiners said that the association normally would not be involved in the state treasurer race, but that it contributed because of help that Dart's opponent, incumbent Judy Baar Topinka, gave the industry while serving as a state senator.

Dart is skeptical of the explanation.

"They have very long memories," he said.