At a time when Tennessee’s nursing home rankings are among the lowest in the nation, the powerful nursing home industry is pushing legislation to protect nursing homes from lawsuits alleging abuse or neglect of those in their care.

The Tennessee Health Care Association, which is financed by most of the state’s nursing homes, and National HealthCare Corp. are reviving their attempts to cap the amount of damages a nursing home would have to pay abused or neglected residents.

The legislation is among several bills moving through the General Assembly this year designed to shield businesses from lawsuits. But in the nursing home arena, where the victims of abuse and neglect are some of the most vulnerable people in society, the debate is getting close attention from AARP.

“Our main concern is to improve the quality of care, rather than just putting a cap on damages so that they won’t have as many lawsuits,” said Margot Seay, AARP Tennessee president. “The way to prevent lawsuits is to make sure the staffing levels are adequate and residents are safe and well cared for.”

Tennessee nursing home residents on average receive registered nursing care 30 minutes per day, she said. The recommended level is 45 minutes.

“If we had the appropriate level of staffing to take care of people, it stands to reason there would be fewer incidents that would result in a lawsuit,” she said.

Industry officials counter that the state’s 330 licensed nursing homes could afford to spend more on staffing if they didn’t have to spend as much on liability insurance, and the insurance costs would likely go down if damages were capped and fewer suits were filed.

AARP released a report in March that concluded that caps on damages and other legal restrictions aren’t effective at reducing nursing home costs, and questioned whether any savings would be used to improve patient care.

Among the better-known lawsuits: National HealthCare Corp. settled 32 actions after a nursing home fire that ultimately led to the deaths of 16 patients in Nashville in 2003. More recently, a jury awarded the family of Cheatum Myers $29.8 million in punitive damages in 2007, an amount that was reduced by a Warren County judge to $163,000. The case centered on the failure to treat Myers for a broken hip after a fall at a NHC facility, and neglect that created other medical problems and suffering before his death in 2005.

The fresh debate comes at a time when Tennessee’s nursing homes rankings are among the lowest in the country, according to the Centers for Medicare & Medicaid Services. One star is worst; five stars is best. Thirty percent of Tennessee’s homes received just one star. Fewer than 7 percent received five stars.

Only Georgia, Virginia and Louisiana had a higher percentage of one-star homes.

Another measure is the number of nursing homes whose admissions were suspended by the state for violations that could endanger patients’ safety. There were 10 suspensions in 2006, 22 in 2007 and 23 in 2008, according to the Department of Health.

Betty Anderson, lead lobbyist for the NHC chain, said the industry is determined to push through lawsuit caps this year. Patrick Willard, advocacy director for AARP Tennessee, is just as determined to require improvements in quality and staffing levels before any liability caps can be instituted.

The legislation defeated last year would have capped compensation at $300,000. This year’s bill would again limit damages for pain and suffering to $300,000. Nursing homes that could prove a higher level of staffing would be subject to lower punitive damage awards.

AARP opposes any cap on punitive damages, which are awarded by a jury seeking to punish a nursing home for wrongdoing.

The nursing home industry is a powerful lobby on Tennessee’s Capitol Hill, and has given hundreds of thousands of dollars to lawmakers in campaign contributions.

This year the political landscape favors bills to limit legal damage awards. Lt. Gov. Ron Ramsey, R-Blountville, has made tort reform a major priority in his role as speaker of the Senate. In the House, the committees that traditionally blocked such bills have been reconfigured and are now friendlier to the nursing home industry.

Seay said she hopes the debate will not erupt into a fight about nursing home profits versus trial lawyers’ fees, with the safety of fragile residents caught in the crossfire.

Paula Wade has covered Tennessee government and politics for 14 years.