Better nursing home oversight needed for dangerous facilities

Nursing-home-holding-hands-300x200Federal regulators need to ramp up their oversight of nursing homes, big time, with recent news reports and studies finding persistent abuses of elderly patients, including during crackdowns on problem operators, and facilities failing to care for vulnerable charges so they don’t lapse into emergency or hospital care.

Jordan Rau and the independent Kaiser Health News Service deserve kudos for digging into Uncle Sam’s “special focus status,” in which the nation’s “most dangerous” nursing homes get an ultimatum to correct major and continuing harms to patients or they may lose crucial Medicaid and Medicare funds from the federal government.

Rau found that more than half of the 528 homes deemed since 2014 to require the supposedly stringent “special focus” from regulators and that still are operating have since harmed patients or put them in jeopardy in the last three years.

The homes, sprinkled across 46 states and run both by large corporations and mom-and-pop type operators, Kaiser Health News reported, have given “patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries.”

The news service also found that problem homes, on a key measure of patient benefit—the number of registered nurses they employ—lag comparable facilities for years after “regulators conferred clean bills of health” on them.

Although federal regulators talk tough, they fail to go often enough to problem sites for in-person inspections. Their heightened oversight lasts, typically, for just months—too short a time for facilities and operators to demonstrate real improvement. Regulators still and often impose fines, some in the six figures. Those penalties may represent little more than “the cost of doing business” for many scofflaws. The homes not only keep operating but they also rarely lose critical Medicaid or Medicare funding.

Since Uncle Sam started his watch list in 2005, 900 or so worst of the worst homes have been put on “special focus status,” but the number of facilities under scrutiny has declined since 2012. That’s because President Obama, under pressure from the GOP-controlled Congress, negotiated a slash in the oversight program’s budget, which also is allocated so each state gets a fixed number of slots for troublesome homes. Regulators can put just 88 homes on notice each year.

Even after they get off the target list, a third of the problem nursing homes stay as bottom dwellers, receiving Medicare’s lowest “star” ratings for health and safety. That has led Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan, to observe that, “You have this recidivism of nursing homes that are special focus facilities. These are the worst of the worst and they’re [allowed] back?”

Federal officials defend their program and say they’re doing what they can with limited resources. They agree that few homes end up closing due to stepped up oversight, and said that may be a necessary outcome—to avoid huge disruption to patients and families, who may not have alternatives in a given area if a problem home does close.

Social media abuses

These toothless regulators aren’t alone. Separately, Pro Publica, the Pulitzer Prize-winning investigative web site, has followed up on its dig into appalling social media posts by abusive nursing home staffers. Though these invasive incidents are supposed to be covered by rigorous federal health care privacy laws, Pro Publica found further instances in which nursing home staffers put online pictures of elderly patients’ buttocks or genitals or published videos of them in compromising and private situations.

Pro Publica says it has cataloged more than five dozen of the intrusive cases involving social media, with nursing homes and regulators only slowly moving to deal with legal and privacy issues they raise.

In my practice, I see not only the harms that patients suffer while seeking medical services, I also am saddened by my extensive representation of the elderly injured by nursing home abuse and neglect. We cannot allow some of society’s most vulnerable and ill to be exploited by profit-seeking nursing home operators. It is, regrettably, a constant battle to ensure even the best of them provide the optimum care the aged have more than earned and for which their families pay dearly. We cannot, by the way, allow nursing homes to hide their problems and errors with care behind legal screens like forced arbitration.

Older patients, to be sure, aren’t easy to care for, especially as their mental and physical health declines with age. It is disappointing that another federal initiative known as INTERACT (interventions to reduce acute care interventions) isn’t helping nursing home patients as much as hoped to avert costly, disruptive lapses into emergency or hospital care.

But doctors, hospitals, and nursing homes deserve credit for putting into place these test procedures, tools, and approaches in hopes of improving care. Such initiatives, including another that is showing some progress to get nursing homes to reduce abusive prescription of psychotropic drugs to make older, sometimes dementia affected patients easier to control, at least offer hope that seniors can get better institutional care.

With our nation graying rapidly, we must ensure that we’re getting the highest and best value for every taxpayer dollar spent to care for the old. It’s also counter factual to think that the costs for medical services for the aged won’t hit all of us—poor, middle- and upper-class alike—hard, and that we will need collective, federal ways like Medicaid and Medicare to deal with this giant challenge. Making radical cuts in these programs makes no sense.

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