Nursing homes and assisted living facilities assailed for risky and shabby care

Nursing homes, by scrimping on their staffing to maximize their profits, put their residents at grave risk for infections that too often have grisly and deadly results. Low-rated facilities run by Uncle Sam to care for elderly veterans also may be concerning. And those oft-pricey assisted living facilities may have their own response to dealing with difficult to care for elders — putting them out on the street.

Kaiser Health News Service, the Chicago Tribune, USA Today, and the Boston Globe all deserve credit for their digging into problems at facilities caring for the old, focusing on issues that should be at the fore for regulators, policy-makers, and politicians as the nation grays.

Kaiser and The Tribune worked together to dive into data on Illinois nursing homes and their shortcomings that allow small infections to blow up and become costly, injurious, and even fatal in the form of the blood stream infection known as sepsis (see explanatory video). The news team reported:

Sepsis is a bloodstream infection that can develop in bedridden patients with pneumonia, urinary tract infections, and other conditions, such as pressure sores. Mindful of the dangers, patient safety groups consider late-stage pressure sores to be a ‘never’ event because they largely can be prevented by turning immobile people every two hours and by taking other precautions. Federal regulations also require nursing homes to adopt strict infection-control standards to minimize harm. Yet the failures that can produce sepsis persist and are widespread in America’s nursing homes, according to data on state inspections kept by the federal Centers for Medicare and Medicaid Services.

Why? Reporters Fred Schulte, Elizabeth Lucas, and Joe Mahr found that nursing homes, seeking to maximize their profits, skimp on staffing with aides and nurses. Insufficient caregivers mean that nursing home residents, most especially the sickest and most incapacitated, fail to get the attention and care they need, including turning them often enough to avoid pressure wounds or preventing them from getting out of bed, falling, and injuring themselves — such as with cuts that become infected.

Jordan Rau, another Kaiser reporter, in a separate story,  caught nursing homes and federal regulators in fudged data on their staffing. The homes, until recently, could self-report their staffing numbers, with only rare and occasional in-person visits and inspections by federal regulators. They changed their rules, so the facilities and their operators had to supply payroll records, which Rau and Kaiser jumped on and analyzed before officials had, showing that many homes were “like ghost towns” at various times due to short staffing.

The latest nursing home investigation also showed that:

[A] federal report has found that care related to sepsis was the most common reason given for transfers of nursing home residents to hospitals and noted that such cases ended in death ‘much more often’ than hospitalizations for other conditions. A special analysis conducted for KHN by Definitive Healthcare, a private health care data firm, also suggests that the toll — human and financial — from such cases is huge. Examining data related to nursing home residents who were transferred to hospitals and later died, the firm found that 25,000 a year suffered from sepsis, among other conditions. Their treatment costs Medicare more than $2 billion annually, according to Medicare billings from 2012 through 2016 analyzed by Definitive Healthcare.

Uncle Sam has sought to publicly shame nursing homes, creating, as the government already had for hospitals, a star rating system to try to help patients and families shop around for better care. Nursing homes nationwide saw their ratings plunge after officials took into account their actual versus self-reported staffing levels.

VA’s shameful and low-rated nursing homes

USA Today and the Globe followed up on the poorest rated institutions, zeroing in on a dirty dozen of them across the country run by the U.S. Department of Veteran Affairs. In a visit to a VA home in Bedford, Mass., reporters detailed finding an “array of problems with care provided to the more than 200 veterans,” including pressure wounds, high rates of medication and declines in residents’ health. In the VA facilities, lack of caregiving staff may be compounded by poor and even harsh and abusive treatment of residents, the news organizations found.

This is unacceptable in any case but is even more troubling because the VA cares for those who have risked their lives to serve the nation and their families.

Seniors ‘assisted’ out on the street

They’re not the only vulnerable seniors who are getting short shrift from institutions that are supposed to care for them. Judith Graham, who writes the “Navigating Aging” column for Kaiser, has highlighted how assisted living facilities — which can be among the pricier options for seniors hoping to stay in one spot and see themselves taken care of as their needs grow — often eject the elderly as they become frailer and their demands for medical services rise. The facilities simply say they can’t offer the needed care and toss the residents on the street, Graham said, reporting:

Evictions top the list of grievances about assisted living received by long-term care ombudsmen across the U.S. In 2016, the most recent year for which data are available, 2,867 complaints of this kind were recorded — a number that experts believe is almost surely an undercount. Often, there’s little that residents or their families can do about evictions. Assisted living is governed by states, and regulations tend to be loosely drafted, allowing facilities considerable flexibility in determining whom they admit as residents, the care they’re prepared to give and when an eviction is warranted, said Eric Carlson, directing attorney at Justice in Aging, a legal advocacy organization. While state regulations vary, evictions are usually allowed when a resident fails to pay facility charges, doesn’t follow a facility’s rules or becomes a danger to self or others; when a facility converts to another use or closes; and when management decides a resident’s needs exceed its ability to provide care — a catchall category that allows for considerable discretion.

In my practice, I see not only the harms that patients suffer while seeking medical services but also the injury and damage inflicted on them and their families  by nursing home abuse and neglect. Institutional care for the elderly, which often must be located urgently and under dire circumstance, costs them and their families dearly, with nursing home costs averaging $100,000 annually and Graham reporting that assisted-living residents she interviewed paying at least as much — besides getting hit with facilities’ demands that they pay an additional $10,000 a month for full-time, individual caregivers. How much blood are the suits that run these places trying to suck from us?

It’s even more unacceptable because Americans not only often pay out of their own pocket for senior care but also they’re certainly footing big bills through Medicaid, which now covers 6 out of 10 nursing home residents who have run through their finances and must rely on government assistance. In 2015, Medicaid was the primary payer for long-term care, including $55 billion spent on nursing homes.

The situation with senior care will only worsen, what with 10,000 baby boomers turning 65 every day and doing so until 2029. Friends and loved ones now bear huge practical, emotional, and financial burdens in caregiving, but as hospitals and other institutions seek to cut costs and find greater operational efficiencies, more Americans than anticipated will end up in nursing homes or other such facilities at some point in their lives and for some period.

Long-term caregiving and support is a fraught topic, especially when institutions pay so little, demand so much, staff poorly, and when partisans push broader national policies — such as heartless and thoughtless approaches to immigration — that will only worsen the supply of potential workers. It’s also true that nursing homes have additional problems that need cracking down on, including their absence of disaster preparedness (despite deaths and regulator warnings) and a few facilities even abandoning residents in the face of grave dangers. We have much work to do, and we can start by insisting that operators of nursing homes and assisted living get regulated closely and more rigorously and meet laws and standards fully.

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