U.S. eases fines even as nursing homes faulted for infections, evictions

Thousands of nursing homes nationwide have failed to control dangerous and often deadly infections, with their basic contagion controls so poor and widespread that federal regulators repeatedly have issued disciplinary citations to almost 3 out 4 facilities.

Thousands of other nursing homes have drawn the ire of families, advocates, and the AARP for summarily evicting or discharging residents in dubious or possibly improper fashion.

So, what action did the Trump Administration officials announce during the hectic holidays about their oversight of nursing homes? They agreed with complaints by facility operators and owners, the New York Times reported, with officials saying they would be “scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury [as] part of a broader relaxation of regulations under the President.”

The American Health Care Association (AHCA), the industry’s main trade group, persuaded officials who run Medicare and Medicaid that the Obama Administration had pursued policies, including fines, that targeted operator wrongdoing rather than helping to improve nursing home care.

The AHCA insisted, the newspaper reported, that operators and owners needed relief from regulators who since 2013 had issued citations to “almost 6,500 nursing homes — four of every 10 —at least once for a serious violation. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.”

Nursing homes, the newspaper reported, had faced average fines in recent years totaling $33,453 each, but 531 nursing homes amassed combined federal fines exceeding $100,000. (To get an idea of fines imposed against Virginia nursing homes, a Capital News story carried by WGNT-TV’s web site is worth a look.)  Regulators can demand specific fines for a violation, or they can assess a fine for each day a nursing home is in violation. Or they can deny payments from the agency for new admissions.

But when it comes to penalties assessed for serious and spreading infections, regulators apparently kept those fines just below high levels where operators and owners would be required to pay significant sums, the Kaiser Health News Service reported.

This has sent the bad message, patient advocates say, that nursing homes need not worry about rampant infections among their residents of nasty bugs like Staphylococcus aureus, the antibiotic (methicillin) resistant bacterium known as MRSA, and Clostridium difficile, the virulent bacteria also known as C-diff.

Hospitals, even more than nursing homes, long have struggled with infections caused while patients are in their care. Although rigorous campaigns have cut their number and reduced their harms some, federal officials have estimated that more than 700,000 patients suffer hospital acquired infections each year and 75,000 die in hospital care due to them.

As hospitals have been required by cost-conscious reforms to keep patients in their pricey care for less time, patients more often have been moved while still sick into less expensive nursing homes, where infection woes keep rising. But unlike hospitals, nursing homes haven’t adopted big, rigorous campaigns to attack infections by requiring measures such as having caregivers and other staff wash their hands, isolating contagious patients, and keeping ill nurses and aides from coming to work.

Even without the added prospect of fines, infection-control programs can add to expenses for nursing homes — and they have shown in another way how ruthlessly cost-conscious they can be with their contested evictions and discharges of their residents. These elderly and often infirm patients get tossed out of homes because of problems with their Medicaid, Medicare, or Social Security payments, or their beds may be needed for higher-paying residents. As California Healthline, an independent and nonprofit health information service, has reported:

Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates. They have become the No. complaint about nursing homes nationwide.

The news service reported that patients ousted from nursing homes, “end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal … ombudsmen say, they often are unethical.”

Ousting nursing home residents has caused sufficient outrage in California that the AARP and the California Long-Term Care Ombudsman, a patient advocacy organization, have sued facilities and demanded federal investigations to halt evictions and discharges they call unwarranted.

In my practice, I see not only the big harms that patients suffer while seeking medical services but also the constant, painful battles by some to protect themselves from nursing home neglect and abuse. Seniors forced into nursing home care are among society’s most vulnerable, and their families and friends too often grapple with finding them suitable accommodations under dire circumstances and terrible deadlines. The care also is costly, approaching almost $100,000 annually for a senior in a private room.

It’s unacceptable then that already sick seniors then may be put at risk for infections or indefensible ejections by nursing homes — which then have regulators wrapped around their fingers as to needed oversight and potential penalties for problem care. Lawmakers need to set aside their partisan beliefs and to examine the evidence: It’s showing that the aged, not nursing home owners and operators, need support and protection.