Federal regulators have given up the unwarranted secrecy enshrouding their watchdog efforts on the nation’s most problematic nursing homes.
With prodding from the U.S. senators from Pennsylvania, Democrat Bob Casey (above left) and Republican Pat Toomey (above right), the Centers for Medicare and Medicaid Services (CMS) disclosed its list of hundreds of nursing homes that perform so poorly they are on the brink of regulators’ most dire supervision.
CMS had declined to disclose its candidates for designation as a “Special Focus Facility” (SFF), preferring instead just to tell the public about its worst of the worst nursing homes, 88 facilities with the SFF tag that receive a targeted, higher level of inspection because of their poor performance. The most rigorous oversight can be resource intensive, and CMS can only scrutinize at the highest level a few poor performing homes, whose infamy is made public. When one facility “works its way off” an SFF designation by improving its failings, others are on the heretofore secret list to take their place.
Casey and Toomey told CMS that many nursing homes seem to perform well and that the agency’s reasons were unacceptable for keeping quiet about hundreds that are “indistinguishable” in their bad operations from the worst.
“Choosing a nursing home is a difficult, and often painful, decision to make,” Casey said in a statement. “Individuals and families deserve to have all the information available to choose the facility that is right for them … When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings.”
The list can be accessed by clicking here.
It includes five nursing homes in Maryland: Autumn Lake Healthcare at Pikesville, Patapsco Valley Center, Canton Manor, and Cadia Healthcare facilities in Wheaton and Springbrook.
Five Virginia facilities are candidates for regulators’ “special focus”: Ashland Nursing and Rehabilitation, Battlefield Park Healthcare Center, Woodmont Center, Augusta Nursing and Rehab Center, and Envoy of Westover Hills.
The candidate list does not include any homes in the District of Columbia. But the CMS site “Nursing Home Compare,” shows how federal officials display ratings and quality information on just under 100 facilities within a 25 mile radius of the nation’s capital. The Cadia Springbrook home is listed with the symbol, indicating it already is a special focus facility.
As the Associated Press reported, oversight of nursing homes needs to be a significant concern for federal regulators: “About 1.3 million Americans live in nursing homes, with more than 15,700 such facilities nationwide. The troubled nursing homes that Casey and Toomey identified are … about 3 percent of all homes.”
Still, there are 2,900 homes nationwide that get only one out of five stars on their CMS rating, meaning inspectors found them to be “much below average” in delivering safe and quality care to residents, the AP reported. That’s hard to accept, given that Uncle Sam says that nursing homes charge on average more than $92,000 annually for a private single room.
Taking on the long-term care problem
Most seniors, of course, would prefer never to spend time in a nursing home, though this is becoming a daunting national and individual challenge as the nation grays. It is further complicated by the fiscal reality that most middle-class Americans won’t be able to afford assisted long-term care if and when they need it.
Money magazine reported on the problem that seniors and the nation face:
The number of Americans 65 and older will double to 98 million by 2050, and studies show few have the financial resources to pay for care in old age. More than half of adults 65 and up will require long-term assistance at some point with everyday activities, for an average duration of about two years, according to a 2015 study by the Department of Health and Human Services.
The magazine found that states are scrambling to find ways to “help people stay in their homes — and not move to nursing homes — [because this] can keep residents happier and save them and the state money. Medicaid programs help cover the costs of 62% of nursing home residents.
Hawaii and Washington are taking leadership roles in novel approaches to supporting seniors staying at home, Money said:
Washington state’s ambitious plan, signed into law in May, will employ a new 0.58% payroll tax (or ‘premium,’ as policymakers prefer to call it) to fund a $36,500 benefit for individuals to pay for home health care, as well as other services — from installing grab bars in the shower to respite care for family caregivers. Hawaii’s Kupuna Caregivers Program, which was initiated in 2017, is also publicly funded, but state budget allocations limit enrollment and benefits. It provides up to $210 a week for services when family caregivers work outside the home at least 30 hours a week.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by nursing home abuse and neglect. Nursing homes have become a booming business with combined annual revenues estimated at $240 billion. Uncle Sam spends $400 million annually, the AP reported, to regulate and inspect the industry, with the Trump Administration seeking $45 million more.
Nursing home nightmares
This is a business that clearly needs more oversight, as Casey and Toomey found, with bad operators in the industry harming vulnerable elderly residents:
- In Michigan, a resident who had his catheter removed bled through the night and when he was finally taken to the hospital the next morning, he died. An interview with his roommate at the facility revealed that the resident was bleeding and moaning through the night. At this same facility, another resident who repeatedly complained of pain over a monthlong period was ignored. The resident was subsequently hospitalized for several weeks due to an infection.
- In Ohio, a facility failed to assess the residents’ nutritional status such that surveyors identified 14 residents who had lost weight in the last 30 days. One resident’s weight loss was so severe that the person lost 33lbs in 31 days, became lethargic, and was hospitalized for malnutrition.
- In Delaware, a facility failed to promptly investigate allegations of sexual assault against a member of staff, which resulted in the victim not being referred to the hospital for examination until two days after the incident. Additionally, the facility allowed the alleged perpetrator of the abuse to continue working during the investigation, with access to the victim. As of May 29, 2019, this facility had staffing and quality ratings of five stars.
- In Hawaii, a facility failed to correct an insect infestation such that there were cockroaches and ants near residents, on countertops and crawling on medical charts. As of May 29, 2019, this facility had an overall rating of two stars, with a quality rating of five stars
A fundamental concern in nursing homes, as well as in health care in general, focuses on staffing. CMS and too many homes got caught fudging federally required data, with a Kaiser Health News service reporter crunching numbers to find that facilities gave short shrift to residents at night and on weekends. Meantime, of course, the money flows upward — to rising profits and pay and perks for money-focused suits. The difficult front-line care, as handled by nurses and aides, is nowhere near as financially rewarding. It also is worth noting that the xenophobia and harsh extremism in the White House-driven immigration policy and action is at far odds with the needs of patients and their loved ones. Taking care of the sick and injured can be hard labor — and the nation needs people willing and able to do it and many of them come from other lands.