Articles Posted in Elder Population Studies

Corporate nursing homes may provide lower quality care to its residents and low salaries for its meager staff but they appear to be doing well when it comes to turning a profit. According to ABC News, some for-profit nursing homes are in violation of the Fair Labors Standards Act for the horrific and exploitative way they treat their staff. An undercover investigation found “rampant wage theft” with nursing home staff working for $2 to $3.50 an hour – less than half the federal minimum wage, which is set at an anemic $7.25 per hour. These nursing home chains tend to hire immigrants, knowing they will be afraid of dealing with law enforcement.

The undercover investigation found that these workers usually awake before dawn to “cook meals, shower residents and scrub toilets.” These for-profit nursing homes who are engaging in behavior that could constitute human trafficking typically only hire staffers who will live at the facility. This means the early mornings lead to nights “deprived of sufficient sleep” as they respond to nursing home residents, change diapers, dispense medication, and deal with unruly patients. The nursing home then charges the staff a fee of $25 each day for “lodging” which leaves workers feeling “desperate and trapped.” The national news publication says nursing home workers are rarely allowed a day off and must pay for their substitute when offered this basic human right.

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Northern Metropolitan Residential Health Care Facility received 17 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on February 13, 2020. The Monsey nursing home’s citations resulted from a total of two surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not implement proper steps to care for pressure ulcers and bedsores. Section 483.25 of the Federal Code stipulates, among other things, that nursing home facilities must provide residents with the necessary treatment and care to promote the healing of pressure sores. A March 2017 citation found that Northern Metropolitan Residential Health Care Facility did not ensure the provision of necessary care and treatment to a resident with a sacral pressure ulcer. The citation states specifically that the nursing home “did not ensure that a protein supplement was administered to the resident as ordered by a Nurse Practitioner to promote wound healing.” In an interview, one of the facility’s Registered Nurses stated that the supplement “was not correctly picked up” and as such was not given to the resident. The citation describes this deficiency as having the “potential to cause more than minimal harm.”

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DRY Harbor Nursing Home received 25 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 19, 2019. The Maspeth nursing home’s citations resulted from a total of three inspections by state surveyors. The violations they describe include the following:

1. The nursing home did not ensure necessary treatment and care of bedsores / pressure ulcers. Section 483.25 of the Federal Code requires nursing homes to ensure that residents with pressure ulcers receive “necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.” A January 2019 citation found that one of DRY Harbor Nursing Home’s Licensed Practical Nurses “did not practice acceptable standards and wound care techniques” for a resident suffering from a stage 3 pressure injury. Among other findings, an inspector observed the LPN removing the resident’s diaper and rubbing the wound site with gauze after running saline over the wound, contravening the best practice of patting areas dry to prevent tissue damage. The inspector also observed the LPN applying “two parallel strip amounts” of medical creams a gauze strip, instead of mixing the creams together. According to the citation, the LPN then put the same diaper back on the resident, later informing the inspector that “using a clean diaper would have been referable in keeping with infection control practices.”

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US News & World Report released their annual rankings for 15,000 nursing homes across the country. The ratings are calculated using data on staffing, success in preventing emergency room visits and repeat hospitalizations, the rates of pneumonia and flu immunizations, antipsychotic use, and other factors. Rankings for each nursing home are calculated both for “short-term” performance and “long-term” performance. 

Here’s how local nursing homes stacked up against the competition, according to LoHud.com

High Performing in both Long-Term Care and Short-Term Care:

In a detailed piece on Health Affairs, David G. Stevenson dissects the current issues facing the nursing home industry and the government’s role in overseeing the unwieldy, complex industry. Beginning with the failed hope of the Nursing Home Reform Act, signed into law more than 30 years ago with the purpose of ensuring nursing homes provide a safe and healthy environment, Stevenson quickly delves into the absentee government oversight that has occurred since the landmark legislation.

After the high-profile rollback of several regulations enacted during the Obama administration deemed unnecessarily punitive or ineffective, the Centers for Medicaid and Medicare Services (CMS) appears to be refocusing its efforts on the well-being of nursing home residents.

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Senators released a list of 400 nursing homes with a ‘persistent record of poor care,’ according to the federal legislators. These nursing homes are not included in the federal government’s “special focus facilities” a list of nursing homes released by the government each year indicating poor care and unsafe conditions. According to the Senators, the list of 400 facilities is “virtually indistinguishable” from special focus facilities and the elder care facilities are not all lumped together only because a 2014 law imposed a cap on the number of so-called special focus facilities. Consequently, this left 400 facilities subject to heightened government scrutiny without public knowledge.

According to the Centers for Disease Control and Prevention, approximately 1.3 million Americans are nursing home residents at 15,600 facilities across the country. The federal government identified 3 percent of these nursing homes as problematic in April. In New York, these nursing homes include New Roc Nursing and Rehabilitation Center in Rochester, The Knolls in Valhalla, and Cayuga Ridge Extended Care in Ithaca, according to LoHud.com. In addition to these nursing homes, fourteen other New York long-term care facilities were included in the list of 400 released by the Senate.

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New York nursing home regulators knew an upstate nursing home’s roof leaked for four years before finally forcing the owner to fix the safety hazard. According to Syracuse.com, the state Health Department inspection records show reports of “water-stained ceiling tiles” and “a hose running down from the ceiling of a resident’s room into a rusty bucket” dating back in 2015 and 2016. The Health Department is responsible for inspecting nursing homes in New York every 16 months.

After noticing the leaky roof in 2015, inspectors worked with Pontiac Nursing Home to fix the ceiling tiles and the leaky roof. Despite the clearly hazardous conditions, the upstate nursing home never implemented the plan. Consequently, the ceiling was still leaking when inspectors returned in 2016. With the water collecting in a “rusty bucket,” nursing home employees assured state regulators that the slip-and-fall danger was only temporary and the leak had been fixed three months earlier.

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Webcams are becoming popular in nursing rooms across the country as families see it as an easy way to check on their loved ones and prevent neglect and elder abuse. Driven by the increased use of security cameras across the country and their reduced prices, webcams are popping up across the country and, when used discreetly, can sometimes catch cases of horrific elder abuse. The legality of webcams inside of nursing homes is sometimes questionable. A Minnesota court ruled in 2017 that a family had a right to set up a webcam in their loved one’s room after nursing home staffers kept unplugged and moving the camera – apparently not wanting to be recorded. Since 2017, seven states have passed legislation allowing families to place webcams in nursing home rooms.

While states move to legalize the use of webcams, privacy advocates have some concerns about the widespread use of webcams in elder living facilities. First, since nursing home residents are particularly vulnerable and prone to cognitive impairments then the decision to set up a webcam usually falls on their guardian or family. Given the serious privacy implications of being constantly filmed, family members would hopefully consult their loved one. Unfortunately, studies reported by Medical Xpress show that families tend to value “keeping the peace” over discussing these important matters.

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Top ranking nursing homes in New York are less likely to admit poor residents despite a state and a federal ban on discriminating against the ability to pay during admissions. According to a recent analysis by The Buffalo News, New York nursing homes routinely deny admission to poor New Yorkers on Medicaid. A reason for denying admission is typically never provided but elder care advocates say it is not difficult to do the math. Medicare, the government-run health insurance program for the elderly, pays significantly more to nursing homes than Medicaid, the government-run health program for low-income New Yorkers. While the payouts differ depend on the region, an upstate New York nursing home can expect approximately $148,555 annually for each Medicare patient. For Medicaid patients, the reimbursement is almost half – just $86,505, according to The Buffalo News.

The price disparity has incentivized nursing homes to seek out wealthier patients, despite a statewide ban against the practice. Some nursing homes are particularly brazen in their efforts. For example, the five-star rated North Westchester Restorative Therapy and Nursing Center admitted zero Medicaid patients out of its 665 total admissions last year. Unable to gain admission to the state’s five-star nursing homes, Medicaid recipients are now taking a larger share of beds at the state’s worst facilities. At Riverdale Nursing Home in the Bronx, nearly two-thirds of new admissions to the one-star nursing home are Medicaid recipients.

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A recent study of veterans with traumatic brain injuries (or TBI) are twice as likely to develop dementia later in life. The expansive study by the United States Military showed that traumatic brain injuries can be more harmful than previously thought. According to the CDC, a traumatic brain injury is “a disruption in the normal function of the brain that can be caused by a bump, blow or jolt to the head, or penetrating head injury.” Previous studies on the link between dementia and TBI showed a connection, however military researchers say this study provides conclusive evidence that traumatic brain injuries sharply increase a veteran’s risk for dementia later in life.

Further, researchers say the evidence shows that even a mild TBI – defined as one that does not cause the injured person to become unconscious – increases the risk of dementia. According to military statistics, between 15 and 20 percent of veterans who served in Iraq and Afghanistan suffered at least a mild TBI and almost half of all TBIs are characterized as either moderate or severe. The military said that the majority of minor TBI are caused by “exposure to a shock wave that follows an explosion.”

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