Articles Posted in Elder Population Studies

Nursing home residents may need family members or advocates to report cases of elder abuse. According to The National Elder Abuse Incident Study, only 20 percent of neglect, exploitation, abuse or self-neglect is reported to state authorities. The nonprofit agency which conducted this study, The Center for Elder Abuse, said that an estimated 2.5 million cases of elder abuse occurred at nursing homes across the country in just the last year. This means that 2 million nursing home abuse cases go unreported and unpunished. This eye-wateringly high number indicates a substantial problem on its own but considering the aging population in America, unreported elder abuse could increase to even higher levels.

While victims can be any age, race, gender, or with any kind of diagnosis, the nonprofit elder care group said that common characteristics of nursing home abuse victims include anyone over the age of 80, elderly women, people with cognitive impairments, and people who are physically or psychologically aggressive. Nursing homes are the most common place for unreported elder abuse, although adult day care centers and hospitals are common locations for this horrific crime, too.

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In an exhaustive report by Care.com on the current state of America’s nursing home industry, the well-researched guide compiles data from various private studies, data published by the government, and even included a recent analysis of approximately 1,000 Medicare patients. While the detailed and illuminating guide to elder care facilities is worth reading in full, these are the highlights:

  • The Scope of the Nursing Home Industry. According to the report, there are 1.7 million nursing home beds in America and 79 percent of these are occupied each day. Nursing home residents receive an average of four hours of personalized care each day. Of these four hours, only 45 minutes are spent with a registered nurse each day.
  • Nursing Home Visitors. A nursing home resident can expect six visits from their relatives each month and spend an average of 1 hour and 27 minutes each visit. A majority – 55 percent – of nursing home patients wish their family would visit them more frequently. Nursing home patients satisfied with their family’s visitation habits report an average of nine visits each month. Apparently, family members feel guilty about their infrequent visiting habits – 14 percent described feeling “extremely guilty” and 21 percent felt “moderately guilty” for rarely visiting their loved one.

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Medicare’s transition to a new pricing model will reduce the risk of fraud, but likely lower the quality of care for some patients. A report by Skilled Nursing News begins by detailing the new payment scheme implemented by Medicare named Patient-Driven Payment Model, or PDPM. Under PDPM’s new pricing structure, Medicare sets reimbursement rates according to a patient’s healthcare needs. Previously, healthcare providers billed Medicare individually for every service, procedure, or medication. To provide a practical example, if an elderly woman sustained a mild fracture at her nursing home then Medicare would reimburse her nursing home a predetermined amount for similarly-healthy patients who suffer minor fractures. Previously, Medicare would reimburse the nursing home for each itemized healthcare service provided to the injured woman – physical therapy sessions, x-rays, medication, etc. The federal healthcare agency says the reimbursement amount depends on numerous factors including the patient’s health, diagnosis, and care plan.

According to the federal government, the former “pay-for-service” model led to widespread fraud, where healthcare providers provided medically unnecessary services and procedures to their patients just to increase their Medicare billing. Artificially inflated therapy services appear to the most common for the fraudsters. Last year, Signature HealthCARE, the owner of 115 nursing homes across the country, agreed to pay a $30 million fine for defrauding Medicare. In Alabama, SNF Management agreed to a $10 million fine the next month.

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While most states continue ignoring the widespread nursing home abuse problem in America, Kansas recently passed legislation cracking down on nursing homes and exploitative nursing home operators. The legislation passed unanimously by a Republican legislator in response to a particularly dire situation in the state. According to The Kansas City Star, the state took over operations of 22 financially troubled nursing homes just last year. According to the newspaper, the out-of-state nursing home operators had fallen behind on basic bills like food and medication. With the health and safety of the nursing home residents at risk, the Kansas Department of Aging and Disability Services had “no choice” but to take over the beleaguered elder care facilities.

The new law requiring extensive financial disclosure for any person or business entity hoping to own a nursing home hopes to solve this problem. Any prospective buyers will also need to show a “12-month operating budget” for the facility and a sufficient amount of funds to follow through on the budget, according to Skilled Nursing News. “It gives us a better opportunity to maybe know in advance if somebody coming in is maybe in financial difficulties,” Rep. Brenda Landwehr told The Kansas City Star. The new state law will also make it easier to remove negligent or financially irresponsible nursing home operators and create a “blacklist” of operators with a record of poor care in other states.

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The Department of Veteran Affairs released its first report on the status of its nursing homes this month and the results show widespread neglect and abuse at the government-run facilities, perhaps even worse than the well-documented problems seen in its private-care counterpart. The federal government is responsible for caring for the country’s 40,000 veterans and, according to its own report, is doing a poor job. The report analyzed 99 VA nursing homes across the country and reported the findings of surprise inspections conducted by outside contractors. The VA spokesperson said that releasing the report in its entirety is part of a new push by the agency for transparency and accountability.

The findings of the report are daunting. Eleven of the 99 nursing homes were so unsafe that veteran safety was in “immediate jeopardy.” More than half of the nursing homes (52) were deficient enough to cause “actual harm” to their veteran residents. “That is really bad. It’s really bad,” Richard Mollot, executive director of the Long Term Care Community Coalition, a nursing home advocacy nonprofit told USA Today.

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Outrage continues to grow at the poor quality of care being delivered at a New York nursing home. According to an investigation by News10NBC, Sodus Rehabilitation and Nursing Center in Sodus, New York is still violating numerous state regulations about the treatment of its senior citizens. The local news agency began investigating Sodus Rehab several years ago and, unfortunately, it does not appear that the quality of care has improved over time. According to the New York Department of Health, the nursing home received 90 citations for health and safety violations in just the last four years. In New York, the average number of violations per nursing home is approximately 30.

After undercover investigations by News10NBC last year showed unsafe and unsanitary conditions, Sodus Rehab says they “cleaned house” and brought in new administrators. Unfortunately, the new staffers do not appear to have fixed any of the nursing home’s problems. In one particularly egregious example cited by the news, Bill Tanner, a nursing home resident with leukemia, dementia and “other health issues,” developed bedsores that one doctor described as “some of the worst” he had ever seen. Bedsores, also called pressure ulcers or pressure injuries, could have been easily prevented in Tanner, according to the doctors. Perhaps even more horrifically, the bedsores were only noticed because a former neighbor visiting Tanner noticed a foul smell in the room. According to the neighbor, she asked for a registered nurse and a licensed practical nurse to attend to the elderly man. Sodus Rehab staff said that neither was on-duty at the time.

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An expert on pressure injuries, also called bedsores or pressure injuries, recommends nursing homes adopt a more individualized approach to preventing and treating the painful and sometimes deadly sores. In an opinion-editorial in McKnight’s Long-Term Care News, Jean Wendland Porter, Regional Director of Therapy Operations at Diversified Health Partners, discusses problems commonly associated with pressure ulcers and alternative approaches that will be more effective at reducing bedsores. In one example, Porter notes the common medical advice to “move a patient around every two hours” fails to take a patient’s ability to move by themselves or any aggravating factors that could make the patient more likely to develop a bedsore, such as a higher BMI or a weakened immune system. According to Porter, the “two hours” rule is not based in science at all and originates in World War II where it was deemed the most efficient method for delivering care to bedridden soldiers.

Instead of following arbitrary, “one-size-fits-all” medical recommendations, Porter likens pressure ulcer prevention measures to selecting a mattress – tailored to the patient’s comfort and healthcare plan. Porter says the best practice involves a “pressure-mapping” solution which displays any pressure points on the patient’s body. With those results, a healthcare plan is developed which includes pressure-relieving devices on areas of the body at high risk for pressure ulcers. This customized plan for each nursing home resident will need to be continually revised as mobility and healthcare needs change.

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Recent data published by Nursing Home 411 shows America’s nursing homes continue to struggle with low levels of nursing staff. Adequate staffing is one of the most important factors in providing quality care to nursing home residents. Unfortunately, the nursing home industry has a widespread problem in staffing their facilities with a sufficient number of nurses and medical personnel. The data analyzed by the nonprofit group included all nursing homes receiving Medicare in 2018. The highlights published by Nursing Home 411 include:

  • Nursing homes spend an average of just 3.5 staff hours with each resident, per day. According to the nursing home advocacy group, the federal government states a minimum of 4.1 hours is required for the average resident.

 

  • Nursing homes spend only 0.5 registered nurse staff hours with each resident, per day. A registered nurse is typically more capable and better educated compared to certified nursing assistants. Another federal study cited by Nursing Home 411 recommended increasing registered nurse hours by 10 to 50 percent each day to satisfactorily meet each nursing home resident’s healthcare needs.

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New York State routinely allows nursing home owners with a record of poor care and government fines to operate more long-term care facilities in the state, according to a report by The Buffalo News. Speaking to the upstate newspaper, Toby Edelman at the Center for Medicare Advocacy described the problem as a “disturbing but all-too-familiar pattern” and joins elder advocates in demanding the New York Health Department provide more transparency and stricter scrutiny when selecting nursing home owners. In response to the criticism, the New York Department of Health, the state agency responsible for regulating nursing homes, drafted legislation intended to allow stronger and more effective government oversight of the long-term care industry.

The evidence uncovered during The Buffalo News investigation paints the portrait of a government agency whose incompetence is endangering elderly New Yorkers. Of the 47 nursing homes in the newspaper’s geographical area, sixteen were purchased in the last decade by for-profit nursing home corporations, which have a documented record of provider lower-quality care to their residents.

In one instance, the Department of Health approved the takeover of a nursing home by a group of New York City investors fined almost $90,000 in the last two years. In another example cited by the newspaper, a nursing home corporation with poor ratings and federal and state fines totaling “at least $325,000” was approved to purchase another nursing home in the state. In both cases, the state agency amazingly concluded that it had received “no negative information” about the nursing home owners. The deputy health commissioner told the newspaper that the agency now vets potential nursing home owners more thoroughly.

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The nursing home industry continues to reshape itself as small, independent nursing homes focused on providing high-quality care are rapidly replaced with corporate conglomerates seeking to maximize the profits. Predictably, the harmful effects of the profit-seeking model have only amplified in the last year. According to industry analysts, the ownership structure of nursing home conglomerates – where multiple nursing homes are owned and operated by the same owners – combined with riskier financial decisions are causing a slew of bankruptcies and closings across the country. In addition to removing America’s senior citizens from their nursing home, investigations into for-profit care providers have raised serious concerns about the quality of care provided to financially stable nursing homes.

Last November, The Washington Post reported on HRC ManorCare, a massive nursing home chain owned by Carlyle Group, reportedly one of the “richest private-equity firms in the world.” Despite an owner flush with cash, the nursing home chain struggled financially for five years and eventually filed for bankruptcy. The five years of financial instability exposed HRC ManorCare’s 25,000 nursing home residents to increased health risks, according to the newspaper. The number of health code violations at the nursing home chain rose by 26 percent, which includes serious health violations for failing to prevent bedsores, medical errors, and failing to provide proper nutrition and hygienic care for residents. Serious health code violations – violations that either caused “actual harm” or put patients in “immediate jeopardy” – rose 29 percent between 2013 and 2017, the year HRC ManorCare filed for bankruptcy.

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