Articles Posted in Elder Population Studies

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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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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