Articles Posted in Elder Population Studies

A study released by the University of Illinois at Chicago reports that for-profit nursing homes provide lower-quality care to their elderly residents. This study provides further confirmation that the for-profit nursing home industry, which is still growing across the country, is sacrificing adequate care for vulnerable senior citizens in the pursuit of ever-growing profits. Once again, elder care advocates are sounding the alarm about the substandard quality of care and the need for greater government oversight while President Trump’s administration continues to deregulate the industry.

The University of Illinois at Chicago study included more than 1,100 senior citizens living at five different Chicago hospitals between 2007 and 2011. The results showed a stark difference in the quality of life and health of elderly residents depending on whether their nursing home operated as a non-profit or as a profit-seeking business. Overall, residents at for-profit nursing homes were twice as likely to have health problems related to poor or neglectful care. Among other maladies, for-profit residents were more likely to suffer from severe dehydration, develop stage 3 and stage 4 pressure ulcers – the most serious and commonly preventable type of pressure ulcer, or bed sore. Further, the study concluded that broken catheters and dislodged feeding tubes were more common in for-profit nursing homes and their patients were less likely to receive satisfactory care for their chronic health conditions.

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Medicare recently lowered the overall ratings of almost one-fourth of the country’s nursing homes due to insufficient staff levels. The move comes after Medicare adopted a new, objective measurement for staffing nursing homes. Previously, Medicare relied on unverifiable data submitted by the nursing homes. Medicare ratings, which can range between one and five stars, are provided for several categories of nursing home care, such as its rating of pressure ulcers or slip-and-falls, along with an overall rating for the nursing home. Medicare now gives the lowest rating, a single star, to 1,387 nursing homes across the country, according to The New York Times.

Medicare requires all nursing homes to have a licensed nurse working at all times and a registered nurse working at least eight hours every day. The payroll data submitted to Medicare by the nursing homes show that the registered nurse requirement produced the majority of compliance problems. Registered nurses, who have the highest level of training and education requirements, are typically able to provide medical services, such as diagnosing illnesses or prescribing medicine.

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A rarity only a few decades ago, nursing homes operating for profit have exploded across the country. According to NPQ, for-profit nursing homes account for over 70 percent of all facilities across the country. According to elder care advocates, the rapid takeover of the nursing home system has harmed America’s vulnerable senior citizens. Instead of focusing on providing the best quality care for a reasonable price, for-profit nursing homes choose to maximize their income while limiting their costs and the resulting legal liability from their cost-cutting measures.

In general, the rise of for-profit nursing homes has coincided with the consolidation of the nursing home industry which means a senior citizen is more likely to choose a corporate nursing home chain than the once-ubiquitous retirement communities that operated solely for the best interest of their residents. Considering the deep pockets of a corporate chain, it would be reasonable to assume the potential for large settlements in the cases of mistreatment or elder abuse would incentivize these corporations to treat their residents with the utmost respect.

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After a spate of negative press coverage last year, Medicare has only issued limited guidance for the upcoming natural disaster season. After widespread lack of preparation in the wake of Hurricane Irma in Florida and Hurricane Harvey in Texas harmed America’s nursing homes, many patient advocates are worried about the nation’s nursing home residents. According to these advocates, the same systems and policies that led to widespread power outages and death last year have not been fixed yet.

Last September when Hurricane Irma struck Florida, residents of Rehabilitation Center at Hollywood Hills found themselves stuck at a nursing home without any air conditioning, power, or a backup generator – all violations of Medicare policies. Sadly, fourteen of the residents at this now-closed nursing home passed away during the 90-degree heat which overtook the nursing home for a week. In response to these flagrant violations, Medicare passed emergency planning regulations last November which required each facility to:

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In response to insufficient medical and nursing staff, Medicare has lowered ratings for 1 out of every 11 nursing homes across the country. The lowered ratings come after the government agency retooled the way it calculates the nursing staff at each nursing home. Under the new method, which requires nursing homes to submit payroll information every quarter, nursing staff numbers appeared grossly deficient at facilities across the country. After Medicare warned nursing homes in April about a possible reduction in their rating without an increase in nursing staff, the government agency followed through last week and reduced the star-rating for nearly 1,400 nursing homes across the country.

For the most part, the nursing homes with recently reduced ratings lacked a sufficient number of registered nurses, which are the “highest-trained caregivers” and responsible for managing other nurses. Under Medicare guidelines, a nursing home only needs to have a single registered nurse working eight hours per day. However, most nursing homes are not meeting these simple guidelines or could not provide payroll information proving the requirement was satisfied. According to Medicare officials, payroll information is not usually “taken seriously” by nursing homes and forcing the facilities to provide proof through their payroll system will hopefully force nursing homes to take their record keeping more seriously.

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After increased regulation under the Obama administration, President Trump has whittled away at federal regulations targeting nursing homes and meant to prevent nursing home abuse across the country. At the same time, the country’s aging population is putting more senior citizens in nursing homes. According to research by Morningstar, by 2020, a full 40 percent of all deaths will occur in a nursing home. Elder care advocates worry about an increasing number of Americans being allowed into a decreasingly regulated nursing home system.

According to elder care advocates, their worry is not misplaced. Between 2013 and 2018, almost four out of every 10 nursing homes in the country received a citation for a “serious violation” that could endanger nursing home residents. Under previous administrations, these violations would typically come levied with a serious fine – hopefully high enough to deter future behavior. Under the Trump administration, however, the amount of these fines has been significantly reduced through new guidelines issued in December 2017. In an example cited by the Kaiser Foundation, a nursing home was fined $300,000 in 2013 after a nursing home resident died because the staff failed to effectively monitor and treat a wound. Under the new guidelines, the maximum fine the nursing home could receive is $21,000.

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The government recently adopted a more accurate measurement for determining when a nursing home has sufficient staffing levels and the results show a glaring problem across the nursing home industry. According to Kaiser Health News, the new method of recording hospital staffing shows a 12 percent decrease in hospital staffs. Further, there seems to be a severe fluctuation at many nursing homes which have sufficient nurses during the week but insufficient staff on the weekends. The new evidence shows that despite the minimal Medicaid requirements on the nursing staff levels at nursing homes, many nursing homes are still failing.

Under the previous method for calculating nursing staff, nursing homes would be required to provide all payroll information for the previous two weeks and government regulators would tally and report on the number of nurses employed during that time period. Because nursing homes sometimes knew when an inspection would occur ahead of time, this method was not generally considered accurate. Under the new method for calculating nursing staff, which Medicare began in April of this year, nursing homes must provide a report to Medicaid on staffing throughout the entire year.

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According to Consumer Reports, approximately 500,000 senior citizens lose over $36 billion each year to scammers who target them for financial abuse. Despite the widespread problem and illegality, only 5,000 confirmed cases were reported last year to states. With the population of America aging, authorities expect the problem to grow even worse and hope to bring more awareness to the problem.

Generally, senior citizens are victims of financial abuse by someone who they trust, or someone who pretends to be in a position of trust. In one of the several examples cited by The Daily Item, a convicted felon posed as a licensed building contractor and convinced an elderly woman that she could take a home equity line of credit to finance an expansion. Then, after performing some of the necessary work, claimed he located asbestos and would need more money to continue with the project. As the made-up excuses kept piling up, the felon continued to demand more money from the woman. In a victim statement to a court last year, the elderly woman said she lost over $100,000 and her home was in significantly worse shape. In another example cited by the online newspaper, a man wired money to an unknown bank account after receiving a call from someone pretending to be a federal agent from the Internal Revenue Service.

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According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

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A recent study estimates that financial abuse of elderly Americans defrauds these vulnerable citizens of almost $37 billion each. The report finds that almost 5 million senior citizens in America are victims of elder abuse each year. In New York alone, financial abuse of the elderly costs at least $1.5 billion a year. While the exact nature of financial abuse can be hard to notice for senior citizens with cognitive impairments, the legal definition perpetuated in the Older Americans Act of 2006 criminalizes “the fraudulent or otherwise illegal, unauthorized, or improper act or process of an individual… that uses the resources of an older individual for monetary or personal benefit, profit, or gain, or that results in depriving the older individual of their use or rightful access to benefits, resources, belongings, or assets.”

The report in Bloomberg Businessweek provides a sad, but unfortunately typical, portrait of elder abuse in 82-year-old Marjorie Jones, who one day received an anonymous call stating she had won a sweepstakes. According to the caller, Jones, who was legally blind and lived alone, would need to pay the taxes and fees on the winnings before the winnings from the sweepstakes could be released to her. After wiring the money to the anonymous caller, more stipulations and conditions became attached and Jones continued to send the money until she had depleted her entire savings, taking out a reverse mortgage on her home, and cashing in on a life insurance policy. Instead of reaching out to her family for help, an ashamed and embarrassed Jones killed herself.

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