Articles Posted in Elder Population Studies

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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Elderly New Yorkers should carefully examine a nursing home’s finances before making their final decision, according to The New York Times. While full-blown insolvencies are rare, a poorly-run nursing home can offer a “bait-and-switch” type of scheme that lures the elderly in with its low costs, only to reduce services and increase costs in the years to come. According to the newspaper, elderly residents looking to join nursing homes or retirement communities with “joining” or entrance fees should be especially diligent about researching the finances of their facilities. These introductory fees, which can range between several hundred thousand to over a million, will not be returned if the nursing home fails to deliver services or increases its fees in the years, or decades down the road.

With little government regulation on the finances of these of retirement homes or retirement communities, potential residents must perform their own due diligence to ensure their future is safe and secure. This research can be performed by utilizing websites, such as Carf.org or MyLifeSite.net. However, these websites offering information about the finances of nursing homes usually charge a fee.

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A recent report released by Kaiser Health News shines a light on the diminished quality of care received by many senior citizens at for-profit nursing homes. The Kaiser Health study found that the average for-profit nursing home receives twice as many complaints by its residents and their families. Further, the research group also found that:

For-profit nursing home chains had an average of 8 percent fewer nurses per residents when compared to independent nursing homes.  Nursing homes that operated for a profit received almost twice as many validated complaints.  For-profit nursing homes received 22 percent more fines, and the fines levied against them were 7 percent higher.

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Mirroring national trends, elderly Americans are beginning to use more addictive prescription drugs. In a report by the New York Times, the number of prescriptions for benzodiazepines, a class of anxiety drugs which includes Xanax and opioids have markedly increased in the last couple decades. Not only do these addictive drugs have serious side effects, they can be deadly to the user, sometimes even when taken as prescribed.

According to the newspaper, the number of benzodiazepine prescriptions for Americans over the age of 65 increased 8.7 percent between 2003 and 2010, the year with the most recent data available. A 2008 study indicated that about 9 percent of adults between 65 and 80 took one of these anti-anxiety drugs. The Centers for Disease Control (CDC) paints an even more ominous picture of the problem – the number of deaths caused by benzodiazepines in Americans over the age of 65 rose from 63 deaths in 1999 to 431 in 2015. In 1999, opioids were a contributing cause of 29 percent of these deaths. A mere fifteen years later, opioid drugs now contribute to two-thirds of deaths caused by benzodiazepines.

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A recent report by the Centers for Medicare and Medicaid Services (CMS) found that individuals with mental health or behavioral problems are more likely to be denied access to higher-quality nursing homes throughout the country. The study relied on data from 3.7 million admissions in 15,600 facilities across the country and found that, while elderly Americans with any type of mental health problem faced more difficulty, those diagnosed with more severe illnesses faced even longer odds of admittance. According to healthcare analysts, this is likely a combination of concerns surrounding individuals with mental health problems and a lack of high-quality nursing homes in lower-income areas, which are more likely to have senior citizens with mental health challenges.

CMS assigns a “grade” to each nursing home based on the number of staff at each facility relative to the number of residents, quality benchmarks and the results of health inspections. CMS then assigns a set number of stars to the facility representing its quality, with a one-star facility providing the lowest quality care and a five-star facility providing the highest.

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antipsyhotic-and-elderlyBetween 2013 and 2017, the Northern Manor Geriatric Center in Rockland County, New York received more than double the average number of citations by the New York Department of Health, the entity responsible for performing yearly inspections at all nursing homes in the state.  Compared to the statewide average of 34 citations- relating to either standard health or life safety violations – Northern Manor Geriatric Center received 73 citations by the government agency. Of these 73 citations, two were related to “actual harm or immediate jeopardy” – the most serious of violations issued by New York State.

The following are some of the most serious or most recent violations found by the New York State Department of Health: Continue reading

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