After addressing the shortage of nursing staff in hospitals, healthcare advocates have set their sights on implementing “Safe Staffing” policies in New York’s nursing homes. Safe Staffing policies would legislate minimum levels of nursing staff across the state’s nursing homes. Currently, New York State law only requires “sufficient staffing” which grants nursing homes wide discretion to determine whether its facility has sufficient levels of staffing. Elder care advocates lobbied state legislators to include safe staffing requirements in the budget this year. Lawmakers in Albany declined their request.
Instead, lawmakers opted to study the staffing levels at nursing homes. According to The Buffalo News, the budget passed earlier this year in Albany included a directive to the New York State Health Department to begin a study on May 1 analyzing “the range of potential fiscal impacts of staffing levels, other staffing enhancement strategies, and other potential quality improvement initiatives,” according to WHEC. The health department will then issue a final report to lawmakers at the end of the year. Given the timing of the report, it appears unlikely that any legislation will pass this year establishing mandatory staffing levels at nursing homes. Studies in Albany can frequently go in two directions. In some situations, studies are meant to endlessly shelve an unpopular idea. In other circumstances, studies can empower government agencies to develop their own policy proposals that will then be quickly passed into law.
Elder abuse is a growing problem in America that often goes unreported. According to a recent article in NPR, healthcare workers and government regulators are failing to report cases of suspected elder abuse to local authorities. The article analyzes a recent report by the Office of Inspector General which found that despite evidence of abuse or neglect severe enough to warrant medical attention, healthcare providers rarely alerted authorities. Under both federal and state law, healthcare professionals are legally required to report cases of suspected abuse.
Elder care advocates are unsurprised by the federal agency’s report, saying that elder abuse is widespread and unreported in the United States. The report only further confirms the severity of the elder abuse and the indifference to tackle the problem. One study relied upon by the federal agency that authored the report analyzed nursing home residents who end up in an emergency room. The researchers looked for potential signs of neglect or elder abuse, such as head injuries, body bruises, bedsores, or any diagnosis that may indicate sexual or physical abuse.
The Centers for Medicare and Medicaid Services (CMS) announced arbitration agreements would be allowed in nursing home agreements which receive federal funding. Under President Obama’s administration, CMS barred nursing homes from inserting mandatory arbitration clauses into their agreements. Mandatory arbitration agreements bar nursing home residents from bringing any legal grievance against their nursing home in a courtroom. Since nursing home residents are particularly vulnerable and nursing homes have a poor record of abuse and neglect, President Obama’s administration reasoned that mandatory arbitration clauses should be banned in all nursing home contracts.
Predictably, the nursing home chain did not support the federal government’s ban on arbitration clauses. The elder care industry said that arbitration provides a faster, more efficient resolution of claims for everyone involved. When President Trump came into office, his administration took a more industry-friendly approach to regulating nursing homes. In addition to sharp drops in fines on nursing homes, CMS also began deregulating the nursing home industry and appears to have reached a compromise on the mandatory arbitration agreement. Under the rule finalized this month, nursing homes will be allowed to include arbitration agreements in their default contracts with nursing home residents. However, nursing homes cannot deny admission to any resident because of their refusal to include a mandatory arbitration clause in their contract.
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.
Over one-third of nursing homes in the country saw their star rating drop last year after the Centers for Medicare and Medicaid retooled their star-based rating system, which judges nursing homes based on the quality of care provided to their patients. A nursing home receives a rating between one and five stars, with five stars representing the highest quality of care. While the majority of nursing home ratings changed for the worse, the retooled metrics used by the nursing home regulator did increase the ratings of approximately 15 percent of nursing homes in the country, according to Skilled Nursing News.
According to the industry watchdog, the new rating metric emphasizes whether a sufficient number of nurses are staffed at the nursing home. According to multiple studies and elder care advocates, the number of nurses is the strongest predictor of the quality of care provided to nursing home residents. The federal agency’s revision came after a report last summer by The New York Times showed that many nursing homes suffered from a nursing shortage and often inaccurately reported their staffing to government regulators. In addition to changing its rating system, CMS also said it would conduct more unannounced inspections on weekends when staffing shortages were reportedly more common.
The national nursing home chain Skyline Health finally collapsed last year after years of aggressive growth fueled by debt and shady business practices. The aftermath of the chain’s collapse is far-reaching – the chain once ran nursing homes in almost every state in the country, according to NBC News. Further, the disastrous financial situation that plagued the company has now fueled lawsuits against the company by employees seeking unpaid wages and residents who say they were neglected because the company could not afford basic medicine or utilities at their nursing home. This does not even touch upon the upheaval that the chain’s closure caused to countless senior citizens across the country.
As more horror stories come out about Skyline Health’s treatment of its residents, families of displaced residents are searching for answers about how the doomed nursing home chain continued its nationwide expansion while its problems piled up. Skyline started with less than 20 nursing homes in 2015 and expanded to more than 200 in just a couple years, all while state regulators levied substantial fines against the negligent and cash-starved corporate chain. During the debt-fueled acquisition period, Skyline Health’s owners pillaged the company with lavish payouts and told nursing homes to enact draconian cuts. According to NBC News, the staff at a Skyline Health nursing home in Massachusetts started bringing their own toilet paper for the residents. A corporate memorandum instructed another Skyline Health nursing home to only provide two disposable briefs to each resident per day, cruelly leaving residents to sit in their filth.
A Virginia nursing home is being sued after ignoring one of their former resident’s growing infection and bedsores. The family of the former patient alleges the nursing home’s neglect of Casey Lamont was so severe that it caused his death after just six months at the long-term care facility. The lawsuit seeks damages related to the medical costs incurred by the nursing home’s alleged negligence and Lamont’s pain and suffering.
Lamont was admitted to the nursing home, Envoy of Williamsburg, in November 2013. According to the medical history provided to the nursing home, Lamont would be susceptible to bedsores and pressures and therefore, the nursing home should take preventative measures, which generally include moving the patient around every few hours. Unfortunately, the nursing home appears to have neglected their responsibility to care for Lamont and within two months he developed “life-threatening bedsores,” according to The Virginia Gazette.
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.
New York State is proactively training nursing home staff how to be “better whistleblowers” whenever nursing home abuse or neglect is suspected. Describing the training as “the first of its kind” across the country, The Buffalo News said the New York Department of Health trained nursing home workers on submitting reports with important details, which include the “time and location of the alleged infractions” as well as any possible witnesses or other relevant information. The health department, which is responsible for overseeing nursing homes in New York, encouraged filing these “comprehensive complaints” in certain situations such as when the nursing home lacked adequate staffing, when important medical devices are malfunctioning, or anything else that puts the health and safety of nursing home patients in jeopardy.
Currently, anyone can file an anonymous report with the state health department. While staffers are obligated to report some instances of nursing home abuse under the state’s “mandatory reporter” laws, elder care advocates say this law is difficult to enforce. The state also prevents nursing homes from retaliating against any employee who files a report or cooperates with an investigation against the facility.