The five weaknesses that led to the fiasco of nursing homes

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Patricia Olthof-Blank thought everything was going well in her mother’s nursing home in Buffalo Country Center, Iowa. Virginia Olthoff lived there for 15 years, and the administration communicated a lot with her family about her care.

Then Ulthof Blank received a call at 3 am from the emergency room nurse. With horror, she learned that her mother was severely dehydrated. “It just didn’t happen,” a doctor in the emergency room told her. It was believed that her mother had been without water for four or five days.

Several hours later, Virginia Ulthoff is dead.

Her daughter recounted the events in her testimony before the Senate Finance Committee in March 2019, and told them that the Inspection and Appeals Department report revealed that her mother had not eaten or drank for nearly two weeks and had not received intravenous fluids. She was crying out in pain and she lost a lot of weight.

Despite repeated pleas by certified nursing aides to their superiors about her mother’s condition, “nothing has been done,” said Olthof-Planck.

The epidemic worsened and raised awareness about poor conditions in many nursing homes across the country. But these conditions were in place before COVID-19 hit the United States, and are likely to persist unless changes are made, experts say.

“There is an opportunity now, because there is a lot of eyes on the nursing home sector,” said David Grabowski, professor of health care policy at Harvard Medical School. “One of my biggest concerns is that things will return to normal … [people will say] We can return to business as usual. Business was not operating as usual before the pandemic, and it certainly did not work during the pandemic. We need to make some real changes here. ”

What made nursing homes so fail during the pandemic? Experts point to five main factors.

1. Recruitment

Chronic staff shortages in nursing homes are bringing current employees to breaking points. Often these jobs for frontline workers, such as certified nursing assistants (CNAs), are as challenging as retail and fast food and usually pay less ( Average annual income To get CNA in a nursing home is $ 28,450). Results? Employees do not comply.

“We found turnover rates of over 100% in a calendar year, which basically means that all employees switch every year – and some nursing homes have turnover of up to three hundred percent,” Grabowski said, referring to a study He and his colleagues posted in March 2021 in Health Matters.

“We are not paying the direct caregivers enough,” he said. “Most of them are women, many of them of color and immigrants, and they are overlooked in many ways in terms of where we direct resources in our healthcare system.”

Grabowski said that insufficient staffing has a direct impact on residents, who may not only receive poor care but cannot develop relationships with workers when they are there one day and go another day.

“You talk to the residents and ask them, ‘What did you like or dislike about this nursing home? “It’s always about the employees.”

Charlene Harrington, Professor Emeritus of Social Behavior Sciences at the University of California, San Francisco School of Nursing, said employment at the professional nursing level is also vital.

Harrington joined 21 other nurses at Post a call To the Centers for Medicare and Medicaid Services (CMS) in March to obtain federal authorization for stronger registered nurses (RNs) in nursing homes.

The CMS Employment Rules currently call for one RN on duty in a nursing home for eight consecutive hours each day. Harrington and her colleagues said that RN’s presence on-site should be increased to 24 hours and seven days. There are no federal ratios for employees of any level.

“It’s quite an anti-aging distinction that you can stock up on seniors without having to get enough employees and pay their salaries to be competent and experienced,” Harrington said.

Pamela Mickens, Dallas Long-Term Care Ombudsman, said she sees the impact of insufficient staffing every day. But a comment from a resident’s family member clarified the issue of employment criteria for her.

Mickens recalls that a family member worked in the prison system and indicated that there were employment rates for inmates, but not for people in nursing homes.

“This was an epiphany for me,” she said.

2. Funding

Medicaid covers more than 60% For all nursing home residents, Medicaid payments cover 70% to 80% of nursing home operating costs, according to the American Health Care Association, an industry group. He notes that the funding gap is the reason for “tight budgets.”

“Medicaid is not a generous payer,” Grabowski said. “The way most nursing homes have made things go well is to deal with those patients who spend a short period of time after they have severe cases and who come from the hospital,” given that Medicare covers these patients for a limited period and at a much higher rate.

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This creates incentives for long-term admission and return of patients, Grabowski said. “The margins on this side of the business are really very high.”

Harrington, of the University of California, San Francisco, said her research shows that the nursing home payment model is not the problem.

All nursing homes say they don’t have enough money, but they are, in fact [for-profit nursing homes] Making excessive profits off the back of their low-wage employees. ”

3. Company structure

These profits are hidden by the Byzantine corporate structure supporting for-profit nursing homes, which make up 70% of the total, Harrington said.

that Article From Kaiser Health News she revealed that it is becoming increasingly common for nursing homes to outsource goods or services to companies they control or have a financial interest in. Some even rent their buildings from a sister company. The result: owners can withdraw profits that aren’t reflected in nursing home books.

A related benefit of nursing homes is that if they are sued, plaintiffs often have difficulty collecting, since the assets are not held with the licensee, Kaiser said.

“They’ve created these complex structures, and they’re drawing in a lot of money from related party organizations … there’s no money left for employees and services,” Harrington said. It calls for more transparency and financial accountability in nursing homes.

4. Lack of oversight and enforcement

Nursing homes agree to follow minimum standards of care when participating in Medicaid and Medicare programs. Federalism Systems They stipulate “the provision of the care and services necessary to achieve or maintain the highest possible level of physical, mental, psychological and social well-being” for their residents. This includes maintaining proper hydration – something Patricia Ulthof Blank’s mom definitely didn’t get.

After the death of Virginia Olthoff and the killing of another resident of the same nursing home, Established CMS fined $ 77,462, and families filed a lawsuit.

But federal measures against nursing home neglect are often inadequate, and many aged care homes are allowed to operate with permanently falling below minimum standards and then bouncing back.

Lori Smyanka, Executive Director of National Consumer Voice, said of high-quality long-term care. “And they just don’t get held accountable.”

“We see constant and routine non-compliance” with laws and regulations, said Eric Carlson, attorney director at Aging Equity, a nonprofit that fights poverty among older Americans. “There are facilities that have business practices that are inconsistent with the law – for example, they treat Medicaid patients worse, and there’s a federal law that says you can’t discriminate based on the source of reimbursement.”

Often times, he said, “CMS doesn’t acknowledge the violation, or if it does admit it, it doesn’t impose a penalty.”

5. Obsolete buildings

The physical environment of nursing homes has become another source of trouble. Traditional nursing homes built 30, 40, or 50 years ago are often modeled after hospitals, With long corridors and small common rooms.

“There is a warehouse mentality that is expressed through this type of floor plan and architecture,” Carlson said. “For most people, our lives are not organized around our beds … we do not sleep within three feet of strangers.”

The Green house In contrast, the nursing care and similar model consists of compact, home-like units confined to groups of 10 to 12 seniors, each with its own room. These models often operate in a “more informed” recruitment arrangement, Carlson said, with nurse aides constantly working with the same population.

Change the culture

One of the ongoing challenges in nursing homes is a lack of recognition of residents’ rights, said Mickins, a Texas ombudsman.

She said, “They have a voice, and their voice and preferences may be contrary to what the nursing home staff, including the doctor, want.”

Even if it’s as simple as taking a shower at night instead of 6 a.m., a nursing home should strive to include this preference in its resident care plan.

Carlson agreed. List collection, available through Justice in Aging, called 25 common nursing home problems and how to solve them.

In addition to enforcement, Carlson said, everyone involved in the system – from hospital discharge planners to staff to family members to residents themselves – should have higher standards.

He said that was the idea behind the guide. Carlson noted that if a facility says it will not fulfill a request “because it will be too much trouble,” then the consumer can say, “No. Unacceptable.”

He said it will require a cultural change. He added that if utilities aren’t doing it themselves, consumers must say, “We’re going to change your culture for you. Because what you’re doing right now isn’t good enough.”

Emily Jornon is the former Senior Content Editor covering Next Avenue’s health and care delivery. Her stories include a series of articles on Guardianship That was funded by journalists in the Elderly Fellows Program. Previously, she worked for 20 years as an award-winning newspaper reporter in the San Francisco Bay Area and St. Paul. 

This article is part of The Future of Elder Care, a Next Avenue initiative supported by the John A. Hartford Foundation. This article is reprinted with permission from NextAvenue.org© 2021 Twin Cities Public Television, Inc. all rights are save.

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