Home Stock 5 holes lead to major failure of nursing homes

5 holes lead to major failure of nursing homes


Patricia Olthoff-Blank thinks things are going well at her mother’s nursing home in rural Buffalo Center, Iowa. Virginia Olthoff has lived there for 15 years, and the government has been in constant contact with her family about her care.

After that, Olthoff-Blank got a call at 3 a.m. from an emergency room nurse. To her horror she learned that her mother was severely dehydrated. An ER doctor told her, “This isn’t just happening.” He believed her mother had been without water for four or five days.

A few hours later, Virginia Olthoff was dead.

Her daughter recounts events in testimony before the Senate Finance Committee in March 2019, telling them a report by the Ministry of Inspections and Appeals revealed her mother had not eaten for almost two weeks. and is not given intravenous fluids. She cried with pain and lost considerable weight.

Although certified nursing assistants continually beg their superiors for her mother’s condition, “nothing has been done,” Olthoff-Blank said.

The pandemic has exacerbated and raised awareness of the dire conditions in many nursing homes across the country. However, those conditions existed before COVID-19 hit the US and they are likely to continue unless changes are made, experts say.

“There’s an opportunity right now, because so many people have an eye on the nursing home field,” said David Grabowski, professor of health care policy at Harvard Medical School. “One of my big concerns is when things get back to normal… [people will say] we can go back to business as usual. The business as usual was inactive prior to the pandemic, and it was certainly not active during a pandemic. We need to make some real changes here. ”

What caused nursing homes to fail miserably during a pandemic? Experts point out five main factors.

1. Personnel

The chronic shortage of staff in nursing homes has stretched the existing workforce to a breakthrough. These frontline worker jobs, like certified nursing assistants (CNA), are often as difficult as retail and fast food and are often lower paid ( average annual income for CNA in nursing homes is $ 28,450). Result? Staff are not around.

“We see a rate of revenue above 100% in a calendar year, which means basically all employees replace each year – and some nursing homes have sales as high as three percent. , ”Said Grabowski, mentioning learn Published March 2021 in the Journal of Health by him and his colleagues.

“We are not paying enough for those direct caregivers,” he said. “They are mostly women, many are of color and immigrant, and they are despised in many ways for where we direct resources within our healthcare system.”

Insufficient staffing, Grabowski said, has a direct effect on residents who are not only poorly cared for, but are also unable to develop relationships with employees when they are here for a day and then leave .

“You talk to residents and you ask them, ‘What do you like or dislike in this nursing home?’ And it’s always about the staff, ”he said.

Charlene Harrington, emeritus professor of social behavioral science at the School of Nursing at the University of California, San Francisco, says staff at the professional nurse level are also critical.

Harrington along with 21 other nursing specialists in publish the call to the Centers for Medicare and Medicaid Services (CMS) in March for federal authorization for a stronger presence of registered nurses (RNs) in nursing homes.

CMS HR rules currently require an RN to remain in a nursing home for eight consecutive hours per day. Harrington and her colleagues say that the on-site RN presence should be increased within 24 hours, seven days. There is no federal rate for employees at any level.

“It’s pure ageism that you can attract older people without having enough employees and pay them to be competent and experienced,” Harrington said.

Pamela Mickens, a long-term care inspector in Dallas, said she sees the impact of a daily inadequate staff placement. But one family member’s comment is the crystallization of her staffing standards issue.

Family members worked in the prison system and pointed out that there are staffing ratios for inmates, but not for nursing home residents, Mickens recalls.

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

2. Funding

Medicaid includes more 60% of all nursing home residents, and Medicaid reimbursement covers 70% to 80% of nursing home operating costs, according to the American Association of Health Care, an industry group. It turns out that the funding gap is the culprit of “budget exhaustion”.

“Medicaid is not a generous payer,” said Grabowski. “The way most nursing homes have done is to admit short-term, acute post-acute patients from the hospital,” because Medicare covers these patients for a limited time and at a higher rate. much.

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That creates an incentive to hospitalize long-term patients and bring them back, says Grabowski. “The margins of that business are actually quite high.”

Harrington, of UCSF, says her research shows the nursing home payment model is not the problem.

“All nursing homes say they don’t have enough money, but in fact they are [for-profit nursing homes] generating excessive profits from their low-paid staff, ”she said.

3. Company structure

Those profits are concealed by the Byzantine corporate structure that often runs for-profit nursing homes, which accounts for 70 percent of the total, Harrington said.

An article It is becoming increasingly common for nursing homes to outsource goods or services to companies they control or have a financial interest in, from Kaiser Health News. Some even rented out their buildings from a sister corporation. As a result: owners can extract profits that are not reflected in the nursing home’s books.

A related benefit for nursing homes is that, if they are sued, plaintiffs often have difficulty collecting them, as the property is not held with licensees, Kaiser reports.

“They set up these complicated structures, and they are drawing a lot of money from their related party organizations … there is no money left for personnel and services,” Harrington said. She favors greater transparency and financial accountability in nursing homes.

4. Lack of supervision and enforcement

Nursing homes agree to follow minimum standards of care when they join the Medicaid and Medicare programs. Federal regulations require them to “provide the care and services necessary to achieve or maintain the highest possible physical, mental and psychosocial health” for their residents. That includes maintaining the right amount of water – something Patricia Olthoff-Blank’s mother certainly doesn’t have.

After the death of Virginia Olthoff and that of another resident of the same nursing home, CMS penalty basis $ 77,462, and families sued.

But federal action against nursing home neglect is often inadequate, and too many nursing homes are allowed to operate while falling below the minimum standard per year and then back up again.

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Lori Smetanka, executive director of National Consumer Voice said: “There’s an industry segment that has what we call ‘yo-yo compliance’, because they constantly come and don’t adhere. quality term. “And they’re just not responsible.”

“We see regular and continuing non-compliance,” said Eric Carlson, a lead attorney for Justice in Aging, a nonprofit that fights poverty in older Americans. laws and regulations. “There are establishments that do not in compliance with the law – for example, they treat Medicaid patients worse and have a federal statute that says you cannot discriminate on the basis of reimbursement. pay.”

Frequently, he says, the CMS “doesn’t recognize the violation, or if it does, it won’t impose a penalty”.

5. Old buildings

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

“There’s a warehouse mentality conveyed by that kind of layout and architecture,” says Carlson. “For most people, our lives aren’t organized around our beds… we don’t sleep three feet away from strangers.”

The Greenhouse In contrast, the nursing care model and others like this include small-scale units, like at home, limited to groups of 10 to 12 older adults, each with a room. their own. These models often work with “smarter” staffing arrangements, with nurse assistants working consistently with the same residents, Carlson said.

A cultural change

Mickens, the Texas inspector, said an ongoing challenge in nursing homes is the lack of recognition that residents have rights.

“They have their voices, voices and preferences that may be contradictory to what nursing home workers, including doctors, wish for them,” she said.

Even if it’s something as simple as bathing at night instead of 6 in the morning, nursing homes must try to incorporate that priority into a resident’s care plan.

Carlson agrees. He’s put together a list, available through Justice in Aging, called 25 Common Problems in Nursing Homes and How to Solve Them.

In addition to enforcement, everyone involved in the system – from discharge planners to staff members to family members and the general public themselves – must have higher standards, says Carlson.

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That’s the idea behind the tutorial, he said. If an establishment says it will not fulfill a request “because it will be too complicated,” noted Carlson, consumers may say, “No. Unacceptable. “

There is a need to change the culture, he said. And if institutions don’t do it themselves, he adds, consumers have to say, “We’ll change your culture for you. Because what you are doing right now is not good enough.

Emily Gurnon is a former Senior Content Editor for health and care for Next Avenue. Her stories include a series of articles above abuse of guardianship funded by the Senior Fellowship Program. She previously spent 20 years as an award-winning newspaper correspondent in the San Francisco and St. Petersburg Bay Area. Paul. Reach her through her website.

This article is part of The Future of Aging Care, a Next Avenue initiative with support from the John A. Hartford Foundation. This article is reprinted with permission of NextAvenue.org, © 2021 Twin Cities Public Television, Inc. All rights reserved.

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