When it comes to big political lobbying organizations who expect big returns on their investments, we usually think of oil and gas companies who want to expand their clout and drilling rights. We aren’t necessarily quick to identify the “nursing home lobby” as playing such a pivotal role, but perhaps this is why their influence has gone under the radar for so long. It’s crucial to realize how their contributions to political candidates have affected health care policy, particularly Medicare and Medicaid spending.
In 2016, hospital and nursing home industry organizations spent over $88 Million on lobbying expenses. Of these groups, 1 of top contributors in the 2015-16 election cycle was the American Health Care Association (ACHA), a nursing home and long-term care facility organization which contributed over $840,000 to both Democrats and Republicans.
Further illustrating their stake in public policy, during the development of the Affordable Care Act in 2009, organizations representing health care companies, like the ACHA, spent over $109 Million on their lobbying efforts – the highest such amount in history. It is also evident that the health care lobby, and the nursing home industry in particular, had the potential to benefit from this historic legislation and changes to Medicaid and Medicare.
What This Could Mean for the Future of Retired Americans
By 2050, 33 percent of Americans will be 65-years-old or older, making it clear that both nursing homes and home care aides will be in greater demand in the coming decades. Given this reality, it’s important to understand why so many people have a bleak outlook when it comes to the future of nursing homes, especially when one uses history as the predictor of what’s in store.
Current nursing home living standards afford people little privacy, with shared rooms, drab cafeteria-style dining, and staff who are often overworked and undercompensated. Further, nursing home abuse and neglect is entirely too widespread. Under these living conditions, is it any wonder why there is a high rate of death, injury, and depression among nursing home residents?
So why do so many people continue to be sent to nursing homes, if it’s such a dreaded option for elderly people and disabled individuals? While other alternatives do exist, they are often downplayed, disregarded, and dismissed by the powerful nursing home lobby.
A Bleak Situation in America’s Nursing Homes
Some estimates suggest that more than 40 percent of Americans over 65-years-old will spend time in a nursing home before they pass away. In 2008, 3.2 million people were living in American nursing homes, and 6 out of 7 of these residents were older than 65. Given the age and vulnerability of these individuals, it’s distressing to learn that between 1999 and 2001, almost a third of all U.S. nursing homes were found to have disregarded a federal policy that could have resulted in a resident being hurt. Further, 1 in 10 nursing homes had caused a resident serious injury.
One study reported that 44 percent of those living in nursing homes said they had been abused, while 95 percent reported they had seen someone else been neglected, or been neglected themselves. In another survey, over 50 percent of individuals who worked in nursing homes admitted they had neglected or abused a patient within the past year. These abuses included psychological (intimidation or invoking fear, for example), physical, and sexual harm to residents. Additionally, nursing home abuse is drastically underreported, meaning these figures are likely quite higher than they appear to be.
According to 1 nurse, while she enjoyed her job and working with residents, the administration at her nursing home didn’t care about their welfare. She witnessed abuse by employees who left residents sitting in their own waste for hours. She also noted numerous problems in the medications log, which suggested residents hadn’t been given their medications, or had been administered the wrong dosage. When she explained these potentially life-threatening errors to the administration, they failed to take any remedial or disciplinary action.
Yet while such cases of abuse and neglect are rampant in nursing homes, they have been effectively hidden from the public by the powerful nursing home industry lobby.
Pay to Play
In addition to contributions to national campaigns, the nursing home industry also lobbies heavily at the state level, donating millions to those running for statewide offices. One need not look further than Louisiana, for the most recent example. Nursing home lobbyists focus much of their attention on state elections because these officials decide how the state’s Medicaid money will be allocated for disabled and elderly individuals.
Over the years, Louisiana has increased the amount of money it pays to nursing homes, while reducing the amount it reimburses community agencies that help seniors and people with disabilities live independently at home. These organizations furnish home health care aides who work for a few hours a day, assisting with personal care and housekeeping duties.
In 2015, then-Louisiana Governor Jindal considered implementing reforms that would have increased the amount the state paid to home health care agencies, while reducing payments to nursing homes. Governor Edwards, his successor, spoke about continuing work on Jindal’s reforms, yet in office he has not made such changes art of his agenda.
Of course, Louisiana isn’t the only example; many other states also have active nursing home lobbying organizations, such as the California Association of Health Facilities (CAHF). Among other campaigns, this particular group has fought to restrict damages under state elder abuse laws, and successfully lobbied against reducing the base reimbursement for nursing home and long-term care facilities.
Brushing Alternatives under the Rug
Rather than go to a nursing home, many people would prefer to have assistance and stay in their own homes. Not only is this option more comfortable for individuals, it’s also less expensive. Estimates suggest that Louisiana could save $200 Million every year if they focused on a home-care based system. But this important fiscal point isn’t mentioned when discussing Louisiana’s current financial problems.
Other states have taken little action to help people to stay in their own homes, according to a report by the American Association of Retired Persons (AARP). Only 9 states and Washington, D.C., spend more Medicaid money on in-home care and home health aides than nursing home care. While the nursing home lobby may not be the only factor in these spending decisions, it is certainly a strong influence.
Nursing home owners realize the financial incentives to maintain a strong grip on their residents. In some cases, people with disabilities who were allowed by their doctors to leave the nursing home and go into independent living have faced long delays. These disabled men and women were barred because of a shortage of independent living and home care options in the community, but nursing home owners are also reluctant to let them go, stalling transfers as individuals sit on waiting lists.
A Home of the Future?
At the same time, the future of nursing home care doesn’t have to be so dismal. While home health care options need to be given more funding, innovations such as Green House Project created by Bill Thomas give residents more freedom and control than traditional nursing homes.
These Green Houses feature 10 to 12 private bedrooms with a common living area, and a nurse assistant who helps with some of the cooking, cleaning, and care for residents. The residents also help make decisions for the facility, such as menu planning. On this smaller and more intimate scale, residents and staff seem to be happier and healthier.
While Green Houses might be expensive to build, it costs several hundred dollars less per resident every year to care for them. Innovative nursing home administrators are trying to adapt Green House philosophies to larger nursing homes, but it is clear this thinking revolves around creating a space where people feel comfortable, not 1 built on keeping costs down.
The sheer strength and multi-million-dollar spending roll of the nursing home lobby makes it clear that Americans must fight harder for better care for elderly and disabled people. This includes innovative ideas such as Green Homes that industry leaders may be reluctant to adopt because of high start-up costs. But we also must push for a wider range of care options, such as more Medicaid and Medicare funding for community health care organizations that let people stay in their homes.
We cannot avoid the fact of aging, or that people have a greater reliance on others as they get older. But the aging process shouldn’t be something we necessarily dread or feel hopeless about; rather, aging should become a process during which we can celebrate the life we’ve lived and experiences we’ve had. Given this, it’s critical that we work toward better health care for elderly people, decisions that will better shape their present, and the kind of future we create for ourselves and those who come after.