“Special focus,” one of the strictest forms of federal oversight, is designated to some of the most dangerous nursing homes in the country. These homes have been cited for putting residents at harm by administering the wrong medications, failing to protect them from violence, neglecting to treat injuries, and many other unspeakable violations facility owners are unafraid to try covering up.
Of around 15,000 skilled nursing homes, over 900 have been put on the special focus watch list since 2005. But in less than a year, oversight has been lifted for about a quarter of them.
Parkview Healthcare Center, a California facility that allowed a paraplegic resident to slip from her wheelchair multiple times, left the watch list after only 15 months of scrutiny. A Maryland home, NMS Healthcare, was sued last year for evicting extremely vulnerable residents “with brutal indifference” when their health insurance ran out. This facility was released from oversight after 10 months. Golden LivingCenter-West Shore, a Pennsylvania home, escaped supervision a mere 17 months after regulators found a resident’s feeding tube had become infested with maggots.
While the horrors inflicting our elders vary across both private, public, and even non-profit establishments, the story of abuse and neglect is the same in no less than 46 states. Public health departments are giving noncompliant facilities an ultimatum: fix problems, or lose federal funding. But it’s all too easy for the facilities to take this threat lightly.
A Corrupt System
Once a nursing home has left the watch list, it rarely returns.
As a result, according to federal health inspection data, 52 percent of the 528 homes released from special focus status before 2014 have taken further opportunities to harm patients. When found out, these homes have drawn thousands of dollars in fines. But these are simply written off as business losses and operation continues – in some cases, even after multiple penalties. Moreover, of the 5 possible stars a home can earn per the federal quality rating system, a third of these homes have only 1.
In a new book, which explores how nursing home abuse is allowed to continue year after year, studies found that “unannounced” inspections are a huge part of the problem.
“Some nursing homes bring in extra staff before ‘surprise’ inspections and scramble to conceal violations,” said William Beerman, Sr., the author of the book, named Mary Regina’s Nursing Home after his mother. Disappointed by her standard of care and how little the state did to handle his complaints, he began researching nursing home regulation after her death in 2011. “Inspectors don't always see how residents normally live.”
It would make sense, then, for residents’ observations to hold more value. Yet Beerman also found that the 5-star rating system, devised by the Centers for Medicare and Medicaid Services (CMS), does not incorporate patient evaluations.
“The oversight system has blind spots,” he said. “Sometimes nursing home inspectors see the violations. Sometimes they don’t.”
Cutbacks in Federal Budgets, Oversight Terms, and Staffing
Added to inconsistencies in health and safety regulations, there is also concern around federal budget cuts. The CMS is allowed a limited number of slots to fill with offending and re-offending homes. This year’s budget of $2.6 Million allows 88 slots – not quite enough to accommodate the 435 total homes that regulators deem unsafe.
Perhaps this is why CMS is unwilling to hold homes under scrutiny for too long. After all, facilities need only pass 2 consecutive inspections after being discharged from the watch list.
“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director of public policy at the National Consumer Voice for Quality Long-Term Care.
And many of them can’t. Some of the most troubled homes lack the resources needed to provide quality care. Resident-to-nurse ratios are as low as 11 to 1 in half of the nation’s homes, including those with a “clean” bill of health.
Dangling on a Lifeline of Taxpayer Funding
In an ideal world, a low-quality rating and several appearances on the watch list would warrant facility closure. Indeed, NMS Healthcare was 1 company forced to shut down a nursing home this month after multiple violations finally led to loss of Medicare and Medicaid privileges. But expulsion from these programs is rare, no matter how often patient harm reoccurs, and many more companies are allowed to weasel their way out of liability.
“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, director of Manhattan-based advocacy group Long Term Care Community Coalition. “These are the worst of the worst.”
While it may seem shocking that these homes are still able to attract new residents, it gets worse. Some homes are attempting to dupe prospective patients and gloss over their sullied reputations by simply rebranding. One of these is Parkview, which now calls itself Kingston Care Center.
Although the CMS plays a big part in failing nursing home residents, it all comes down to this: the greed-driven dishonesty of the industry. With over 60 percent of the nation’s long-term care facilities under the control of Wall Street investors, staggering numbers of homes are prepared to forfeit patient health for profits. From a business perspective, fines and lawsuits are cheaper than putting quality care measures in place – meaning investors would rather see a patient die than pay to keep them safe.
According to Grant, there “appears to be little enforcement” of the law and “fines for abuse are not sufficiently high to impact facilities’ actions.” If this situation is ever to improve, much of the effort will need to come from federal and state health regulators.
“Conditions are not changing rapidly enough,” she added. “We hear frequently about poor nursing homes, and usually they’ve been poor for a long, long time. Why are we allowing these providers to continue?”