A new study by researchers at the University of Illinois-Chicago finds that residents of for-profit nursing homes are at a greater risk of neglect than elderly people in other types of care environments. This study adds to previous research that examined the physical results of neglect, but it also investigated more subtle cues that could suggest someone was not receiving proper care.
The study’s authors argue that many problems with care stem from staffing issues in for-profit nursing homes, such as low pay, understaffing, and highly paid administrators. In short, for-profit nursing homes often manage funds in a way that puts profits before people.
Seeking Subtle Signs of Neglect
This report analyzed data from 5 hospitals in Chicago from 2007 to 2011, records that included 1,149 people who were age 60 or older. Researchers examined these files for 24 different symptoms of neglect, ranging from being dehydrated to having broken catheter tubes. The study found that people living at home with family members or caregivers had the fewest signs of neglect, while those living in for-profit nursing homes had more frequent and serious symptoms of neglect.
Among the worst signs were bed sores, broken feeding tubes, and medications that were not being given properly. Yet the researchers also pointed out that many signals of improper care are hard to see, such as malnutrition and dehydration.
The study’s authors stressed that hospital workers must be trained to spot symptoms of neglect, so nursing home residents are not sent back to a potentially dangerous situation. Yet there are often no hospital guidelines for how to report neglect, and hospital workers do not have the right training to discuss these problems with their superiors.
According to study author Lee Friedman, a researcher at the University of Illinois-Chicago’s School of Public Health, “As reported in prior research, for-profit facilities caring for the patients in this study were significantly inferior across nearly all staffing, capacity, and deficiency measures.” Friedman said that low wages hurt morale among nursing home employees, which results in residents receiving inferior care.
Yet Friedman and the other researchers stress that over the past decade there have been fewer nonprofit and government nursing homes, but the need for nursing home beds is rising. For-profit nursing homes must fill this gap, but be monitored carefully. The problem is that government agencies which are given this task rarely have enough funding to do an adequate job.
Sounding the Alarm No One Hears
While the number of people going into nursing homes has dropped in recent years, complaints about nursing home care rose by 33 percent between 2011 and 2015. The Health and Human Services (HHS) Inspector General released a report revealing that states were not doing their part to investigate complaints against nursing homes in a timely fashion.
While the reports of nursing home residents being at risk of serious harm doubled, many states did not look into these matters within the required 2-day window. State agencies explain they need more staff to do the job properly because the turnover rate is high. In this age of social service budget cuts, we should not be surprised to return to the problem of finances and people not being paid enough to compensate them for difficult jobs.
Playing Pinball with Patient Care
Cases of nursing home neglect have been increasing to include not only elderly patients, but ones recovering from surgery. To reduce costs hospitals often move patients into nursing homes, yet nursing homes may not have enough staff to care for them. These individuals require careful attention, so they do not experience complications. At the same time, there are often problems communicating care instructions between nursing homes and hospitals. Care providers can lose crucial information about medications and detailed care instructions.
Medicare patients sent to a nursing home after a hospital stay have a 20 percent chance of going back to the hospital within the month, due to a complication or error with care. Medicare started to fine hospitals in 2013 if they had a high rate of readmission, hoping that hospitals would look for nursing homes with quality care, or keep patients longer to ensure they were on the road to recovery.
Follow the Money
Nursing homes also have a financial incentive to send residents to the hospital, since they are often covered by Medicaid. Medicaid does not reimburse nursing homes as much as Medicare or other kinds of health insurance. If a resident goes to the hospital, they will return to the nursing home with up to 100 days of coverage by Medicare, financially benefiting the home. Yet residents are put at risk from repeated hospital stays, since they can get new infections, or return to the nursing home with other illnesses.
Medicare and Medicaid plan to implement a similar system with nursing homes as they have with hospitals, giving homes bonuses and penalties based on whether residents are repeatedly admitted to the hospital. Yet some advocates for nursing home residents worry that with the regulations in place, some nursing homes will decide not to send any patients to the hospital even when such care is needed.
Caring for Caretakers
The secret to better care in our nation’s nursing homes is no secret at all; it’s giving nursing home workers the wages they deserve to perform a difficult job. It isn’t uncommon to have a turnover rate of 55 to 75 percent among nurses in nursing home facilities. This statistic is even higher in for-profit nursing homes, where the benefits package and pay are not as good as in other facilities.
Nursing home caregivers leave because the workload and inadequate number of staff lead to burnout, and they do not have a sense of control over their job and the hours they are scheduled to work. If we want caring people to stay in these high-stress occupations, for-profit nursing homes must be required to pay staff what they are worth. They can no longer be allowed to neglect both patients and care providers as they put profits before people.