Nursing homes are closing their doors for good across America, but especially in rural states.
Over the last decade, according to a new report by the New York Times, more than 440 nursing homes in rural areas have undergone mergers or gone out of business. South Dakota saw 5 nursing homes close in the past 3 years. Nebraska saw 5 close just last year with more at risk of the same fate. In Maine, a record-high 6 facilities closed last year.
The question on the lips of nursing home regulators is what forced all these closures and what can be done to prevent them. But more importantly, how do they affect residents?
The Problem with Nursing Homes in Rural States
In remote areas of the U.S., long-term care choices are few and far between. Senior living communities have waiting lists. Nursing homes are relatively scarce. So are home health aides, who are often too expensive for families to hire around the clock.
“How often have you heard somebody say, ‘If I go to a nursing home, just shoot me?’” Stephen Monroe, an author who researches aging in America, told NYT. “In the rural areas, you don’t have options. There are no alternatives.”
So when nursing homes close, they scatter residents to the winds. They’re shipped off “like cattle,” in one nursing assistant’s words, to other nursing homes around the country – sometimes hundreds of miles from the families, friends, and communities they’ve known all their lives and often without warning. One South Dakotan rehabilitation center highlighted in NYT’s report gave residents only 2 months to find elsewhere to live.
Relocations can be traumatic for families, too, of course. At this time of year, extreme winter weather makes it impossible for children or elderly spouses to make the trip to their loved ones’ new homes. Best case scenario, families are forced to cut back visits. With loved ones who suffer from conditions like dementia, families cannot know how that passage of time will affect their relationship.
Thirty-six rural nursing homes have closed in the last decade for failing to meet health and safety standards. Yet far more, according to NYT, have collapsed in the wake of a nationwide plunge in occupancy rates. Fueling this trend is the fact that more Americans are choosing to age in their own homes – in part because of changing healthcare policies that encourage independent or assisted living, in part because we’ve lost faith in the alternative.
The Problem with Nursing Home Abuse
The Times’s report came days before a Senate Committee of Finance hearing called by Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA), the latter of whom recently sponsored a new law designed to address an ongoing concern across the U.S.: abuse in nursing homes.
The panel heard testimonies from 2 children of nursing home abuse victims: one whose mother died as a result of severe neglect, and another whose 87-year-old mother, an Alzheimer’s patient, was “brutally raped by a nursing aide,” according to Grassley. He and Wyden described still more cases involving, for example, a resident found with mold and infections after going a week without bathing and a nurse who stole pain medication until the prescribed patient died.
“In each of these cases, the victim’s trust was betrayed by the very individuals who were entrusted to care and protect them,” said Grassley.
Sadly, these aren’t isolated cases, he noted. Overall, according to a 2018 Inspector General testimony, an unfathomable one-third of elders have experienced harm while under the care of federally-funded nursing homes. More than half of cases were preventable. In those, the nursing homes in question were cited as unsafe, understaffed, or uninterested in providing even basic (let alone quality) care of their extremely vulnerable residents.
What Can Be Done to Reduce Closures and Abuse?
Wyden proposed addressing nursing home abuse at the federal level by “raising standards and rooting out harmful, substandard care and those who provide it.” Governors have proposed increasing their state’s Medicaid reimbursement rates, according to the New York Times.
Yet, the experts that the Times interviewed doubt this is enough. What we need, and what we’ve not yet seen any hint of, is a culture shift in how nursing homes treat their patients and their willingness to invest in the resources elders need and deserve. Only quality care can convince disillusioned elders and families to put their faith in nursing homes – rural or not – once again.
In the meantime, Grassley stressed, it’s our job as families and health officials to protect elders as best we can.
“Every family has a loved one – a mother, a father, or a grandparent – who may someday need nursing home care. That makes this a topic of enormous concern to every American,” Grassley said. “I’ll continue to make it a top priority to ensure our most vulnerable citizens have access to quality long-term care in an environment free from abuse and neglect.”