It’s a sad fact that nursing home abuse has reached epidemic proportions in the United States. What many members of the public may not realize is just how many different forms this type of abuse can take: emotional or verbal abuse, financial abuse, physical or sexual abuse and neglect.
Numerous federal, non-profit and university studies have detailed the seriousness of this problem. At the same time, the federal government has failed to publish the names of 400 nursing homes with multiple violations that have threatened the health and safety of residents. A recent Senate report called attention to this lack of information and suggested that budget cuts have been stressing a system that was already strapped for funds.
The Centers for Medicare and Medicaid Services (CMS) released a shorter list of approximately 80 nursing homes that are in its Special Focus Facility (SFF) Initiative. These are care centers that have a history of repeated violations that have seriously endangered residents. The nursing homes in the program are monitored by the federal government and can be prevented from receiving Medicaid and Medicare payments if they do not improve. The Senate report argues that even funds for inspecting these few homes are dangerously low.
The Nursing Home Compare website, sponsored by federal government, marks the names of these facilities with a yellow triangle. The Special Focus Facility homes also do not have a 1-5-star quality rating, as do other care centers on the site. Equally upsetting is the fact that 2,900 homes have the lowest rating possible, earning only one star.
Working Across the Aisle to Improve Nursing Home Care
This report was a bipartisan effort by Sens. Bob Casey, a Democrat, and Pat Toomey, a Republican, both of Pennsylvania. The senators argued that by not revealing the names of so many nursing homes with violations, they were putting prospective nursing home residents and their families at great risk. Such secrecy, they emphasized, works against federal efforts to help improve nursing home care, and allow families to make informed decisions. According to Sen. Casey,
"We've got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis."
There are over 15,700 nursing homes in the United States, charged with caring for 1.5 million people. The senators noted that the homes on the short and long lists represent about 3% of this total. The 400 homes with serious violations that are not part of the SFF monitoring program have been left off the list because there is not enough money available through the CMS.
CMS Administrator Seema Verma explained this in a letter, noting there have always been more nursing homes that should be in the program than there are spaces available. In 2010 there were just 167 spaces for 835 homes that qualified. Currently there are 88 spaces and over 400 homes that should be in the program.
Symptom of a Larger Problem
The lack of funds to properly monitor nursing home care is part of a much larger problem in our country’s elder care system. Not only have we failed to assure that nursing home residents are receiving the best treatment possible, we know that the rates of nursing home abuse and neglect are much higher than are actually reported.
According to one study by Health and Human Services’ Office of the Inspector General (OIG), nursing homes do not report over 25% of abuse cases to the police or other federal authorities. In the instances studied by the OIG, these residents were hurt seriously enough to be taken to the emergency room.
There were 134 such cases between 2015 and 2016, a number the OIG calculated by examining Medicare claims and checking them against emergency room reports for evidence of abuse. If so many serious injuries are not being reported by nursing homes, how many other abuse and neglect cases are going under the radar?
An earlier report from the OIG found that 33% of nursing home residents had been harmed in their care facility. There was a range of causes for this harm, including falls, infections, complications with medications and pressure sores. The study further estimated that 59% of these incidents could have been prevented.
Other reports have pointed to the high number of sexual abuse cases among nursing home residents. Some facilities are cited many times for this offense, but instances of sexual and other forms of abuse in nursing homes are grossly underestimated.
Fighting for Fair Funds
Many instances of abuse and neglect could be prevented if nursing homes had adequate staff to care for patients. For example, homes that are larger for-profit operations as opposed to nonprofit facilities have higher rates of patient harm. Such facilities tend to put profits before people to pad the pockets of their shareholders, which hurts the quality of care. They, however, are not the only problem facilities, as non-profit homes have also been cited for violations.
It remains undeniable that there is a heartbreaking lack of investment in care for our most vulnerable citizens. If we want to provide true quality of life for these individuals, we must raise a strong voice and demand that the federal government provide adequate funds to monitor nursing homes. It is only through this kind of commitment that we can provide a safe environment for nursing home residents and enforce standards of care that will make their golden years shine.