Patricia Olthoff-Blank thought all was well at her mother’s nursing home in rural Buffalo Center, Iowa. Virginia Olthoff had lived there for 15 years and the administration communicated frequently with her family about her care.
Then Olthoff-Blank got a call at 3 am from an emergency room nurse. He learned, to his horror, that his mother was severely dehydrated. An ER doctor told him, “This didn’t just happen.” He believed his mother had been without water for four or five days. Several hours later, Virginia Olthoff was dead. Her daughter recounted the events in testimony before the Senate Finance Committee in March 2019, telling them that a report from the Department of Inspections and Appeals revealed that her mother had not eaten or drunk for nearly two weeks and had received no fluids. intravenously. He had been crying in pain and had lost a lot of weight. Despite repeated pleas from certified nursing assistants to their superiors about her mother’s condition, “nothing was done,” Olthoff-Blank said. The pandemic has exacerbated and raised awareness of the poor conditions in many nursing homes across the country. But those conditions existed before COVID-19 reached the US, and they are likely to continue unless changes are made, experts say. “There is an opportunity right now, because there are a lot of eyes on the nursing home industry,” said David Grabowski, professor of health policy at Harvard Medical School. “One of my biggest concerns is that things return to normal … [people will say] we can go back to work as usual. Business as usual didn’t work before the pandemic, and it certainly didn’t work during the pandemic. We need to make some real changes here. “What caused nursing homes to fail so drastically during the pandemic? Experts point to five main factors: 1. Staffing Chronic staffing shortages in nursing homes lead existing staff to Breakpoints. These front-line worker jobs, such as certified nursing assistants (CNAs), are often as difficult as retail and fast food and typically pay less (the average annual income of a CNA in a nursing home is $ 28,450.) The bottom line? Employees don’t stay. “We found turnover rates of more than 100% in a calendar year, which means basically all staff are changed every year. , and some nursing homes have a turnover of up to three hundred percent, “said Grabowski, referring to a study he and his colleagues published in March 2021 in Health Matters. enough to those direct caregivers, ”he said. “They are mostly women, a lot of people of color and immigrants, and they are overlooked in many ways in terms of where we direct resources in our healthcare system.” Inadequate staffing has a direct impact on residents, who not only may receive poor care, but are unable to develop relationships with workers when they are there one day and leave another day, Grabowski said. “You talk to the residents and ask them, ‘What did you like or don’t like about this nursing home?’ and it‘s always about the staff, ”he said. Nursing professional-level staffing is also vital, said Charlene Harrington, emeritus professor of behavioral social sciences at the University of California, San Francisco School of Nursing. Harrington joined 21 other nursing experts to post a call to the Centers for Medicare & Medicaid Services (CMS) in March to get a federal mandate for a stronger presence of registered nurses (RNs) in nursing homes. CMS staffing rules currently require a registered nurse on duty in a nursing home for eight consecutive hours each day. Harrington and his colleagues said it should be increased to a 24/7 on-site presence of registered nurses. There are no federal ratios for staff at any level. “It’s sheer age discrimination that you can store older people and not have to hire the right staff and pay them to be competent and experienced,” Harrington said. Pamela Mickens, a long-term care advocate in Dallas, said she sees the impact of understaffing on a daily basis. But a comment from a member of a resident’s family crystallized the issue of staffing standards for her. The family member worked in the prison system and noted that there are staff ratios for inmates, but not for people in nursing homes, Mickens recalls. “It was an epiphany for me,” he said. Medicaid funding covers more than 60% of all nursing home residents, and Medicaid reimbursements cover 70% to 80% of nursing home operating costs, according to the American Healthcare Association, a group of the industry. He points to that funding gap as the culprit for “tight budgets.” “Medicaid is not a generous payer,” Grabowski said. “The way most nursing homes have made things work is by accepting these short-stay post-acute patients who come from the hospital,” since Medicare covers these patients for a limited time and at a much higher rate. . Don’t Miss: The Best New Retirement Ideas That Create Incentives to Hospitalize Long-Term Patients and Bring Them Back, Grabowski said. “The margins on that side of the business are really quite high.” UCSF’s Harrington said his research shows that the nursing home payment model is not the problem. “All nursing homes say they don’t have enough money, but in reality [for-profit nursing homes] make excessive profits at the expense of their underpaid staff, ”he said. Corporate structure Those gains, Harrington said, are hidden by the often Byzantine corporate structure that underpins for-profit nursing homes, which account for 70% of the total. A Kaiser Health News article revealed that it has become increasingly common for nursing homes to outsource goods or services to companies they control or in which they have a financial interest. Some even rent their buildings to a sister corporation. The result: homeowners can divert earnings that are not reflected on the nursing home books. A related benefit for nursing homes is that if they are sued, the plaintiffs often have a hard time collecting, as the assets are not held by the licensee, Kaiser reported. “They set up these complex structures and they are taking so much money out of their related party organizations … there is no money left for staff and services,” Harrington said. Advocates for greater transparency and financial accountability in nursing homes. Lack of supervision and compliance Nursing homes agree to follow minimum standards of care when participating in the Medicaid and Medicare programs. Federal regulations require that they “provide the care and services necessary to achieve or maintain the highest possible physical, mental, and psychosocial well-being” of their residents. That includes maintaining adequate hydration, something Patricia Olthoff-Blank’s mother certainly failed to achieve. After the deaths of Virginia Olthoff and another resident of the same nursing home, CMS fined the center $ 77,462 and the families filed a lawsuit. But federal action against nursing home neglect is often insufficient, and many nursing homes are allowed to operate while permanently falling below minimum standards and then recovering. Related: Covid-19 Devastated Nursing Homes – Here Are Safer, More Profitable Options “There is a segment of the industry that has what we call ‘yo-yo compliance, because they are constantly in and out of compliance.” and rotating through various gaps, said Lori Smetanka, executive director of National Consumer Voice for Quality Long-Term Care. “And they just aren’t held accountable.” “We see ongoing and routine noncompliance” with laws and regulations, said Eric Carlson, senior attorney at Justice in Aging, a nonprofit that fights poverty among older Americans. “There are facilities that have business practices that are not in accordance with the law; for example, they treat Medicaid patients worse and there is a federal statute that says you cannot discriminate based on the source of reimbursement.” Too often, he said, CMS “does not recognize the violation, or if it does, it does not impose a penalty.” 5. Aging buildings The physical environment of nursing homes has become another source of problems. Traditional nursing homes built 30, 40 or 50 years ago were often inspired by hospitals, with long corridors and small shared rooms. “There’s a warehouse mentality that communicates with that kind of layout and architecture,” Carlson said. “For most people, our lives are not organized around our beds … we do not sleep three feet away from strangers.” The Green House model of nursing care and others like it, by contrast, consists of small-scale home units limited to groups of 10 to 12 older adults, each with their own private room. These models often operate on a “more enlightened” staffing arrangement, with nurse aides consistently working with the same residents, Carlson said. A change in culture Mickens, the Texas ombudsman, said an ongoing challenge in nursing homes is the lack of recognition that residents have rights. “They have a voice, and their voice and their preferences may be contrary to what the nursing home staff, including the doctor, want for them,” he said. Even if it is something as simple as taking a shower at night instead of 6 in the morning, the nursing home should strive to include that preference in the resident’s plan of care. Carlson agreed. She put together a list, available through Justice in Aging, called 25 Common Nursing Home Problems and How to Solve Them. In addition to enforcement, everyone involved in the system – from discharge planners to staff, family members and residents themselves – must have higher standards, Carlson said. Read next: Want to grow old at home instead of in a nursing home? Consider this first. That’s the idea behind the guide, he said. If a facility says it won’t accept an application “because it’s going to be a nuisance,” Carlson noted, the consumer can say, “No. Unacceptable.” It will take a culture change, he said. And if facilities don’t do it themselves, he added, consumers should say, “We’re going to change your culture for you. Because what you’re doing right now isn’t good enough. “Emily Gurnon is the former senior content editor covering health and care for Next Avenue. Her stories include a series of articles on guardianship abuse that was funded by Senior Journalists Fellows Program. Previously, she spent 20 years as a reporter for an award-winning newspaper in the San Francisco and St. Paul Bay Area. Contact her through her website. This article is part of The Future of Elder Care, an initiative of Next Avenue with support from the John A. Hartford Foundation. This article has been reprinted with permission from NextAvenue.org, © 2021 Twin Cities Public Television, Inc. All rights reserved. More from Next Avenue :