Nursing Home Horrors Heard By Senate Panel
27 Jul 2007
1999-Excerpts From AARP Bulletin
The stories are real and appalling. A nursing home in Florida tried to evict 52 residents whose care was paid by Medicaid. A man died emaciated in another Florida home so filthy that maggots hatched in beds. A Maryland resident died of asphyxia after being trapped between her bedrails and mattress; five months later, the home was found at fault but failed to correct the problem and was fined $100.
These horrors led in late March to legal and legislative decisions that moved in the same direction as a nursing-home initiative announced by President Clinton last year.
The first case prompted a law that prohibits one kind of Medicaid "dumping" nationwide. The second brought a jury award of $15 million against the nursing home in question. The third, together with hundreds of similar cases, brought new federal regulations for inspecting homes and enforcing standards.
More than 1.6 million Americans -- our most frail and vulnerable citizens -- live in nursing homes. Most receive care that ranges from adequate to excellent.
But an ongoing investigation conducted by the Senate Special Committee on Aging has revealed a Dickensian underside: One-fourth of the nation' s 17,000 nursing homes, it finds, "cause residents actual harm or put them at risk of serious injury or death."
Sen. Chuck Grassley, R-Iowa, the committee's chairman, concluded bluntly: "Is the government doing enough to protect nursing-home residents? No, it is not. Patients suffer. Bad homes profit. Taxpayers are suckered."
The federal government has a huge investment in nursing homes. In 1999, the Health Care Financing Administration (HCFA) will pay them $39 billion through Medicare and Medicaid. In fact, Medicaid picks up the tab for about two-thirds of all nursing-home residents -- the great majority of whom pay their way at first yet soon exhaust their savings, usually in less than nine months.
HCFA pays another $210 million each year to state agencies that inspect and certify nursing homes and are supposed to enforce federal standards of care. But U.S. General Accounting Office reports, requested by the aging committee and based on surveys of 14 states, show that enforcement is not working well.
They cite serious violations in care -- most frequently, homes' failure to prevent accidents, malnutrition, dehydration and pressure sores.
Complaints often "remain uninvestigated for weeks or months," and delays of more than six months are common, even in cases where residents allegedly died from neglect.
About 40 percent of the homes found with deficiencies are repeat offenders, yet sanctions for noncompliance are often delayed years or, in some cases, never imposed.
This documentation galvanized HCFA to announce tougher regulations. State agencies must now investigate within 10 days any complaint against a nursing home alleging harm to a resident. And the states can now fine homes up to $10,000 for each serious violation that threatens residents' health and safety -- without having to allow a grace period for homes to correct the problem, as they do now.
Other possible reforms include surprise inspections; a report card system for homes; and a national registry of nursing-home workers convicted of abusing residents.
Resources
"Nursing Homes: Getting Good Care There," $17 from National Citizens' Coalition for Nursing Home Reform, 1424 16th St. N.W., Suite 202, Washington, D.C. 20036.
"Nursing Home Compare" -- New Web listings of all Medicare/Medicaid certified homes, with data on their last inspections, including severity and scope of any deficiencies: www.medicare.gov
"Rights of Nursing Home Residents" -- AARP Webplace guide at www.aarp.org/getans/consumer/rights.html
