The Shame of Substandard Care: Shadow Economic Crisis (Part 3)
It is rare that politicians step into the nightmare of shame that is today’s nursing home industry in an effort to protect the innocent and condemn an industry rife with greed and substandard care.
“Nursing homes are rapidly becoming nothing other than legalized scams…a place to ‘warehouse’ the elderly, suck away their money, treat them like children, let them die, and then take in another from the waiting list.” —Former Iowa State Senator Dennis Black
Senator Black’s lament reveals the desperation of families across the nation.
“It is hard for people to accept reality about people being abused. Out of sight, out of mind. Unless it happens to you, people do nothing about it. My experience has been extremely heart wrenching. I did not really know the man. He was not even a constituent. I just stepped in and tried to help.”
In a nation that prides itself on quality health care, first-hand investigations and extensive research reveal a shameful truth that must be brought out of the shadows. While embedded as a journalist for years in the elder care system from hospitals to nursing homes, what became evident was a broken system of care for families and their elderly loved ones. In a system where too frequently profits trump care, the results are ugly, inhumane and often deadly.
What the Iowa Senator details, in addition to deficient care, is a great moral collapse undergirded by greed in today’s America. The continuing degradation of the nursing home industry is forcing a crisis of conscience. Senator Black speaks of a man, a father, a grandfather and a U.S. veteran:
“America needs to know that he is but one of untold or unknown numbers of people who are being ‘farmed’. They represent a certain amount of cash and assets, and are seen as such by the money changers who only see them as a cash crop. He was just a ‘throw-away’ person that this system of DHS [Department of Human Services] has deteriorated to in Iowa and apparently across the nation. We allow our elderly to be placed in confinement in a nursing home at $6,000 per month, drain them of their life’s savings and assets, medicate them into a stupor of near comatose…" Sharon, I can’t go on with this. It brings back too much from my experience and memory. [But,] I can’t put it away, because my buddy is six feet underground, placed there without the truth being told.”
Senator Black continues:
“I am not broad-brushing the entire nursing home industry. Readers know who the good and the evil are, for you have either experienced it with your elders, or had reliable verification of the travesties that occur to others. Frankly, I’ve been exposed to an epidemic of abuse that emanates from the fact that ‘the bottom line’ is the first statistic viewed by the management of these [nursing home] corporations… As always, the almighty dollar dictates.”
Families in every state across America feel abandoned as government policies fail to adequately regulate the multi-billion dollar nursing home industry. Contract fraud is rampant. An average of $5,000 is paid monthly for each resident’s care. Yet, the shortage of actual services rendered to patients often reveals a theft that would not be tolerated in other businesses. With no one taking account, nursing homes regularly cutback on staff, nutrition and supplies (such as toothpaste and diapers) in order to shave costs. Savings stolen from patient care are applied to bottom-line profits for the owners who are reaping a reported financial boon of billions of dollars during a down-economy. The average nursing home administrator’s salary is over $100,000 annually.
What would be condemned or prosecuted just outside of the doors of nursing homes goes unchecked once inside. Prosecution of abusers is rare to nonexistent in the majority of cases where people are subjected to physical harm. Physical assaults, mental taunting and emotional bullying occur regularly to frail, defenseless victims and go unpunished. America cannot consider itself a civilized society when our aging and fragile parents and grandparents are left in the hands of bullies and predators without protection or relief.
The first critical step is strict enforcement of the laws that are on the books, both financial and criminal. Closing down what some call “houses of horror” is another. Marjie Lundstrom of The Sacramento Bee reports that the California State Attorney General’s Office filed involuntary manslaughter charges against a nursing home in suburban Los Angeles: “Two registered nurses on staff also were charged with felony abuse. Public officials in neighboring South Pasadena continue to press the Attorney General's office for criminal charges against another nursing home — a facility the local police chief denounced as a "cesspool” and a “community menace.”
What Senator Black and others may not know is that many nursing home owners reward nursing home administrators with thousands of dollars in bonuses if they can get a four-or-five-star rating from State and Federal inspectors. Akin to the atrocities that have gone on in the Veterans Administration and its treatment of our veterans, nursing home managers have become adept at hiding the ongoing neglect and abuse during inspections. First-hand experience reveals that inspectors are easily fooled or choose to look the other way.
With a nursing home dependent on profits, a good rating from government inspectors, even when false, attracts customers and potential investors. To affect the bottom line or mollify stockholders, nursing homes cut services and care to increase profits. What is at stake is quality-of-life and, oftentimes, life itself. Prioritizing cost cutting over basic care is endemic throughout the industry. The result, according to Whistleblowers, is that people suffer or die. The good deserve credit, whereas the bad remain profiteering merchants of misery.
Every ten years a study comes out proclaiming that nursing home “care” is every bit as shameful as it was ten years prior. That pattern remains unbroken. Conditions have worsened since U.S. Senator Charles Grassley (R-IA) wrote a letter to the U.S. Dept. of Health and Human Services over a decade ago after reviewing an investigation by the Office of the Inspector General. Senator Grassley complained that “facilities are given too many ‘free passes’ to correct deficiencies… Surveyors’ noted that in most instances a facility would, as an initial matter, correct the deficiency only to revert back to its "old ways” once a follow up review is completed.“
Grassley further adds and recent investigations reveal that surveyors state that "patients and/or family members are rarely interviewed; administrative and medical records are rarely reviewed; valuable information is routinely recorded incorrectly; and the word of the facility is often taken at face value over that of a resident and/or family member. As a result of these inherent procedural failures, complaints are rarely substantiated and serious quality problems are therefore not corrected. Despite years of reports, evaluations, and investigations, the surveyors that we interviewed portray a bleak and dismal situation in America’s nursing homes. The surveyors themselves are demoralized when blatant quality of care deficiencies and findings are watered down, substantively altered, and/or blatantly ignored or dismissed. These surveyors have raised enormously disturbing issues for anyone who cares a wit about the very health and safety of frail nursing home residents.”
Senator Grassley asserts that government ratings’ systems are unreliable and misleading since nursing homes are allowed to “self-evaluate” as part of the government’s five-star system of ranking. Families are unable to discern which are the good ones and which are bad.
Grassley denounces Medicare’s rating s as notoriously outdated and incorrect: “The concerns include questions about the integrity and reliability of the information provided to the public through the Nursing Home Compare [Medicare] website. A plan of attack is needed to restore the integrity of the system… The survey process, I am sure you will agree, is meant to improve the quality of care for residents, not to ignore it, gloss over it, and most of all, not make it worse. If the survey and certification process is not working–and it looks like it is not–it must be fixed.”
Carole Herman, a foremost advocate for the rights and protections for the elderly and co-founder of Foundation Aiding the Elderly, weighs in on the matter: “My personal experience with our over 5,000 clients is that Medicare should not be rating nursing homes…they are in no position to give accurate information thus giving the general public a false sense of security that the facility they pick has been sanctioned by the government if the rating is a high one.”
Owning and running nursing homes is based on a financially strategic decision where making a profit is central. Some open their doors to provide a decent service to meet a critical need. For others it is an ugly, get-rich scheme off the backs of families and our most vulnerable members of society. Dr. Charlene Harrington, has researched nursing home standards and regulations for more than three decades. I posed questions to Professor Harrington:
Q. How do nursing homes cut their operational costs? Is it by chronic understaffing, cutting supplies, and poorer quality meals?
A. There is really only one major way to cut costs and that is to cut staffing especially RN staffing since it is the most expensive. The chains often have very low supplies and equipment and spend little on meals but they can’t go much lower on those [food] expenditures.
Q. If sufficient funds are paid [average $5,000 per month nationwide] and insufficient care is provided, is that fraud against the government and those paying thousands of dollars monthly per resident for the promised quality care that is most often advertised by these companies?
A. Yes, that is fraud and false advertising and there have been a number of legal actions on this, but unfortunately not enough to put the bad companies out of business.
The book, “Aging Warning: Navigating Life’s Medical, Mental and Financial Minefields,” details how widespread substandard care is and provides insight on how families can protect themselves and their loved ones medically, mentally and financially.
Nursing homes are licensed by the State to provide quality care and protection for their residents. As a care facility, they have a greater calling to decency, morals, ethics, kindness, and patience — in addition to appropriate levels of skill and training. Yet, the system is corrupt. A symbiotic arrangement exists between many in the billion dollar nursing home industry and politicians. Whistleblowers report that State and Federal politicians’ pockets are lined as lobbying occurs across party lines. Wealthy owners’ with deep pockets buy influence from both sides of the aisle to influence legislation favorable to the industry. Quality skilled long-term nursing facilities are an important part of the future. Along with families, ethical nursing home owners must demand a purging of the fraud and corruptness that permeates the industry.
Without the public holding government overseers accountable, conditions will continue to worsen inside nursing homes. Expect overcrowding, understaffing and the hiring of less skilled personnel handling more patients, including an increase of those with brain diseases such as dementia and Alzheimer’s. Our elderly and their families face a dismal future unless strict enforcement of criminal and civil laws inside of nursing homes becomes a reality nationwide.
Daily, people are being physically hurt, emotionally traumatized and bullied. The vulnerable must be protected. Ongoing suffering at the hands of predators must stop. A quality level of services must be rendered. The shame on this great nation will manifest itself as a grievous moral and financial crisis that could have been avoided — if only the warnings were heeded.
Take action. Email this article, and the links to this 3-part series posted below, to your representatives in Congress and to legislators in your state.
Related articles in the series:
Sharon Sebastian, author of the book, “AGING: WARNING — Navigating Life’s Medical, Mental & Financial Minefields,” is a columnist, commentator, and contributor in print and on nationwide broadcasts on topics ranging from healthcare, culture, religion, and politics to domestic and global policy. Sebastian’s political and cultural analyses are published nationally and internationally. Website: www.AgingWarning.com.
