Report on nursing homes predictably appalling

By Brian Lee, Executive Director

(Featured on HealthNewsFlorida.com)

A new report released by the Government Accounting Office earlier this month shows private investment firms that own for-profit nursing homes are doing a mediocre job at best.

Findings revealed that overall deficiencies swelled, direct care staffing declined and profit margins ticked higher.

Predictably appalling.

It is troubling to learn that even with the preponderance of quality improvement initiatives, ombudsman advocacy work and government inspections (all of which providers often claim as ‘burdensome’ or ‘overregulating’) deficiencies continue to spike in these homes.

This new report (GAO-11-571) is the second government report that stems from a 2007 New York Times critique of the management of care and services conducted by private investment firms of massive nursing home conglomerates. The Times reported that resident care suffered in part from cutbacks on nurse staffing to increase profitability.

Everyone knows that nursing home quality hinges on a high number of well-trained, direct care staff. It was just this year another academic study concluded that there is a direct correlation between the quality of care in nursing homes and staffing.

Whoops, I guessed these operators missed that study—along with the countless others that scream about the importance of staffing.

But the GAO report wasn’t all bad news for the industry. It also revealed that serious deficiencies went down and registered nursing hours went up.

This does translate into fewer residents experiencing the agony of improperly treated bedsores, fewer medication errors and fewer resident elopements.

But these results, taken in tandem with the overall increase in deficiencies, are illusory; analogous to a decrease in tragic car accidents all the while citations for speeding tickets and DUIs skyrocket.

The potential for more significant problems for residents is reaching a boiling point.

A closer look at the increase in registered nurses and decrease in certified nursing assistants might signify a paradigm shift in for-profit homes. As state lawmakers contemplate further reductions to Medicaid budgets, more for-profit facilities are modifying their bed licensure structure to accommodate short-stay, post-acute care.

Operators may be trying to capitalize on higher Medicare rates that can pay as much as two or three times more than some state’s dwindling Medicaid rates, even with the recent Medicare rate correction. While this may temporarily offset a portion of Medicaid shortfalls, this strategy lessens the number of long-term care beds needed by a baby boomer population that will rise nearly 80% by 2030.

In other words, they are just trying to keep the “profit” in “for-profit."

Another reason for the reduction in serious deficiencies may be attributable to owners hiring savvier lawyers to get them off the regulatory hook.

Too often serious deficiencies are negotiated down through an appeals process only open to providers and state regulatory personnel. Here is how this plays out. If a surveyor cites a facility for an improperly treated bedsore, providers can appeal that finding and talk the violation down from a serious deficiency, avoiding a severe penalty and forgoing a bad mark against their record.

This really equates to no justice for the residents.

So now that we have two government auditing reports exposing the need for additional nursing home transparency, what should Congress do next to hold the industry more accountable to residents, taxpayers and consumers?

Here is an idea, since the industry is disproportionately funded by Medicare and Medicaid dollars (nearly 80%), Congress should demand an immediate disclosure of the industry’s overall and aggregate organizational structures and profitability including, but not limited to, any nursing home corporations, limited liability companies, affiliated corporations, or private investment funds before cutting any more checks.

Until that happens, resident concerns will continue to take a backseat as the industry and policymakers battle over how many taxpayer dollars are really needed to supplement the pocketbooks of wealthy owners, all in the name of caring for our parents and grandparents.
 

Brian Lee served as the state of Florida nursing home and assisted living resident ombudsman for most of the past decade. He now serves as the Executive Director of the long-term care resident advocacy group; Families For Better Care, Inc.