Nursing Home Problems

There many problems that are associated with old age, as the human body begins to break down in physical ways, and the mind begins to break down as well, resulting in memory loss, psychological issues, and in some cases dementia and even the dreaded Alzheimer's disease.

For most families in America, taking care of their elderly grandparents or parents in the home is not an option. The average family finds it too big a burden; and in fact many families are simply not equipped to provide the necessary healthcare and psychological skills to their aging parents and grandparents.

And so, those families unable to provide for their elderly at home turn have no choice but to turn to elderly care facilities like nursing homes. But nursing homes have severe problems, which in too many cases actually cause harm to the senior citizens who reside in those homes. And while the federal government tries to keep track of those problems - and resolve those issues - elected officials are not always successful in those efforts, according to the literature used for this paper.

In a United States Senate "special committee hearing" seven years ago, on September 5, 2000, it was pointed out that not only are nursing homes struggling to provide adequate care for the elderly, they were struggling to stay financially solvent. An article in AHA News (Baisden, 2000) reported that five of the nation's ten biggest nursing home chains had filed for bankruptcy between 1999 and 2000.

If there were plenty of patients to fill the beds of those nursing homes, why would so many nursing home companies be losing money? The blame, according to nursing home administrators who testified at the hearing, lies partly in the fact that federal money previously used to subsidize nursing home facilities had been cut back.

Indeed, in 1997 the Congress passed - and President Bill Clinton signed into law - the "Balanced Budget Act" which tightened budgets throughout the federal bureaucracy. That fact aside, the Senator who was the chairman of the "Special Committee on Aging," Republican Chuck Grassley from Iowa, said that he was "not convinced" that the companies running nursing homes "need more money" (Baisden, 2000). If patients have "access to adequate nursing home care," then the money taxpayers shell out to nursing home chains "is adequate as it is," Grassley said.

The senator went on to point out that nursing homes in America at that time were receiving upwards of $39 million annually from Medicare and Medicaid money, but some of the financial problems that nursing home corporations have created for themselves is because they made "business decisions based on the belief that Medicare payments would continue to increase." And those payments have not been on the increase. Grassley said there was a study underway by the U.S. Government Accountability Office, which he was eager to see, to determine what can be done to improve nursing care in American, from a human comfort aspect and a financial point-of-view.

How bad is nursing home care in America? There are signs that it is shamefully bad. Indeed, in a St. Louis Post-Dispatch article (O'Connor, 2002) it was revealed that, "...thousands of America's nursing home residents are dying each year from preventable causes." In Missouri, Governor Bob Holden has launched a Web site that gives consumers and families up-to-date information on the status of that state's nursing facilities. The governor's spokesperson, Mary Still, said in the article that while there is a Web site for nursing care information, it is run by the U.S. Centers for Medicare and Medicaid Services, and nursing homes provide their own reports, which tend gloss over the truth about condition in those nursing homes.

Meanwhile, because of the previous lack of objective information available, the Missouri Coalition for Quality Care launched its own Web site: (http://www.mcqc.com/index.shtm),and some of the reports from that sight are disturbing. For example, in June 2007, the Royal Care Center, a 108-bed "Skilled Nursing Facility" in Excelsior Springs, Missouri was cited for a "Class 1 Notice of Noncompliance." What happened was there was a failure on the part of Royal Care to properly train their staff; to wit, a staff member "incorrectly strapped one resident in her wheelchair" in the nursing home's van. The van hit a curb, which threw the patient out of the wheelchair and suffered "...a broken clavicle and lacerations."

In another incident, according to the Missouri Coalition for Quality Care, the Autumn View Gardens nursing home (a 100-bed assisted living facility in St. Louis) failed to have "adequate staff" on duty for 16 of the 20 nights that were monitored. Moreover, the staff failed to follow up with a patient who had threatened to commit suicide. And sadly, the patient was found dead in his room after not having been seen for 13 hours, according to the report.

A third troubling incident in a Missouri nursing home, reported by the Missouri Coalition for Quality Care, a facility (Alexian Brothers Landsdowne Village in St. Louis) failed to "ensure [that a] resident's physician understood the resident's critical laboratory values, monitor the resident, follow physician orders and keep the physician informed of the resident's status." What resulted from those lapses in care was that the resident in question was hospitalized on December 26, 2006, and diagnosed with "severe dehydration and a urinary tract infection." Complications from that illness led to the resident's death on February 7, 2007.

The lack of quality care of elderly people is not limited to civilians, according to a story in the Washington Post (Lee, 2007). In fact, the Arizona State Veteran Home, a facility serving chronically ill and elderly veterans, was in such bad shape during a routine investigation that the governor, Janet Napolitano removed the head of the state's Veteran's Services Department, Patrick F. Chorpenning from having the legal oversight and responsibility for that facility. He resigned the next day from his statewide post. What inspectors found when they investigated the Arizona State Veteran Home was one patient with serious bedsores and another patient "who remained unattended and in soiled bed linens after he pulled out his colostomy bag," according to the article in the Washington Post.

Other violations of health regulations in nursing homes at that facility included: "...Inadequate supplies" and "slow response by staffers to patients' call buttons." The reasons for Chorpenning's departure included nepotism, the article explains. In fact, the governor ordered a review of management practices at that nursing home, and asked the Arizona Attorney General's office to investigate charges that Chorpenning had put his wife on the nursing home's payroll - as an "interior designer" - and also Chorpenning had "improperly" given his son and "a cousin of his wife" paid positions at the facility.

It would seem that Chorpenning - a Marine Corps veteran who was wounded in Vietnam - was more interested in providing income to his wife, son, and relatives, than he was in providing quality care for the elderly veterans he was duty-bound to care for in the nursing home.

The Government Accountability Office (GAO) conducted one of the latest reviews of the nursing home situation in the U.S.; the GAO is the watchdog agency for the U.S. Congress. The GAO is dedicated to investigating how money is being spent and how federal programs are being run. In a report titled "Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents," issued to the Committee on Finance in the U.S. Senate, the GAO basically told Congress that "sanctions" against repeat violators in the nursing home field were not effective.

In fact, the GAO investigated 63 nursing homes that had "a history of serious quality problems" and the GAO found that though the number of sanctions had "decreased" for those 63 nursing homes, "the homes generally were cited for more deficiencies that caused harm to residents than other homes in their states." The homes that were cited may have temporarily corrected their deficiencies, but even though those homes had to pay "sanctions" (fines), they were "again found out of compliance" with federal regulations regarding the safety and health of patients in homes.

For example, nearly half of the 63 nursing homes in question "...continued to cycle in and out of compliance"; indeed, 19 of the 63 nursing homes were in and out of compliance four times or more. But the problem goes deeper than just the incompetence or lack of training regarding the staffs at these 63 nursing homes. The problem in compliance with sanctions can be traced back to the federal government's Centers for Medicare & Medicaid Services (CMS), the GAO asserts. What happens too often is first, there is a violation of federal regulations that causes harm to a patient (or "resident" as the nursing homes like to call their patients); second, the CMS imposes a fine and issues a demand that the nursing home remedy the problem.

But third, in more than half the cases, theā€¦