By William J. Beerman, Sr.
Over the decades, bad nursing homes have hemorrhaged a ceaseless stream of scandals and lawsuits alleging neglect and serious harm to patients.
Yet the world of nursing homes comes close to looking like single-payer health care. The American Health Care Association (AHCA) reports that 71 percent of nursing home revenues come from the government: 57 percent from Medicaid and 14 percent from Medicare. Some nursing homes get virtually ALL of their revenue from Medicaid.
So, in light of our experience with nursing homes, should single-payer health care advocates be more careful about what they ask for?
AHCA is a non-profit federation of state health organizations, together representing more than 13,500 non-profit and for-profit nursing facilities, assisted living facilities, and other facilities that care for approximately 1 million elderly and disabled individuals each day.
AHCA says the payments the nursing home industry gets from Medicaid fall short of what the nursing homes need to fully comply with regulations by $25 per Medicaid-patient-day, or collectively by $7 billion a year.
The nursing home operators say they are plagued by excessive and inappropriate regulations and costly questionable lawsuits that consume money that could be better spent at the bedside.
Hundreds of thousands of people have filed formal complaints about nursing homes, while in recent years, as the number of complaints rose, the number of government enforcement actions declined.
There are many good nursing homes, and many poor ones. Medicare.gov rates nursing homes on a scale, with one star equating to “much below average” and five stars meaning “much above average.” The rating for “average” is three stars. For example, a search I did in 2016 for nursing facilities in Pennsylvania belonging to the Golden Living chain, which is the subject of a contested Pennsylvania Attorney General consumer-protection lawsuit, turned up 36 Golden Living nursing homes. Two had five stars, seven had four, 10 had three, seven had two, and 10 had one star. So, 47 percent were below average (one or two stars). Some below-average nursing homes stay open for years and continue to receive government funds.
Critics say nursing homes can game the Five-Star rating system and that the system does not consider the opinions of the residents. Nursing home workers told investigators in multiple states that managers knew when state inspectors were coming. A Florida state nursing home regulator, Bertha Blanco, was sentenced in December 2017 to prison for selling confidential inspection schedules and copies of patient complaints to nursing home operators for $100,000 in bribes.
The overseer of nursing homes is the would-be single payer: the government. The inspectors generally are state health departments, which in turn follow regulations issued by the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS).
On the west coast, the California Advocates for Nursing Home Reform released a white paper in December that the organization says summarizes major problems in long-term care in California. It begins: “The quality of nursing home care in California has never been worse.”
On the east coast, New York State Senator Rob Ortt (R-North Tonawanda) announced in a televised news conference December 27 that he was introducing new nursing home regulatory bills because: “Since I have been in office, the quality of care in the nursing homes across our state has been a persistent issue and it has continually gone unaddressed.”
U.S. Senator Bob Casey (D-PA) has been criticizing government oversight of nursing homes for decades. When he was Pennsylvania’s auditor general in 1998, he issued a scathing audit report about the state health department’s oversight of nursing homes. It was entitled “Residents in Jeopardy.” In a 1998 news release Casey said the Pennsylvania Department of Health had “failed miserably” in its oversight of nursing home care. Casey followed up with another audit report entitled “Residents Still in Jeopardy.”
More recently, current Pennsylvania Auditor General Eugene DePasquale issued a report critical of the health department’s oversight of nursing homes in 2016, and ongoing state attorney general lawsuits in Pennsylvania and New Mexico describe horrendous conditions that AG investigators found in nursing homes.
Last year, about 20 years after his “Still in Jeopardy” audit, Casey was among a group of 12 U.S. senators who sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma saying in essence that they were alarmed that proposed easing of nursing home regulations was putting nursing home residents “at greater risk.”
The senators cited a report by the HHS Office of Inspector General (OIG) from 2014 that found that, during a Medicare-covered stay, nearly a third of nursing home patients experienced an adverse event or an incident that led to temporary harm, with 59 percent of these events being considered preventable. “More alarming,” said the senators, “is that during the one-month period that OIG reviewed, Medicare incurred a cost of $208 million due to hospitalizations (of nursing home residents) alone and found that adverse events contributed to 1,538 deaths, most of which had not been anticipated.”
So, one must wonder, is the government system that oversees and largely funds our nursing homes ready to take over all of our health care?
William J. Beerman, Sr., is a retired former journalist whose mother’s nursing home experience motivated him to write Mary Regina’s Nursing Home, a book about nursing homes and government oversight of nursing homes (www.WBeerman.com). Besides his home page, William maintains a Facebook Page, Nursing Home Monitor.