Fresh documentation compiled by congressional investigators shows physical and sexual abuse victimizing the U.S. nursing home population is not reported promptly to the proper authorities and rarely is prosecuted.
Revolting details of criminal abuse by fellow residents and nursing home employees was uncovered during an 18-month investigation by the General Accounting Office, the nonpartisan auditing arm of the U.S. Congress. Issued in early March, the report also says more than 30 percent of the nation’s 17,600 nursing homes has been cited by state inspectors for violations that harmed residents or put their well-being at risk.
While it would be wrong and unfair for critics and the public to read the headlines and jump to conclusions about the entire industry and the majority of its conscientious workforce, it would be equally unjust for elected policymakers and federal regulators to sit back and accept the status quo. Clearly, the safeguards currently in place to protect nursing home residents aren’t measuring up to the most basic standards family members expect when they admit a loved one into a nursing home facility.
The federal government needs to a better job protecting this vulnerable population of elderly and disabled citizens. Tax dollars funneled through the Medicaid and Medicare programs help pay for approximately three-fourths of the 1.6 million people living in the nation’s nursing homes, reaching $58 billion in 2001.
During my service as chairman of the Senate Special Committee on Aging, I launched a crusade that continues today to improve the quality of life and delivery of care to the growing nursing home population. Congressional hearings I held in 1998 and throughout my chairmanship exposed substandard care in almost one-third of the nursing homes studied in California that resulted in residents suffering from malnutrition, dehydration and even life-threatening bed sores.
In response, the federal agency in charge of Medicare and Medicaid vowed to step up its oversight and enforcement efforts to improve the quality of care in nursing homes. Thanks to vigorous congressional oversight, some progress has been made. However, this latest investigation seems to indicate the regulatory and industry response necessary to improve nursing home care and accountability is falling short.
The report outlined reprehensible accounts by family members of residents victimized by criminal abuse in a nursing home. Federal auditors concluded a handful of reasons for the delay or failure to report such abuse, including relatives and the victim may fear retribution to the patient; administrators may harbor concerns about bad publicity, fines and or penalties; co-workers may fear job loss or backlash from their fellow employees.
As long as I’m in the Senate, such disturbing revelations about nursing home neglect and criminal conduct aren’t going to be swept under the rug. While these issues can’t be resolved overnight, it is imperative that policymakers, regulators, inspectors, advocates and industry representatives work together to implement solutions to these persistent problems. Proposals on the table include the implementation of a national registry of nursing home employees and mandatory background checks so nursing homes can better screen job applicants.
And in the coming weeks, a long-awaited federal study about staff shortages in the nation’s nursing homes will be reported to Congress. Critics have long argued that low staff-to-patient ratios contribute to substandard care. The report and its recommendations will hand Congress the challenging task of tackling a longstanding dilemma to balance quality improvements, like setting a minimum staffing requirement, requiring more rigorous inspections or developing a national registry of nursing home workers, with cost. Policymakers also will have to take into account the demographic and labor demands in store for the nation’s nursing homes, home care agencies and hospitals. Quality, long-term care will become increasingly important as the American population ages, especially the growing segment of those age 85 and older.
As the top Republican on the Senate Finance Committee, which bears legislative and oversight authority over the federal agency in charge of nursing home regulations and enforcement, I am working with the administration, industry and employee representatives, consumer advocates and other experts to develop a consensus on the staffing issues.
While it may not be easy to reach an agreement, all parties involved would agree we must find a solution that makes the system more accountable and is affordable and achievable at the same time. And folks need to remember the best way to support a loved one who lives in a nursing home is to visit frequently, trust your instincts and report concerns to the community or state ombudsman. In Iowa, contact the Long Term Care Ombudsman at the Iowa Department of Elder Affairs, 515/242-3333 or 1-800-532-3213 or the Health Facilities Division at the Iowa Department of Inspections and Appeals, 515/281-4115 or 1-877-686-0027 to report allegations of abuse or wrongdoing.