"Rise in the presence of the aged, show respect for the elderly and revere your God. I am the LORD." -Leviticus 19:32 NIV
Old age ain't for sissies—especially if you happen to be living in one of America's 15,000 nursing homes.
While there are some fine facilities for the long term care of the elderly, many nursing homes have become dangerous places for the residents who live there. I know because I have seen their suffering up close and personal. As a trial lawyer, I represent many victims of abuse and neglect in nursing homes and assisted living facilities across the country.
But you don't have to take my word for it.
A recent Department of Health and Human Services report found that 94% of America's nursing homes have been cited for violating federal health and safety standards. Perhaps even more disturbing, however, is a study by Consumer Reports that found that state regulators fined only 50% of nursing homes whose misconduct warranted fines.
Pressure ulcers (bed sores) are all too common among the elderly in nursing homes. They develop as a result of leaving a resident in one position for too long without turning or repositioning them. Pressure from a mattress or chair on a bony prominence deprives the resident's tissue of blood flow and the skin breaks down. While "bed sores" sound benign, they are not. I have seen countless pressure ulcers that penetrate to the bone. They are gaping wounds that are often infected and foul smelling as a result of contamination with urine and feces. They develop because short-handed staff frequently don't have enough time to turn or reposition residents, or even to clean them up after they have soiled themselves. Malnutrition is estimated to plague up to 65% of nursing home residents and countless others suffer from avoidable dehydration—all because harried staff don't have time to assist with feeding or to provide fluids to thirsty residents. Still others suffer broken bones resulting from falls and the lack of supervision. Often this occurs when the resident's call light isn't responded to in a timely fashion and the resident attempts to get to the bathroom without assistance in order to avoid soiling themselves.
Make no mistake about it—pressure sores, malnutrition, dehydration, and falls in nursing homes are not the inevitable consequence of old age and ill health. They are, all too often, the result of understaffing of nursing homes and the resulting inability of the staff on hand to provide the care their residents need and deserve. Shockingly, government studies show that more than half of nursing homes fall below the "minimum" staffing standard proposed by the Health Care Financing Administration (n/k/a the Center for Medicare and Medicaid Services) of two hours of care each day from certified nursing assistants, and nine out of ten homes fall below the HCFA "optimal" standard of 2.9 hours of care each day from certified nursing assistants. Iowa Senator Chuck Grassley rightly observed, "More than half the nation's nursing homes don't meet a minimum benchmark for staffing. That means residents don't get fed enough. They don't get turned to prevent bedsores. They end up in the hospital much more often than they should."
But why wouldn't nursing homes provide adequate staffing to take care of their frail elderly residents? Two words: "corporate greed", the same two words that are at the root of our current economic meltdown. You see, the largest expense of a nursing home's budget is "labor." Nursing home executives have learned that one surefire way to increase the profitability of their homes is to reduce costs by "shorting" the staff. That pumps up the bottom line. In the process, however, residents who depend on the staff for their basic needs are shortchanged.
One example from the New York Times is informative: Habana Health Care Center was taken over by private investment firms in 2002. The firms immediately cut the staff, reducing the number of registered nurses (RNs) by 50%. Budgets for care were slashed. Fifteen residents died and their families sued the home for negligent care. Regulators warned the home time and again, but received no response. These procedures are commonplace. Sixty percent of homes which have been bought out by private investment firms in recent years have cut their number of RNs, sometimes to illegal levels.
The offending nursing homes often try to conceal their perfidy by falsifying patients' charts. In an attempt to deceive state inspectors about the level of care being delivered, nursing homes frequently host "charting parties" where staff will hastily fill in blanks in patients' charts. The result is that they often chart care as having been given on non-existent days (February 31), or after the resident is dead, or, perhaps, before the resident was even admitted to the facility. Sometimes, they will chart care as having been given despite the fact that the identified care giver wasn't at work (a review of the employee time cards reveals this fraud). Such actions no doubt account for John T. Bentivoglio's statement in the Washington Post on February 4, 2000 that, "A number of high flying nursing home chains appear to have incorporated defrauding Medicare as part of their business strategy." At the time he made that statement, Mr. Bentivoglio served as Special Counsel for Health Care Fraud at the Justice Department. His statement is no less true today than when he first uttered it.
Lamentably, there is little media coverage of elder abuse. Perhaps that's because much of it goes on behind the closed doors of nursing homes. Perhaps it's because our culture is obsessed with youth and no one wants to contemplate getting old. Or perhaps it's because we simply devalue the elderly—after all, many of them have substantially degraded mental and physical abilities. For whatever reason, no one seems to pay much attention to elder abuse these days.
The Ethics and Public Policy Center is a rare exception. It recently acknowledged that elder abuse is on the rise: "According to a National Center on Elder Abuse survey, more than 565,000 cases of suspected elder abuse were reported in 2003—an increase of nearly 20 percent from 2000." But, mark it down: things are only going to get worse. The perfect storm is brewing. A massive age wave has begun. The over-65 population will more than double between 2010 to 2040. The leading edge of the Baby Boomers is approaching retirement age. Huge numbers of Boomers will need nursing home care. They will overwhelm existing capacity, and they will do so at a time when America's old age entitlement programs are on the verge of collapse. In 2017, Social Security's cash flow is projected to go negative, and in 2019 Medicare is slated to go broke. Meanwhile, our national consensus has shifted from a sanctity of life ethic to a quality of life ethic. The elderly suffering the ravages of time—strokes, dementia, disability—do not score well using quality of life calculus. It will become easier to view them as "disposable" when they cost more to maintain than they produce.
Americans need to wake up to the implications of what it means to become a mass geriatric society. Individuals need to prepare now for the years when they will live in decline. Families must prepare to assume a greater role in caring for their aging loved ones. The church must acknowledge that the elderly are part of the "least among us" and reach out to lend a helping hand. Government needs to get its head out of the sand and prepare for a crisis that will make Hurricane Katrina look like a walk in the park. And the nursing home industry must mend its ways and be held fully accountable whenever it abuses, neglects or exploits those it has agreed to care for.
We all have a stake in averting this crisis. Only the dead don't grow old.
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