Why can’t we improve nursing homes?
Jim is 78 and a patient of mine who lives in a skilled nursing facility — more commonly known as a nursing home. More than one million Americans live in more than 17,000 nursing homes. Most nursing home residents are like Jim — they have long-term severe illnesses that do not allow them to live independently and require 24-hour supervision. Jim’s problems in the nursing home are typical. He can’t get the physical therapy that’s been ordered three times a week, his twice-a-day medicines are often not delivered, and he is fed horrible food.
Both state and national governments have proposed standards to improve safety and staffing. The rules are intended to reduce resident abuse, ensure adequate fire sprinklers, and enhance infection control. Many nursing homes in California have been cited or are subpar. To improve public transparency, the federal government has a nursing-home-compare website. It is based on five stars in areas such as inspections, staffing, use of restraints, and quality.
Over 70% of skilled nursing facilities — referred to as “SNIFFS” (SNFs) by health professionals — are for-profit, meaning they work to maximize profits. Most money for SNFs comes from government programs like Medicare or Medicaid. The government website shows many for-profit SNFs are poorly rated on staffing and quality of care, averaging just two on a five-point scale. Many have been fined, but the fines don't make a difference. The penalties are just a cost of doing business.
For-profit owners — most private equity-owned operations — claim they are losing money. On paper, the for-profit companies do show they're losing money, but this is just accounting fancy work. Often, a separate holding company owned by the same investors charges the nursing homes exorbitant fees for real estate rent and facility management. Because SNFs provide meals, physical and occupational therapy, and social activities, they can cut corners to increase profits in many areas.
The Biden administration proposed changes to improve staffing. For example, there are new rules requiring a registered nurse to be on duty 24/7 to improve safety. There are also more comprehensive benefits to improved staffing. For example, it would eliminate 12,000 hospitalizations each year. Less than one in five SNFs currently meet the required number of hours for trained staff, and those that are for-profit have even lower compliance rates than non-profit facilities.
The nursing home industry trade group and the American Hospital Association have mounted an aggressive campaign to oppose the new rules. Thanks to money channeled to legislators, the Republican-controlled House Ways and Means Committee just passed a bill prohibiting the government from imposing new staffing rules. However, if these for-profit companies operated fairly, they could improve the quality of care and still make a profit.
As Americans age and live longer with more chronic diseases, it is past time to address quality issues in nursing homes, which allows private investors to generate huge profits while patients and staff suffer.
– Dr. Michael Wilkes with a Second Opinion
Further Reading:
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