Special Report: Nursing Home Abuse
Radio Asks:
Why America's elderly are still vulnerable to neglect in nursing homes and what families can do to keep their loved ones safe.
Twenty-three years after the passage of the Federal Nursing Home Reform Law, the safety of nursing homes residents is still a major national problem. A 2008 federal survey found that more than 90 percent of U.S. nursing homes had been cited for health and safety violations. Many of the complaints against these facilities involve abuse or neglect of residents‚ complaints that include infected bedsores, medication mix-ups and a lack of adequate nutrition. Advocates say federal and state regulators often fail to provide proper oversight of these facilities. Even if a citation is issued against a nursing home, rarely are facilities forced to close and families will often turn to litigation.
In an ElderLaw Radio Special Report, producer Rachel Gotbaum, examines why America's elderly are still vulnerable to abuse and neglect in nursing homes and what steps families can take to keep their loved ones safe. To get answers to these questions, ElderLaw Radio talks to a longtime nursing home reform advocate, an attorney who represents victims of nursing home abuse, a representative of the nursing home industry, and one woman who's father died as a result of a lack of care in the California nursing home where he lived.
Inadequate staffing in nursing facilities is a recurring theme in this series. Many residents need to be turned frequently to avoid developing sometimes lethal bedsores, food often must be cut up to prevent choking and malnutrition, and some residents need close monitoring to prevent them from falling or wandering. All of this care requires proper staffing, something that is often lacking in nursing facilities, says Janet Wells of the National Consumer Voice for Quality Long-Term Care. She points out that there is no shortage of certified nursing assistants (CNAs) but many of these workers don't stay on the job long due to low wages, a lack of training and an overwhelming workload. Wells says that some CNAs are responsible for as many as 30 nursing home residents on a shift.
For more then two decades, advocates for nursing home reform have been urging Congress to pass minimum nurse-resident staffing ratios, but so far without success, Wells says. This year's major healthcare reform legislation does require all nursing homes to provide data on staffing ratios online. Advocates hope this newly publicized information will help make the case that minimum staffing levels should be required in nursing homes.
The nursing home industry's reliance on public Medicaid and Medicare money makes it a challenge to staff appropriately, says Scott Plumb of the Massachusetts Senior Care Association, which represents both non-profit and for-profit nursing homes in the state. Although Plumb says the quality of care in nursing homes has gone up nationally, he warns that "it has the potential to go down." He points out that while caring for a Medicaid patient in a nursing home costs the facility an average of $210 a day in Massachusetts, Medicaid actually pays $180 per day per resident. This funding gap is a problem for nursing homes nationwide. Facilities have historically turned to Medicare and private pay patients to make up for the financial shortfall, but Medicare's rates are slated to be cut, says Plumb and private pay patients are disappearing.
Interviewee Barbara Salerno talks about the tragic consequences that can result from a lack of appropriate care in a nursing home. She and her family thought they were making the right decision by sending their 80-year-old father, Albert Salerno, to a nursing home. But even though family members visited Mr. Salerno nearly every day, when he took a sharp turn for the worse, they were initially unable to convince staff of the severity of his condition. By the time he received medical attention, Mr. Salerno was in acute renal failure, had advanced pneumonia and was malnourished. When Mr. Salerno was being taken to the hospital, Barbara Salerno reports, a CNA at the nursing home said, "It's about time. He's been like that for two days." Mr. Salerno died a few days later.
At what point should families seek legal action? Jim Sokolove, an attorney who has been representing victims of nursing home abuse for more than 20 years, says the first step is to speak to the nursing home administrator, the doctor in charge, and to the state agency to try to investigate the problem. Sokolove says that many lawyers specialize in nursing home cases, but they will only take cases that involve catastrophic injuries, death, total disability, or a fracture or other injury that will last a long time. And the catastrophic injury must have been caused by a clear deviation from the standard of care.
"What we really want is to change the system," says Sokolove, "because it doesn't work."
