Here’s a trivia question. Where did the phrase “Be afraid, be very afraid” originate? It was Geena Davis’ line is the gory film classic, The Fly. That film was made in 1986 so I wouldn’t be surprised if today, many cast and crew members have parents living in Los Angeles nursing homes. Maybe some are patients themselves. (After all, almost half of those over 65 will spend some time in a nursing home so the odds are pretty good.) That means they have likely come to learn the true meaning of the phrase, “Be afraid, be very afraid.” (And this is no movie.)
Reports are out today that, “Facing a backlog of hundreds of health and safety complaints about nursing homes, Los Angeles County public health officials told inspectors to close cases without fully investigating them.” It’s an effort they like to call the “Complaint Workload Clean Up Project”! That's "Clean Up" as in "Whitewash". And now, "The federal Centers for Medicare & Medicaid Services is conducting a separate inquiry" into this. Not that this is even a new problem:
The state public health department has previously faced criticism for its handling of nursing home complaints. A 2005 lawsuit, a 2007 state audit, a 2011 report by the federal Office of the Inspector General and 2012 sanctions by the Centers for Medicare & Medicaid Services all have taken issue with the time it takes to resolve complaints.
The lawsuit, brought by California Advocates for Nursing Home Reform, resulted in an order by the San Francisco County Superior Court for the department to begin its investigations on time as required by law.
In October, the Foundation Aiding the Elderly filed another lawsuit against the state, alleging that complaints were not investigated in a timely manner. The suit alleged violations of state law “continue unabated at nursing homes and other long-term health care facilities, exposing the residents to unnecessary health risks.”
An earlier legislative effort to address the delays failed. In 2007, Gov. Arnold Schwarzenegger vetoed a bill that set a deadline for the investigations to be completed. In the veto letter, he wrote that the legislative fix was unnecessary because the department was making progress in meeting its workload.
Connors, of California Advocates for Nursing Home Reform, said that progress clearly has not been made. “Here we are seven years later,” he said.
It would be one thing if nursing home patient care problems weren’t immense. But that word hardly even captures it. The Department of Health and Human Services has released a new report finding, according to ProPublica's reporting yesterday, that, “One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment.… A “skilled nursing” facility provides specialized care and rehabilitation services to patients following a hospital stay of three days or more. There are more than 15,000 skilled nursing facilities nationwide, and about 90 percent of them are also certified as nursing homes, which provide longer-term care.” Moreover,
Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable. More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied — about 2 percent of Medicare’s total inpatient spending.
Patient safety experts told ProPublica they were alarmed because the frequency of people harmed under skilled nursing care exceeds that of hospitals, where medical errors receive the most attention. …
Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled. …
Patient advocates said the study verifies what they’ve heard from skilled nursing patients and their families. Richard Mollot, executive director of New York’s Long Term Care Community Coalition, said he was “flabbergasted” by medication errors, bedsores and falls that were identified in the report.
They are prominent problems that nursing homes should be “well versed” to address, he said.
Mollot said the report should have more forcefully called for better enforcement of the existing standards in nursing homes.
States inspect nursing homes on behalf of Medicare every year  when there are complaints, he said, but some inspectors are tougher than others. Medicare’s current standards of care are good, he said, and “if they were enforced we wouldn’t have these widespread problems.”…
“They are dangerous, dangerous places,” he said.
And then, of course, some cities and states Whitewash the complaints entirely. (See above.)
John Sheridan, a member of the American College of Health Care Administrators, which represents nursing home executives, “agreed that skilled nursing facilities could improve, but said the caregivers face a daunting task and work diligently despite low reimbursements Medicare pays to the facilities.”
“They don’t go to work every day to cause an adverse event,” Sheridan said of the providers. “They do it to care for the residents there. They do it with sacrifice and love.”
No doubt. They are also extremely underpaid for the work they do - median salary of $24,400 per year - and also "the injury rate for workers in these facilities is double the injury rate for all full time workers in other occupations."
We don't blame the aides who risk injury to themselves every day. But we do blame nursing home executives, like Mr. Sheridan, and the industry they represent. The nursing home industry devotes an inordinate amount of time trying to weaken their accountability and get out of compensating the families of patients, which their institutions abuse and neglect. (See some of our prior posts here, here.) Another case in point: the death of Dorothy Douglas, who was killed when West Virginia’s Heartland of Charleston nursing home “failed to feed and care for” her causing her death from dehydration. A jury awarded $90 million to her family, including a substantial punitive damage award, and the nursing home has appealed the verdict to the West Virginia Supreme Court, arguing that “all of the claims made against the nursing home and its employees should be subject to the state's medical malpractice [$500,000 in noneconomic damages] cap” even though the law does not say that.
Imagine if they spent the same money, time and effort properly staffing their nursing homes, paying aides a decent salary and ensuring that their patients are actually safe.