Nursing Home Care: The Unseen Crisis
With more than 1.3 million Americans now in nursing homes, 70% of us over age 65 will need long-term care. By 2050, up to 30 million people will require it, according to Zippia.com, a career information center.
The people that make up these numbers are not at our borders, they’re not in our schools, they’re not out marching. They’re faceless. Unless we work in a nursing facility, we forget they exist. The quality of care is decreasing at an alarming rate.
Did we hear anything about this crisis from the recent crop of candidates?
As the National Consumer Voice for Quality Long-Term Care notes, “chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the covid-19 pandemic.” The high number of patients per staff leads to a poor quality and quantity of care. The guidelines set by the Centers for Medicare and Medicaid Services (CMS) call for 4.1 hours of nursing care per patient per day. In 2019, only one-third of nursing homes in the United States reached that level.
The American Association of Retired Persons faults the nursing home industry for blocking changes to minimum staffing requirements.
Of the 15,000 nursing homes in the U.S., 69% are for-profit. Industry lobbying groups object to what they call "over-regulation" and argue they are more regulated than the nuclear power industry.
A Washington Post story quotes Kelly Bagby, vice-president of AARP Foundation Litigation, as saying, “shortchanging the direct-care workforce primarily made up of women and people of color with low pay, poor training, and insufficient numbers is a tempting way for nursing homes to boost the bottom line.”
The Medicare web site notes that, on average, a nursing home administrator stays little more than a year. A quarter of certified nursing assistants rely on Medicaid and 64% do not have paid sick leave. Registered nurses working in long-term care are paid 7% less than those in hospitals.
In 2023, CMS is expected to issue minimum staffing standards, and the industry is expected to continue to fight these standards. Consumer Voice calls conditions in nursing homes “a crisis.” Its surveys show that nursing homes, on average, experience a 52% turnover of nursing staff annually. Numerous studies have shown that nursing turnover is related to poor pay, lack of benefits, high workloads, inadequate training, poor management, and lack of career advancement.
High turnover means poorer health outcomes for nursing home residents. A recent study directly connects high turnover with poor care. A review of federal data shows that nursing homes with higher turnover have higher instances of resident abuse, poorer Medicare ratings, and greater numbers of substantiated resident complaints.
A White House Fact Sheet issued in February 2022 noted that “private equity firms have been buying up struggling nursing homes, and research shows that private equity-owned nursing homes tend to have significantly worse outcomes for residents. Private equity firms’ investment in nursing homes has ballooned from $5 billion in 2000 to more than $100 billion in 2018.”
In November 2022, the Office of Inspector General for the U.S. Department of Health and Human Services released a report documenting the failure of a 10-year effort to reduce the inappropriate use of medications in nursing homes to sedate residents. Of those staying over 100 days, 80% were given these drugs. There was a direct correlation between the use of these drugs and staffing levels. The report noted that illegal drugging was being used to offset the need for care and adequate staffing.
Where is the public outrage?
Muriel Cole is Co-Chair of the Kent County Commission on Aging and was, for ten years, a volunteer long-term care ombudsman for Upper Shore Aging, Inc.
Common Sense for the Eastern Shore
