Another article from Huffington Post, about nursing homes. This reflects a sad state of affairs that I’m afraid is true.

Philip Cohen:

Even as the poor quality of nursing home care has become a cliché, nursing home care costs have been rising faster than those for services in general. According to economist Nancy Folbre, writing in Science, this has to do with increasing demand for paid care as women enter the workforce, and as they get better job opportunities. But the other “problem” is that care workers actually care about their clients, which makes them behave inefficiently. In response, employers create bureaucracy to keep the care workers in line. Because good care work requires hard-to-measure skills and behavior, this defensive action by employers may actually increase costs and reduce the quality of care. Folbre writes: “Unlike the idealized consumers of standard economic theory, care recipients may not know themselves what they need, and they don’t enjoy a menu of many alternative choices. Their very lack of consumer sovereignty makes them vulnerable to institutional pressures to cut costs by lowering aspects of quality that are difficult to measure.”

The elephant in the room of the care quality crisis is gender. The bedrock of nursing home care is the staff of nursing aides, orderlies and attendants. There are 589,000 of them, with average annual wages are $23,000 - and 89% of them are women.

So, by setting low standards to begin with, we see how this happens. Also, counting on residents being uneducated about their rights as well as what good care really is, the industry takes advantage. Add to this the lack of respect given to CNA’s, as evidenced by low pay and bad benefits, we see a pattern of institutional pressure for sure.

When will this change? CNA’s must become their own advocates before they can do so for their residents. Luckily we have many family groups and other resident advocacy organizations standing up. But how effective is their work when they push the very buttons that created this mess in the first place? Political action and trust in certain groups and parties is close minded. Everyone who really cares must think outside the box and come up with other solutions.

Les Weisbrod shares his thoughts on two recent news events that will effect nursing home residents.

Two notable events occurred this week that should be of concern to seniors and families who will have to make the tough decision of placing a loved one in a nursing home.

Number 1. The Inspector General of the Department of Health and Human Services released a report showing that 94 percent of nursing homes around the country have violations.

Number 2. A New York Times article highlights, as of Wednesday this week, Medicare, the nation’s largest senior insurer will no longer pay for preventable mistakes that occur in hospitals including serious bed sores, injuries from falls, and infections caused by prolonged use of catheters.

Les further notes:

For different reasons both of these news revelations affect seniors and their families but they also shed a revealing light on the industry that cares for our nation’s older citizens.

According to the Inspector General, for-profit nursing homes are the worst offenders when it comes to violations in nursing homes. These troubling numbers reflect a dangerous trend in nursing home care of placing profits over patient safety, charging Medicare and Medicaid for errors and using a little known practice called binding mandatory arbitration to avoid the scrutiny of the judicial system.

Nursing home residents and their families sign agreements that eliminate any legal action against the facility in case of negligence or error.

A possible consequence of the No-Pay-For-Errors ruling:

What is not known is how this proposal will affect nursing homes that are highly prone to committing preventable medical mistakes. Currently nursing homes receive more than $75 billion from government programs like Medicare and Medicaid. Medicare pays higher rates for those who are sicker. According to the Inspector General report, nursing homes were found to be overstating patients’ injuries in order to get additional money from Medicare. Essentially, Medicare’s practice of increased payments for frailer seniors results in nursing homes profiting from their bad actions.

Will it pay to plan for the decline of residents? It looks that way to me. We see here, perhaps, reasons for staff and supply cuts in facilities owned by these nursing home corporations who hide themselves behind layers of front companies. This all goes together in the name of profit over care.

From McKniights Long Term Care News:

Over the course of a 48-week trial, researchers at Vanderbilt University assessed the unintentional weight loss of 76 nursing home residents. During the first 24 weeks, half of the group received additional attention during mealtime while the other half served as a control group. For the second 24 weeks, the groups switched roles. Researchers noticed that 52% of residents maintained their weight when they were part of the extra attention group. That compares with 28% of residents in the control group.

During the study, “extra attention” constituted one-on-one sessions of 42 minutes per resident per meal and 14 minutes per resident per snack. Researchers suggest that groups of three or four residents per staff member during mealtimes are more practical and just as effective as one-on-one care.

They could have gotten a group of CNA’s together and reached the same conclusion. Time. Everything takes time. Something the current staffing standards of nursing homes cannot provide. A CNA can be assigned to sit a table with a group of residents for each meal. The aide can eat her own meal and converse with and supervise at the same time. It doesn’t have to be a CNA. It can be an administrator, a DON, an activity aide, even a housekeeper. Anyone can sit down and enjoy the company of residents. It takes some thinking outside the old dusty box.