Wednesday, Sept. 6, 2023 | 2 a.m.
Given the enduring scandal of shoddy care in many of the nation’s nursing homes, highlighted by the roughly 200,000 deaths in the early stages of COVID, there were high hopes for the federal government to come to the rescue.
But Friday’s long-awaited Biden administration proposal to set minimum staffing requirements, while a step in the right direction, left much to be desired.
Advocates for the more than 1 million elderly and disabled patients in nursing facilities wanted far more beefing up of current nurse-patient ratios. Meanwhile, industry representatives complained the new requirements are unfunded, even as low wages make it difficult to recruit and keep employees.
The two sides are likely to wage war during an upcoming public review of the proposal, which would be implemented nationally over a three-year period. And while that plays out, you can be sure that more patients will suffer from negligent care. That’s the way it’s always been, given the level of disregard for the elderly and disabled in American society.
Tony Chicotel, senior staff attorney for California Advocates for Nursing Home Reform, credited President Joe Biden with following through on his 2022 State of the Union promise to address deficiencies that put patients in jeopardy. But his praise came with a caveat or two.
“I think it’s a big deal and a positive step forward for residents,” Chicotel said, citing the proposals’ higher nurse-patient ratios and a 24-7 requirement for RNs to be on site. “But Biden wanted to ensure safety and quality of care, and I don’t think these numbers ensure safety and quality care. I think they need to be higher.”
And that’s only part of the problem. Another glaring deficiency is the deplorable lack of federal and state oversight.
Chicotel has been working on an article for his agency’s fall newsletter, in which he tells the story of Sam Rios, an 87-year-old former college professor who died after developing bed sores during a two-week stay in a nursing home in 2017. Chicotel writes that a nurse at the facility testified that care there “was barbaric.” This year, a jury in a civil case alleging elder abuse, negligence, understaffing and wrongful death awarded $30.9 million to the Rios family.
Chicotel told me there have been marginal improvements in recent years. And some facilities offer a much higher quality of care than others. But understaffing, overdue facility inspections and delays in complaint investigations continue to take a toll.
“This means enforcement actions are often rare and weak, surveys are delayed, and operators with poor track records are able to buy and run more facilities, even after they have been denied licenses in the past due to an extensive track record of poor care and regulatory noncompliance,” Chicotel writes for the newsletter.
So why would such an owner be allowed to stay in business? First, said Chicotel, there’s a fear that if facilities are shut down, patients will have nowhere to go.
And then there’s the gradual slide toward de-institutionalization. Nursing homes are expensive, they cost taxpayers billions through Medicare and Medicaid payouts, and there’s a growing preference among patients to age at home.
But it’s not as if we’ve got that aspect of elder care figured out, either, with workforce shortages and people going broke paying for home care that’s not covered by insurance.
When COVID tore through the country’s nursing homes, hundreds of thousands of patients were trapped in what became death chambers. Of course, older people with pre-existing conditions were more vulnerable to the virus. But if any other age group or community of patients had been hit as hard as our elders, the level of outrage and the swiftness of the intervention — including use of protective equipment, testing and medical treatment — would have been greater. Instead, too many people died miserable deaths, often cut off from loved ones.
Shame on us.
In the wake of the carnage, the Los Angeles County Board of Supervisors ordered its Office of Inspector General to investigate facilities and county oversight of them, and the result was a scathing report filed in October 2021.
The report cited widespread problems beyond the handling of COVID, including employees who complained of being inadequately trained, overworked and pressured to rush or prematurely close complaint investigations.
The report spelled out 39 reform recommendations, including stricter enforcement against the purchase and operation of facilities by owners with shady records, some of whom use webs of affiliated companies to obscure financial dealings. It also recommended independent investigation of elder abuse cases and improper record keeping, along with other “potential misconduct or systemic deficiencies.”
Almost two years later, few of the recommendations have been implemented in Los Angeles or elsewhere in the country. Given what we’re talking about here — the health and welfare of the frailest and often most helpless among us — every last detail of what’s wrong with our current system of nursing homes and elder care should be aired out and the solutions to fix them implemented.
The sooner the better, and I’ll be watching.
Steve Lopez is a columnist for the Los Angeles Times.
