By Steve Moran

Over the weekend I was drawn (in the worst way) to these two articles:

From the New York Times: How Nursing Homes’ Worst Offenses Are Hidden From the Public

From CalMatters: From maggots to sex abuse, nursing homes sue California to overturn citations, fines

These articles are frustrating, infuriating, and unfair. And yet, they contain truths that ought to turn our stomachs. I was particularly nauseated by this quote in the CalMatters article:

“At a nursing home in Los Angeles last year, a nurse’s aide was giving a resident a bed bath when she noticed something moving around his feeding tube. When she looked closer, she saw maggots crawling from underneath the tube’s dressing.

Another nurse noted that the patient’s tube — inserted into his stomach to provide nutrition — “had not been cleaned” and “flies are always in the building.” There was no record of the feeding tube being cleaned for 23 days . . .”

We as an industry spend so much time talking about how to make our industry more appealing. And those organizations that don’t do skilled nursing spend a lot of time distancing themselves from the nursing home part of senior living. But they are in fact a part of what we do. They are a part of the family and these stories hurt all of us.

It’s Unfair

I get 100% that sometimes regulators are overzealous. I also get that just because there are a few bad actors it does not condemn all nursing homes, all senior living communities. But if you were to think of it a little differently, if nursing homes were airlines and we had the same number of deaths and horrible things at the same ratio it would likely mean 5-25 airline crashes per year. And as a percentage of total flights the number would be tiny, maybe 1 one thousandth of a percent. And yet . . .

None of us would fly, if there were that many crashes each year.

It’s Complicated, Sort Of . . .

It is complicated:

  • As a percentage, the number of reported nursing home abuses are small and it is impossible to make that number go to zero.
  • The regulatory system is a complete mess that has not moved the needle with respect to quality of care all that much. It is adversarial and inefficient. It adds hundreds of millions of dollars to the cost of providing care but with dubious benefits.
  • Reimbursement is not really adequate to provide good care, which means both sufficient wages for front-line workers and adequate staffing.
  • The instinctual response to problems is to increase fines and enforcement, but it turns out this is consistently counterproductive.  Nursing home companies spend huge amounts to fight fines and penalties, which takes money away from staffing and patient care
  • For as terrible as it is, there are lots of organizations making plenty of money from it being the way it is. And they will be resistant to changing it. There are government regulators who have developed deep power structures that would need to be dismantled. And those at the top will resist that dismantling.

Solutions will only come when the industry is willing to admit we have some bad actors doing terrible things and the government will come to admit the current system is doing great damage to people and to our nation.

There is not a single good operator who supports the status quo, who thinks this is acceptable and yet no one wants to call it out. We must condemn these operators, this kind of behavior if we are ever going to make progress.