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Corporate neglect in nursing homes: over the years, government agencies and independent investigators have found rampant abuse and neglect in nursing homes. So far, nursing home owners have evaded responsibility, but that may be starting to change.

Article Excerpt
We think of nursing homes as safe havens, places where people go when they can no longer be cared for at home. Federal law--and common decency--demands that these homes provide their residents with a comfortable and dignified existence. (1) While many facilities do live up to this nurturing ideal, too many others have failed.

In lawsuits and newspaper articles, stories about ill treatment and shoddy medical care at nursing homes are making regular appearances. How did this sad situation come about?

To its residents, a nursing home is home; but to the owner, it is a business. These two propositions do not necessarily have to conflict with each other, but many owners have put their desire for profits over the residents' needs, and the result is unnecessary suffering.

Most of today's nursing homes are operated by for-profit companies owned by large corporate chains. According to the American Health Care Association, in December 2007, there were 15,772 certified nursing homes in the United States, housing 1.4 million residents. (2) June 2008 data shows that for-profit nursing homes account for 67 percent of all facilities, and 53.3 percent are owned by multi-facility organizations (chains). (3)

This was not always the case. Before 1965, most nursing homes were mom-and-pop operations. In 1965, Congress passed Medicare and Medicaid legislation and allowed these services to pay for residential care, giving nursing homes an influx of government money that caught the eye of investors. This was the genesis of corporate investment in the nursing home industry, a presence that dominates the field today.

Last year, Ronald Silva, president of an investment firm that recently purchased one of the larger corporate nursing home chains in the country, told the New York Times that "there's essentially unlimited consumer demand as the baby boomers age.... I've never seen a surer bet." (4) As of June 2008, Medicaid paid for the care of 63.8 percent of all nursing home residents, and Medicare covered the care of 13.9 percent. This means that federal and state tax dollars paid for the care of nearly 78 percent of all residents. (5)

Congress enacted regulations for nursing homes in the late 1960s and early 1970s. These largely focused on the homes' structural capacity to provide care and not on the quality of resident care. In the mid-1970s, reports of sub-standard care, fraud, and abuse began to surface. In 1986, the Institute of Medicine (IOM) issued a study of nursing homes that recommended several legislative changes to ensure better care. (6)

In 1987, many of the IOM recommendations became law. Regulations promulgated under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) stated that residents are entitled "to attain or maintain the highest practicable physical, mental, and psychosocial well-being." Any nursing home that receives Medicare or Medicaid funds must abide by the regulations, and violators are subject to sanctions. (7)

Other provisions forbid the use of physical or chemical restraints for discipline or convenience and outlaw clinically avoidable pressure

sores or contractures (loss of motion). (8) The rules mandated nutritional standards that would maintain a resident's bodyweight and hydration at healthy levels and established the standard that all facilities have sufficient staff to ensure the delivery of these services.

Perpetual problems

The laws look good on paper, but reports by many government and non-profit organizations have indicated that serious problems...

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