Nursing home care: A growing crisis for an aging America
Unsurprisingly, we are once again seeing the kind of nursing home abuse documented in the past. Just recently Massachusetts settled cases involving premature deaths for failing to administer medications or to keep up with proper safety railings. It fined eight nursing homes after a statewide investigation uncovered significant care problems.
In 1973, Gov. Nelson Rockefeller (R-N.Y.) created the Temporary State Commission on Living Cost. Part of the commission’s role was to investigate patient abuse and massive Medicaid fraud in the New York state nursing-home industry—an investigation that revealed rampant corruption and sleazy side-deals at the expense of the elderly.
The report exposed unspeakably frightening conditions in nursing homes, all while the owners ran fictitious real estate schemes to defraud Medicaid and steal hundreds of millions of dollars in Medicaid reimbursements. Politicians were in bed with the operators and the system dripped of corruption.
The U.S. Senate Committee on Finance recently held a hearing on reports of abuse and neglect in some nursing homes — reports that were not all that different from what was found in 1974, despite massively increased legislation and regulation.
During one hearing exchange about allegations of sexual abuse, Sen. Chuck Grassley (R-Iowa) noted that a particular nursing home “received the highest possible ranking from the Centers for Medicare and Medicaid Services for quality of resident care, though it had been fined for physical and verbal abuse a year before." So even the top-rated homes are ones with problems and abuse.
This is a mammoth challenge and, unless we tackle it, we are headed for an eldercare calamity. First, we need to have better safeguards for payments and insurance systems as they relate to longterm care. It is unacceptable that the current system complicates people’s personal and financial lives, often by categorizing people who need longterm care as day-to-day patients who are simply “under observation.” The government now pays for more than 80 percent of all nursing home care, which leads to tremendous opportunities for fraud at the same time that the programs attempt to squeeze every dollar out of the system — so false workarounds are rampant, defeating unsustainable controls.
Second, there needs to be more coordination with local, state and federal governments to ensure balanced geographic coverage in line with the care population so that families do not have to travel hours to see loved ones.
Third, technology is going to have to play a central role in managing and monitoring eldercare. We need to find the right balance between home care, nursing home care and hospice care. At the same time, we need to realize that sensors and friendly bots are going to have central roles in providing care, as we run out of home health aides.
Fourth, we need to balance the need for regulation and supervision without creating standards that can never be met and making running a nursing home an impossible task. We need a system of more uniform regulations and enforcement, rather than the crazy-quilt system we have now.
Finally, it’s time to form a national commission on eldercare to draw up a roadmap for how we not only root out fraud, waste and abuse, but also how we plan for a new future for the growing millions who will need compassionate, professional care. The growing ranks of nonagenarians can’t wait.
Andrew J. Stein is a former president of the New York City Council and a former president of Manhattan Borough.
Mark Penn is a managing partner of the Stagwell Group, a private equity firm specializing in marketing services companies, as well as chairman of the Harris Poll and author of “Microtrends Squared.” He also is CEO of MDC Partners, an advertising and marketing firm. He served as pollster and adviser to President Clinton from 1995 to 2000, including during Clinton’s impeachment. You can follow him on Twitter @Mark_Penn.
Jeff Sodoma, MPA, Esq. is a lawyer based in Virginia Beach, Virginia
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