Nursing Homes

We’re all grown-ups, right? So why is it still so hard to talk to our aging parents about leaving their homes and moving to senior living?

A recent poll found that 35 percent of respondents most feared speaking to their parents about the need for long-term care or a move to assisted living. This topic even beat out conversations about dying!

Watching our parents age, develop medical problems, lose their mobility, and begin to forget names and conversations is incredibly sad. After all, for so much of our lives, these were our protectors, teachers, and supporters.

But that’s why it’s important to remember our parents are relying on us now. Today is the right time to begin talking about aging and long-term care. And even better, talk about it often — because it isn’t just one conversation.

As for what’s coming next, poll respondents suggested some emerging technology that might help them remain independent as they aged. Their suggestions included smart homes, mobile patient monitoring, artificial intelligence, and even robots! Now that sounds interesting for the future — but don’t put off that hard conversation.

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As healthcare consumers, we rely on the government to protect our loved ones from unscrupulous caregivers. Each year the US Department of Health and Human Services compiles evidence from assisted living facilities across the country. The HHS has recently released its Medicaid Fraud Control Units Fiscal Year 2015 Annual Report. Think of it as an annual report card for assisted living fraud and abuse.

How assisted living facilities across the country fared

The report revealed an increase in criminal convictions. In fact, 2015 saw the highest number of convictions. There were 1,553 criminal convictions reported by all types of facilities studied.

Breaking down convictions according to caregivers

Nearly one third of convictions involved personal care service attendants, who provide most of the hands-on care. The remainder of the convictions were for assisted living fraud. An example of fraud is when caregivers bill for care not given, such as when an assisted living resident temporarily stays in a hospital but continues to receive bills for assisted living services. Almost half of the fraud convictions involved unlicensed providers. The report also highlighted that civil settlements and judgments are slightly down, which was due to a decrease nationally.

How Ohio facilities fared

In 2015 Ohio had 986 open fraud investigations, which resulted in 16 civil settlements or judgement. Of the 432 cases open to investigate abuse or neglect, there were only 27 criminal convictions.

Is it enough?

Based on these numbers, investigations into abuse and neglect are resulting in only a very small fraction of convictions. That is troubling because our seniors can be such a vulnerable population. It makes you wonder if we’re devoting enough resources to investigating claims of abuse in assisting living.

Certainly, requiring assisting living facilities to operate in compliance with federal regulations (like nursing homes must do) would make a good first step. But as I have discussed before, strong and sustained lobbying efforts have so far prevented that much-needed oversight.

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Your elderly mom probably doesn’t use social media, but what about her caregivers? How do nursing home resident rights come into play online?

As we work to prevent elder abuse in nursing homes, physical harm is the first thing on our minds. But virtual abuse and exploitation can also be devastating. Advocates have been calling for federal regulation updates since last year, when ProPublica and the Washington Post revealed dozens of incidents in which nursing home and assisted living workers shared “embarrassing and dehumanizing” photos and videos of residents.

In response, the U.S. Centers for Medicare & Medicaid Services (CMS) has announced it will begin reviewing nursing homes’ social media policies for their employees. A memo last month (August 2016) informed providers that CMS surveyors will want to see policies that prevent staff from sharing photos or videos that “demean or humiliate a resident” on social media platforms such as Snapchat and Facebook.

“Each nursing home must establish and enforce an environment that encourages individuals to report allegations of abuse without fear of recrimination or intimidation,” the CMS memo reads.

The memo also touches on what can be considered violations of a resident’s rights. Examples include sharing images of nudity and bathing, publishing derogatory statements about residents, or agitating residents to elicit a response.

I look forward to nursing homes establishing more formal procedures for sanctioning employees who make degrading posts about residents on social media platforms. It’s critical for staff to consider the CMS guidance before posting sensitive information, even with the best of intentions.

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I am taking a detour from one of our regular topics of nursing negligence in long-term care to comment on an interesting news item about nursing home costs.

It probably is no surprise that the cost of long-term care is on the rise, but the numbers might surprise you. It might be cheaper to check into a hotel and order room service than to check into a nursing home.

Hold on to your seat, or your wallet — the average cost of a private nursing home room was $92,376 per year or $7,698 per month. Meanwhile a semi-private room was $82,128 per year or $6844 per month. These rates increased by 2.27% and 1.24% respectively, according to Genworth’s 13th annual Cost of Care Study, released this week.

Ohioans, are you interested in what that means here in the land of Buckeyes? The study has a neat calculator which breaks down nursing home costs per state and region within our state. Northeastern Ohio costs are $250 per day for a private room in a nursing home or $230 per day for semi-private (annually that is $91,250 and $83,950).

Both interesting and alarming is the increase in assisted living costs, which saw a 4% increase to $47,700 annually. So how does that compare to the costs of keeping our seniors in their homes? This approach costs about half of what a nursing home charges: a home health aide costs $46,332 annually. And certainly keeping seniors in their homes is what most would prefer. The study found that costs in the Northeast were higher than the Southeast.

If only these rising rates came with improved care, maybe the higher price tags would yield a better value.

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Traditional efforts to prevent nursing home abuse have focused on the nursing staff. Lawmakers have considered reforming all kinds of staffing practices, from background checks and training to data collection. But a new study finds that we should be just as concerned about elder abuse by roommates and neighbors. At least one in five seniors living in nursing homes has experienced some sort of abuse at the hands of another resident.

The most common resident-on-resident abusive events included verbal mistreatment, menacing gestures, and physical violence. More than 20 percent of the 2,011 residents in the study said they’d experienced at least one abusive event in just the past month.

What’s worse, the risk of abuse was greater in residents with cognitive or memory impairments — the very people least able to defend themselves or report their concerns. Higher incidents of abuse were also correlated with higher nurse aide caseload.

The authors advocate for better protection for residents. They suggest healthcare providers should avoid convenient but harsh interventions like sedation or restraint. Instead, they should look into ways that technology like cameras and data collection can help measure and prevent abuse.

The study was released last week (June 14) in Annals of Internal Medicine. To learn more about elder abuse by roommates and peers, read the editorial article that accompanied the study. Or find out how you can take action on elder abuse in Ohio.

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