Nursing Home Abuse Report: Elderly Abused
at 1 in 3 Nursing Homes By David Ruppe - July 30, 2001
Reports of serious, physical, sexual and verbal abuse are "numerous"
among the nation's nursing homes, according to a congressional report released
today.
The study, prepared
by the minority (Democratic and Independent) staff of the Special Investigations
Division of the House Government Reform Committee, finds that 30 percent of
nursing homes in the United States - 5,283 facilities - were cited for almost
9,000 instances of abuse over a recent two-year period, from January 1999 to
January 2001.
Common problems included untreated bedsores, inadequate medical care,
malnutrition, dehydration, preventable accidents, and inadequate sanitation and
hygiene, the report said.
Many of the abuse
violations caused harm to the residents, the report said. In 1,601 cases, the
abuse violations were serious enough "to cause actual harm to residents or
to place the residents in immediate jeopardy of death or serious injury,"
it said.
"What we have found is shocking," says Rep. Henry Waxman, D-Calif.,
the committee's minority leader, who instructed the staff to do the study.
Kelley Queale, director of communications for the California Association of
Health Facilities, however, says reports such as the one released today can be
misleading, since stringent regulations require reporting even the most minor of
incidents, such as one resident slapping another.
"That inflates the figures and makes it sound a lot worse than the reality
is," she says. "We believe that nursing homes are providing the best
care they can in a difficult environment."
Grotesque Abuse
In some reported
cases, a member of the nursing home's staff was accused of committing physical
or sexual abuse. In others, staff were cited for failing to protect people from
abuse by other residents.
The report documents instances of residents being punched, slapped, choked or
kicked by staff members or other residents, causing injuries such as fractured
bones or lacerations.
Some of the violations uncovered are particularly disturbing. In one case,
according to the report, an attendant walked into a resident's room, said
"I'm tired of your ass," and hit her in the face, breaking her nose.
In another case, attendants bribed a brain-damaged patient with cigarettes to
attack another resident, then watched the two fight. The report also described a
case in which a male attendant molested an elderly female resident while bathing
her.
Instances of abuse appear to be on the rise. The percentage of nursing homes
cited for violations has increased every year since 1996, according to the
report.
Many for Profit, Taking Federal Money
The homes cited by
the study for instances of abuse accommodate some 550,000 residents. Nationwide,
some 1.6 million people reside in 17,000 nursing homes and 11,000 of them are
for-profit businesses.
The federal government is the biggest contributor of nursing home care, mostly
through Medicaid, a joint federal-state health care program for the poor, and
Medicare, the federal program for elderly and disabled people. Federal heath and
safety standards are designed to protect nursing home residents from abuse.
To enforce the standards, the U.S. Department of Health and Human Services
contracts with the states to conduct annual inspections of nursing homes. The
states also are required to investigate individual abuse complaints. The
report's statistics were derived from these state inspections.
Industry Says Money a Factor
Nursing home
industry representatives attribute problems, in part, to a nationwide difficulty
in attracting and keeping quality, skilled staff.
"In California also, we don't have enough licensed vocational nurses, and
we don't have enough working aides or certified nursing assistants," says
Anne Burns Johnson, CEO of the California Association of Homes & Services
for the Aging. "There are not enough people entering the field. And so
staffing becomes more complicated when you can't even hire people."
Insufficient state and matching federal Medicare funding levels are an important
reason, she says. "The reimbursements are low compared to what the
residents' needs are," she says, and so nursing assistants, paid through
those funds, can average around $7 to $9 per hour.
Waxman plans to introduce a bill this week, designed to improve nationwide
nursing home care. Among other things, it would increase funding, set minimum
staffing limits, increase Internet disclosure of nursing home conditions, and
impose new fine levels.
Waxman, who's mother is in a home in Maryland, also believes insufficient
funding is a cause of problems: "[U]nless we are willing to pay nursing
homes enough to do their job, intolerable incidents of abuse and other types of
mistreatment will continue to persist … "
He said he knows many nursing home operators are "dedicated to providing
the best care possible," and who "would never knowingly tolerate abuse
or other dangerous practices in their facilities."
But added: "[T]he bottom line is clear: Something clearly needs to be done
to improve nursing home conditions," said Waxman. "It would have been
intolerable if we had found a hundred cases of abuse; it is unconscionable that
we have found thousands upon thousands."
Not-for-Profit Better?
Johnson maintains
that a higher level of care is provided at not-for-profit facilities, such as
those represented by her organization.
"Most of our facilities are small, community-based and
religious-based," she says.
Queale of the California Association of Health Facilities, which represents
for-profit facilities, says for-profit care can be just as good if not better.
But she adds some not-for-profits have advantages because they have higher
staffing with more volunteers, and they get more government funding.
Johnson notes nursing home care is inherently complicated because residents
frequently have multiple medical problems, are frail, and in most cases would
prefer to be in a different setting. (See: Will They Need Help?)
When putting people in a facility, says Queale, "[relatives] should do
research ahead of time if possible, get referrals from their physician or word
of mouth about a good reputation."
A Snapshot Look
Another report
prepared by the minority staff of the Special Investigations Division, released
last Monday, found more than 70 percent of 59 homes in one Pennsylvania
congressional district failed to meet federal health and safety standards during
recent state inspections.
Such standards included measures for preventing pressure or bed sores, providing
sanitary living conditions, and protecting residents from accidents, that report
said.
More than half the homes, it said, had violations that caused actual harm to
residents or had the potential to cause death or serious injury.
Examples of perhaps some of the worst care in other staff reports since 1999
include: a Chicago nursing home where dozens of residents were found in physical
restraints, many in violation of federal health and safety standards, and a San
Francisco nursing home where inspectors found hundreds of ants crawling over the
body and in and out of the mouth of an 83-year-old resident.
Nursing home representatives argued that the "overwhelming majority"
of nursing homes meet government standards and that many violations causing
actual harm are actually trivial in nature, the report said.
The report countered that many allegations were examined in detail, documenting
harmful violations, including at least one incident that contributed to a death.
Many other incidents were documented that, the report said, "would be of
great concern to families, but were not classified as causing actual harm"
DUMAS
MEDICAL INVESTIGATIONS
P.O. Box 850172 Mobile, Alabama 36685
(251) 423-2307 / Fax (251) 776-7563