The Indianapolis Star has found that many of Indiana’s nursing homes employ fewer critical staff members than are needed to care for their residents. The newspaper found that staffing levels are low at the state’s large number of for-profit nursing homes. The Star also found that those for-profit nursing homes dominate the ranks of Indiana’s most poorly performing homes.
The newspaper reviewed thousands of pages of nursing home documents and analyzed data compiled by regulators and provided by the industry. Its investigation found a system that tolerates nursing homes that skimp on quality to maintain profits. It found that pay and benefits are low, especially in for-profit homes.
State lawmakers should initiate minimum staffing requirements. The amount of time certified nursing assistants spend with residents in Indiana is less than in any other state and the District of Columbia. The Star said that the number of hours these critical caregivers — the ones who must get residents into wheelchairs, bathe them, change their bedding and feed them — devote to each resident is just 15 a week. Their tasks are so grueling and pay and benefits so low, the turnover rate for nursing assistants in Indiana is a stunning 93 percent annually. Lack of adequate staffing may have been a contributing factor in a South Bend nursing home where staff failed to keep a cut on woman’s leg clean. The Star reported the leg became so infected it had to be amputated. The woman later died from the infection.
The South Bend Tribune had an editorial opinion about Indiana nursing homes. The editorial bemoans the lack of quality care provided in a majority of nursing homes in Indiana. The editorial emphasizes regulatory oversight and enforcement to turn around the sad state of long-term care in Indiana. Enforcement of existing state and federal regulations is an issue that can and should immediately be addressed. Efforts to ensure compliance with regulations have eroded. Financial penalties so often are reduced on appeal that breaking the rules makes more profit than following them.
28 percent of Indiana’s nursing homes were assessed the lowest overall rating. It placed Indiana among the 10 worst states in the nation. St. Joseph County ranked even more poorly than the state as a whole. Now, overall conditions for 40,000 of the most fragile Hoosiers appear even more bleak. The system requires a complete overhaul.
A Government Accounting Office report released last August identified 52 Indiana nursing homes, or about 10 percent of all those in the state, among the 580 "most poorly performing" in the nation. Not a single long-term care facility was decertified in 2008, the final year covered in the dismal GAO report.
During a five-year period ending in 2008, state health inspectors said the percentage of Indiana homes cited for problems that placed residents in jeopardy or resulted in actual harm grew from 32 percent to 45 percent — nearly twice the national average.
State regulation that fails to standardize good care defrauds the public. It is unconscionable that legislators continue to ignore the scandal. The standards for protecting the health and safety of long-term care residents are, indefensibly, lower than those aimed at the well-being of the rest of us. When a patient claims abuse, for example, police aren’t typically called and an investigation may not even begin for a week or more. REAL Services notes an area nursing home kitchen was granted 30 days to clean up mouse feces in food; it wasn’t shut down like we’d expect a restaurant would be.
Medicaid, funded by state and federal dollars, picks up about two-thirds of the annual $1 billion cost of long-term care in Indiana. The needs of those whose personal welfare is at stake must be considered as seriously as the wishes of the state’s powerful nursing home lobby.
If there is to be improvement, the state must intervene forcefully. Indiana must address these life-and-death issues. The pressure on families, care providers and government can only increase as the baby boomers age. Failure to act would be shameful.