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."
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."
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 … "