Industry Continues to Decline

The problems surrounding nursing home care continue post-COVID. The USA Today article “Many Nursing Homes are Poorly Staffed. How do they get away with it?” shows these facilities are understaffed, place profits over people, and complaints are ignored by law enforcement. We continue to see a decline in the quality of these facilities being mandated by the federal government and its agencies.

“The American Health Care Association, the nation’s largest trade group for nursing homes, said in a news release this summer that 94% of the country’s facilities missed minimum staffing guidelines tougher than those used in USA TODAY’s analysis.”

The USA Today analysis shows that more than three-quarters of the nursing homes in the US had fewer nurses and aides in 2021 than expected under Medicare’s expected direct care staffing based on payment formula. Many of these underlying issues can be seen through the large, nationwide presence of understaffing in facilities.

The lack of regulation and enforcement of these facilities has some serious consequences. From residents having falls due to the lack of present caregivers to the rapid decline in physical and cognitive health due to lack of food and water, these residents have continued to struggle with living in nursing homes around the US.

The worst part is that these facilities rarely receive penalties for the lack of support that they have. This is due to people becoming “desensitized to the lack of care among the elderly”, according to Tracey Pompey of Virginia. If inspectors “were empowered and interested, able or willing, to enforce this, I think the sufficient staffing requirement would be fine,” said Mollot, executive director of the Long Term Care Community Coalition. “But unfortunately, they’re unwilling or unable to do that.”

“Inspectors, who often are registered nurses, can find better wages and less out-of-town travel in the private sector. Federal funding for nursing home enforcement has not changed since 2014: about $397 million a year. Biden wants to increase that by 25%, matching inflation over the past seven years” (Fraser and Penzenstadler, 2022)

USA Today reported that several nurses have been asked to speak dishonestly to inspectors regarding the employment status of the facility. When it comes to reporting issues such as continued injuries in nursing homes, it is not a challenge for nursing home administration to bypass these issues. Doing different managerial things such as adjusting staffing schedules would then deem these facilities back into compliance to operate as normal. This is shown by USA Today in a report from California stating:

“Lovette-Black, the retired California state inspector, recalled seeing the same staffing-related problems – “frequent falls or pressure injuries or infections,” he said – year after year at the same facilities. By submitting paperwork that testifies they had retrained their staff members or had adjusted staffing schedules, he said, the nursing homes would be deemed back in compliance. ‘A year later when you went back, they would have slipped back into their bad practices,’ he said. ‘There still wasn’t enough CNAs. Wasn’t enough licensed nurses. Nothing really changes. The culture doesn’t change.’”