The Truth May Not Be What You Think
For many families, safety is the primary consideration when selecting a nursing home or assisted living facility for a loved one. The knowledge that there are trained medical staff, a controlled environment, and an increased level of care can provide a great sense of comfort. That trust, however, may not be warranted.
While the recent COVID-19 crisis has highlighted safety and protocol weaknesses in elderly care facilities, sadly they are nothing new.
One area of weakness is infection control. In nursing homes, with a majority of elderly residents with weakened immune systems, stringent cleanliness and infection protocols are necessary. In fact, most nursing homes inspected by state agencies have been cited for infection prevention and control deficiencies (82% in the period 2013-2017). Of those, about half are cited for persistent problems over multiple years.
Another area of weakness is staffing. Over 90% of recently surveyed nursing homes reported staff shortages. Fewer staff caring for the same number of residents results in degraded quality and standard of care and negatively impacts morale.
A third area of weakness is facility maintenance and security. Failing to ensure routine maintenance is performed, poor cleaning protocols, and lack of adequate security all present significant risks to resident safety and health.
Unfortunately, there are significant gaps in oversight of nursing facilities. The Centers for Medicare and Medicaid Services (CMS) contracts with state agencies to inspect nursing homes. The good news is that CMS keeps a list of “special focus” facilities with a history of serious quality issues. The bad news is that the list itself is capped at only 88 names. While there are 400 additional (and published) “candidate” facilities that qualify for the list, slots for the candidate list are also numerically capped by CMS. So, even if your facility is not part of the Special Focus Facility (SFF) Program or on the candidate list, do not assume it is “safe,” especially given the percentage of facilities with cited and self-reported discrepancies.
Even using a tool such as Medicare’s nursing home compare tool carries caveats. A New York Times investigation found that the rating system itself is deeply flawed, providing a “distorted” picture of the safety of facilities. Relying largely on self-reported information, “[m]any relied on sleight-of-hand maneuvers to improve their ratings and hide shortcomings….” As a consumer, there are a few steps you can take to make an informed assessment of a nursing facility’s safety.
- Read actual inspection reports. (A good source that uses data from CMS is ProPublica.)
- Know staffing levels. Ask the facility or use a source such as Nursing Home 411.
- Rely on your own observations. Conduct a thorough periodic walk-through and document staff interactions that may indicate an issue. Be sure to quickly elevate any issues and document the response.
The good news is that, in the wake of heightened scrutiny because of COVID-19, nursing home safety is front and center, but successfully addressing longstanding and systemic issues will take time. If you feel your or a loved one’s care has suffered because of a nursing home or other facility’s safety lapses, let us help.