LITTLE ROCK — In the not-too-distant future, America will become grayer and grayer, the percentage of the population over the age of 85 will double, and the demand for nursing-home beds will increase. Even if we limit admittance to patients who are totally dependent, the nursing-home industry is primed for a major boom.
While it may be difficult to find a positive nursing home for our parents, can you imagine how difficult it will be for our children? With a sea of dependent 85-year-olds, the demand will likely far outweigh the supply. Just as the industry faces major change, private-equity firms are looking to cash in on the coming nursing-home boom. But, as seen on the front page of The New York Times, privatization may mean "more profit, less care."
In recent years, the heavy regulation of the nursing-home industry has created a very difficult environment to providequality care. Nursing-home operators face more regulation than almost any other industry in America. Paperwork is enormous, record-keeping is arduous, and staff spend more time completing administrative tasks than actually providing quality care. To make matters worse, staff compensation is typically low and retaining quality staff is extremely difficult. Poor reimbursement for nursing-home care is also a major problem.
This issue of litigation creates another huge challenge for nursing-home operators.Talk to the malpractice lawyers involved in litigation, and they will tell you they provide a valuable service in "keeping nursing homes honest." While this may be the case, I fear that many more lawsuits were frivolous than those that were justified. As a result, the cost of insurance has become prohibitive and more and more nursing homes faced bankruptcy. This is where the private investors have "come to the rescue" - or have they?
Many nursing-home providers strive to provide quality care in difficult circumstances, but privatization has come at a huge cost to many nursing-home residents. These private investors obviously see the nursing-home industry as a "sure bet." With rising demand, supply must increase, and dollars will surely follow.
These investors remain clearly focused on one thing - the bottom line. Increasing profit comes at almost any cost, whether byreducing the number of qualified clinical registered nurses, reducing budgets for supplies or cutting activities for residents. The New York Times reports that in many cases, regulators identified numerous deficiencies and benchmarks of quality care deteriorated.
In one investor-owned nursing-home chain, there are 20 residents for every one registered nurse, which is seven residents more than the national average of 13. In order to insulate themselves from litigation, investorrun nursing homes have created a corporate structure that makes it difficult to identify exactly who is responsible for poor care.
We must solve this problem. Nursing-home reform must again come to the forefront of our nation's attention. Luckily, there are solutions out there. It is so hard for families to take care of their parents at home. In Canada, for example, there are tax incentives to add on to yourhome to bring your parents closer to you (Granny Flats). And where can we take our parents during the day while we work or do other things? This can be solved by adult day-health-care programs.
We must provide more training and greater value (monetary and otherwise) to the dedicated individuals who deliver handson care to nursing-home residents. There are no incentives to attract the best and brightest physicians and other health-care providers to practice in longterm care. Reimbursement is low and risk of litigation high.
Even regulation that aims to guarantee quality care for nursing-home residents is burdensome, unrealistic and frankly cannot be accomplished honestly. Instead of being destructive, regulation must be realistic and constructive.
While the legal profession may argue, I believe that malpractice and tort reform is critical. Finally, create rewards for the best care and recognize that when human lives are involved, the bottom line cannot be our highest priority.
With all the other ills facing our nation, it is not surprising that nursing-home care is on the back burner. Failing to address the unique needs of our oldest and frailest citizens is frankly depressing.
More information is available at:
High Profile, Pages 47 on 10/07/2007