LITTLE ROCK — Nursing homes must balance the desire to earn money with their moral and legal responsibility to properly care for the most defenseless among us.
I agree with Little Rock attorney David Couch, who for years has filed lawsuits against nursing homes that fail in their obligations, when he says this desire to care should be a passion.
It is possible to earn respectable profits in these homes without sacrificing compassion and quality care. Unfortunately, it doesn’t happen nearly enough as evidenced by the chronically poor results of state and federal inspections. Things surely can improve when state and federal inspectors discover 2,800 incidents of actual harm in Arkansas’ more than 200 nursing homes during 2011, according to the state’s Office of Long Term Care.
Couch has amassed a mountain of data. Most is deeply disturbing. Among other revelations, it shows that the type of nursing-home ownership affects quality of care. And such things appear to matter most when it comes to for-profit versus nonprofit and community-owned homes.
The Center for Medicare Advocacy reports that in 2011, a study analyzed the top 10 largest for-profit nursing-home chains. That study said that between 2003 and 2008, compared with all other home-ownership groups, the facilities owned by those 10 had the lowest staffing levels, the highest number of deficiencies cited by public regulatory agencies and the highest number of violations causing harm or jeopardy to residents. In 2010, the Government Accountability Office reported that, when compared to other nursing facilities, those identified as among the poorest-performing nationwide are more likely to be part of a chain and for-profit, and employ fewer registered nurses per resident day.
Martha Deaver of Little Rock, who leads the group called Arkansas Advocates for Nursing Home Residents, has long been a staunch activist with high expectations of humanitarian care. And Deaver is impressed with the 97-bed, privately-owned Greenhurst Nursing Center in Charleston. It’s a for-profit home not affiliated with a corporate chain. “Greenhurst has a long history of great inspections and few if any significant deficiencies,” she said. “They also have never been sued in over 50 years of operation.”
Greenhurst’s owner-administrator for the past 32 years is Kriss Schaffer, nephew of Sen. Dale Bumpers and brother of Archie Schaffer. No big surprise, he has a waiting list. “I usually go by the ‘need’ factor in filling a bed,” he said. “If someone was put on the list six months ago and they’re in the hospital and need immediate care, I’ll take them before someone on the list longer but who’s doing all right at home.”
As with most homes, Greenhurst accepts Medicaid patients. “In olden days we averaged about a third private pay, all in the spend-down process toward qualifying for Medicaid,” he said. “Nowadays, we have no more than 10 percent who private pay.”
I wondered how this home started by his mother has fared in inspections. “Our last three I’d characterize as very good. In all my years as a perfectionist I don’t recall having what I’d call an ‘excellent’ survey.” It’s clear enough that Greenhurst established its reputation based on Schaffer’s career of concern, whether he’s hands-on in the kitchen ensuring meals are enjoyable, or seeing to each patient’s quality of life.
“It would sound trite for me to say that a nursing home should be as much of a home as possible,” he said. “We’ve adjusted mealtimes. We offer continental breakfasts now and alternatives for all meals. Residents select what they prefer. They have the option of getting up and going to bed as they want. Three even have dogs. Yet no matter how hard we try to make things more ‘homelike’ you can’t escape the fact this is a facility for long-term care.”
He said most arriving patients require considerable care. “Thirty years ago about every other admission was a stroke victim,” he said. Today almost every other arriving resident is in some stage of Alzheimer’s.
The key to any nursing home’s success boils down to the staff, says Schaffer. “You can train the heck out of ’em, but if they aren’t going to hang around . . . the constant flow does nothing but disrupt the ‘homelike’ feeling. We have turnover, but I’m blessed to have many nurses and CNAs that have been here from five to 30 years.”
Another key to success is for all the employees to get along as family. “I won’t ask anyone to do something that I wouldn’t do myself,” he said. “You do what you have to do. I want the residents to be respected, to be treated as family, to feel loved and comfortable, to get enjoyment out of life and laugh everyday.”
Then Schaffer got to the bottom line, literally. He said there’s no reason—other than profit—to cut corners. “Each year, if we’ve had a good year of no injuries and Workers’ Comp cases, we get money back from the insurance premiums we’ve paid in. Sure, we could pocket that money, but we give it to the employees.”
And now you and I know some of what’s necessary to run a quality nursing home.
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Mike Masterson is opinion editor of the Arkansas Democrat-Gazette’s Northwest edition.
Editorial, Pages 15 on 03/24/2012