Nursing Home Abuse
Nursing homes are meant to be a safe haven for the elderly to cared for in their golden years and instead of become a nightmare for a lot who have been subjected to countless acts of abuse and neglect. Furthermore, the significant others of those in nursing homes are subjected to highly stressful conditions by having to meet harsh economic requirements.
According to the National Center on Elder Abuse, there are nearly 17,000 nursing homes in the United States that currently care for 1.6 million residents, a figure expected to quadruple to 6.6 million residents by 2050. In past years, there have been reports that nearly 1/3 of all nursing homes have been cited for abuse violations. Each year the number of incidents increases while there is a significant underreporting of nursing home abuse and neglect.
More than twice as many nursing homes were cited for abuse in 2006 and with numbers expected to quadruple these numbers are going to rise. Reports show that there are thousands upon thousands of abuse cases yearly and investigators believe many violations go undetected or are simply not reported, leading federal regulations to believe the problem is underestimated. Even when serious issues have been identified federal and state enforcement policies have not been effective in ensuring that the issues are corrected and remain corrected.
The first issue I have found with abuse of the elderly in nursing homes is economic. Medicaid and Medicare which cover more than two-thirds of residents in nursing homes cost more than $75 billion a year. Medicaid is a federal program administered at the state level that provides health care for low income individuals. To qualify for Medicaid your income and assets must be under a certain level, which is determined by your state. Most states use a percentage of the Federal Poverty guidelines as a guide for eligibility. “In Maryland and 47 contiguous states and the District of Columbia any two person family can’t make more than $15,130 a year if they want to receive Medicaid benefits.” ("2012 HHS Poverty Guidelines, 2012) If it is determined that you make more than $15,130 a year, he or she entering the nursing home must enter as a private resident and spend down any assets to become eligible. As an example, in the case of my grandfather between his retirement from the Navy, his social security and my grandmother’s social security, my grandmother has to give his Navy retirement check and social security check to the nursing home and still pay $3,000 a month to the nursing home to spend her money down until Medicaid will step in to help her. This leaves her with barely any money. My issue is that Medicaid states that it doesn’t want the spouse that is not living in a nursing home to be destitute but in my grandmothers case it doesn’t seem like they are giving her an option. Medicaid can also require some payback after the spouse in the nursing home has passed by billing their estate.
Because Medicaid tends to pay lower than private payers, nursing homes may try to provide second class treatment to those residents. The second issue is a moral issue. Many nursing homes attempt to squeeze more out more profit and therefore are using unqualified help, which puts the facilities and their members at a higher risk for cultivating abuse and neglect. There have also been reported cases of temp nurses being hired at nursing homes when demand increases. Problems arise when neither the temp company nor the nursing home perform background checks on the temp nurses. It has been reported that some of these temp nurses have been known to steal medications, fall asleep on the job, and even fail to perform critical tests on patients. These temp nurses can be disciplined and even lose their license but moving to another state lets them get hired again.
The third issue is political. The nursing home complaint process is the front line response system for addressing problems raised by residents, their families and nursing home staff. In recent years various Government reports have documented vulnerabilities in nursing home complaints. One of the problems with the process is that state agencies don’t investigate some of the most serious complaints within the required timeframe. State agencies didn’t investigate 7% of complaints alleging immediate jeopardy in the required two day timeframe. State agencies report that staff shortages and insufficient training limit state agencies agility to investigate within the required timeframe.
The issues mentioned above are serious and there definitely needs to be a change. State agencies should make it a policy that any complaint should be investigated within a ten day timeframe and that family members should be notified of the investigation. Additional training for all staff should be given and all employees or new employees should be required to have a background check and all past employers contacted to verify employment and to see if there were any complaints against the employees. In regard to Medicaid, the thresholds should be higher. How do you expect a two person family to live off of $15,130 a year? That is not enough money for one person to live off of and then still contribute to any nursing home expense.
One of the most important steps in ending elderly abuse is to recognize that no one no matter what age should be subjected to abuse of any kind. In addition, to promote positive steps towards ending abuse people need to be educated. Education is one of the cornerstones to ending elderly abuse. The expanding population of older Americans, insufficient staffing and poor training all contribute to the problem. Nursing homes do not effectively screen their employees and frequently hire people looking for easy abuse targets. In many instances, the institution itself develops an abusive personality.

The first solution to end nursing home abuse is to install hidden cameras in each nursing home. In New York in 2006 the Attorney General Andrew Cuomo thought that if hidden cameras were installed in a nursing home in Western New York they might be able figure out why some the residents were getting hurt. “The surveillance video showed that the staff "routinely failed to turn and position immobile residents, often leaving residents in the same position for an entire shift" and the nursing staff failed to administer medications as well as treat residents for pressure sores.” (Fisher, 2010) After the cameras were installed they led to the arrest of 19 nursing home employees and uncovered cases of serious abuse. If hidden cameras were installed in every nursing home people might be less likely to try and abuse the residents.
Another solution to end nursing home abuse is to make sure that all employee’s that work in a nursing home have proper training and receive adequate pay. The pay for nurse’s aides and orderlies is often low. Because dealing with physical needs of the elderly can be hard work job burnout and stress are common. The result can be loss of concern for patients. Also, a high job turnover rate means that staff members are not likely to develop strong relationships with patients. Nursing home employees should be properly trained and educated on how to care for the elderly. These employees should also receive continuous training on how to care for the elderly and what to do in certain situations. Since most nursing homes are federally funded they should have incentive programs for their staff. When someone on the staff has done an exemplary job they should receive praise and a bonus. For example, at the company I work at we have an Employee of the Quarter program. The employee of the quarter is nominated by one of their peers and they receive a $1000 bonus for doing a great job. When employees feel as though they are respected and treated well they will want to do a better job in return.
In regard to a financial solution, Medicaid should make it easier for people to receive benefits without having to feel as if they have nothing. In order for Medicaid to pay for any nursing home needs, it must be determined that you need healthcare services provided by a nursing home. You also cannot have more than $2500 worth of countable resources. If this limit is exceeded even by a $1 at the first day of the month, are ineligible for that month. Medicaid is a welfare benefits program jointly administered by the federal government and the states and the rules are very complicated. Medicaid processes and rules should be made easier for all and a family should be allowed to make more than what the state allows.
There are a lot of solutions and people who care what happens to the elderly in nursing homes. Nursing home abuse can end if laws are followed and if the people that work in the nursing home are properly trained and undergo background checks. Elderly deserve to live in a place where they are well taken care of and families shouldn’t have to worry.
Each solution has different advantages and disadvantages. Some of the disadvantages to the solutions are listed below.
One disadvantage to the first solution, installing hidden cameras is that eventually everyone knows that there are cameras and if they still have bad intentions towards the residents they will find a way to get around the cameras. Another disadvantage with hidden cameras is if the laws to get the cameras installed in every nursing home aren’t passed then they wouldn’t be able to be put them in. There also might be families that don’t want their loved ones on camera no matter what the situation. Administrators at nursing homes claim recruiting and maintaining staff will be more difficult because of the increased stress of working under continual surveillance. They also assert privacy and dignity rights of the residents and staff.
A second disadvantage to my second solution, making sure employees have proper training and that they receive adequate pay is that there could be constant training depending on the employee turnover. For employees to be happy where they work they need to be in a positive environment and nursing homes aren’t some of the happiest places to be. But for employees to have a boss that respects them and treats them fairly is a start in the right direction. Another disadvantage is making sure employees are fairly compensated. In Table 1 it shows the median pay in 2010 for a nursing home aide was $11.54 per hour. As a result of being underpaid and the job being extremely taxing it would seem as though there would be a lot of turnover.
Quick Facts: Nursing Aides, Orderlies, and Attendants
2010 Median Pay
$24,010 per year
$11.54 per hour
Entry-Level Education
Postsecondary non-degree award
Work Experience in a Related Occupation
None
On-the-job Training
None

Table 1
The third disadvantage to the financial solution, Medicaid should make it easier to receive benefits without feeling like you have nothing left. Medicaid is a federally funded program which wouldn’t be easy to make changes too. In order to try to get a waiver to a Medicaid plan a state must submit a State Plan Amendment (SPA) for review and approval. If there are changes that you want to make to a federal Medicaid plan it must go through Congress. Congress also oversees executive branch agencies that carry out these changes. There are a lot of solutions that could help to end the abuse at nursing homes and there are a lot of disadvantages to those solutions. The main thing is to do something. Too many people do not do anything about suspected abuse, and your loved ones are the ones who pay the price for continued nursing home abuse.

REFERENCES

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Nursing Aides, Orderlies, and Attendants, on the Internet at http://www.bls.gov/ooh/healthcare/nursing-assistants.htm (visited June 02, 2012).
Department of Health and Mental Hygiene. (n.d.). Long term care. Retrieved from website: http://dhmh.maryland.gov/ohcq/LTC/default.aspx
Nursing Home Abuse and Neglect Research Center. (n.d.). Retrieved April 20, 2012 from www.nursinghomealert.com/stoppingabuse/federalregulations.html
Fisher, J. (2010, April 01). Nursing home abuse caught on camera in north troy!. Retrieved from http://www.protectingpatientrights.com/blog/nursing-home-abuse-caught-on-camera-in-north-troy.cfm
Massachusetts elder abuse lawyer warns of inadequate staffing in nursing homes. (2012, April 9). Law Firm Newswire, Retrieved from http://www.lexisnexis.com.libdatab.strayer.edu/hottopics/lnacademic/
Medical Assistance for Nursing Home Care. (n.d.). Retrieved May 16, 2012 from http://www.peoples-law.org/node/1004
Nursing homes: What you need to know. (n.d.). Retrieved April 16, 2012 from http://www.oag.state.md.us/Consumer/nurshome.htm
2012 HHS Poverty Guidelines. (2012, January 26). Retrieved May3, 2012 from http://aspe.hhs.gov/poverty/12poverty.shtml