If you suspected that you or a loved one might one day end up in a nursing home, and you breathed a sigh of relief when the Biden administration announced increased staffing requirements On April 22nd, you may need to pull a Larry David and curb your enthusiasm.
Biden’s follow-through The earlier promise was lauded by many, given the dark history of substandard care and chronic understaffing, which has led to needless levels of suffering and even death. But will the nursing home industry actually be hiring, or repeat cuts that it can’t afford without higher government reimbursement rates, or that it can’t find enough new workers for?
It didn’t take long for the protests to begin.
mark parkinsonThe president and CEO of a health care union representing 14,000 nursing homes criticized the Biden administration for implementing “this unfunded staffing mandate despite overwhelming concerns from experts, stakeholders and policymakers on both sides of the aisle.”
came again doomsday predictionParkinson claimed the mandate “threatens to close more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care.”
This is an interesting perspective, given the fact that although the recruitment pool may be very small, there is no shortage of investors vying for a portion of the profits generated by nursing homes. Profits filtered, if not protected, by using elaborate financing schemes.
(in March, kff health news It was reported that “Benefit Group owns about 72% There are approximately 15,000 nursing homes in the United States, serving more than 1.3 million residents.” Additionally, “900 nonprofit nursing homes and senior living communities across the country have changed hands (since 2015). , more than half of them have been acquired by for-profit operators.”)
I asked david grabowskiHarvard University professor of health care policy, for his opinion on the Biden administration’s new rules.
“Minimum staffing rules are an important step. However, for this rule to work, it cannot be implemented in a vacuum,” Grabowski responded in an email. “If nursing homes are unable to hire additional staff, we need to understand whether it is because they cannot afford to because of low Medicaid payments or because they are hiding profits in related party transactions.”
And in Grabowski’s opinion, this will require “strong data transparency and accountability measures” from the Biden administration.
But let’s get back to the “profit hiding” reference.
Residents of the Brett Hurt Retirement Inn in Grass Valley, California heading to the dining room for lunch.
(Elias Funez/Associated Press)
Aging, as we are now like never before due to the age wave, is big money if you know where to place your bets. And investors, including venture capitalists, private equity firms and real estate interests, have flocked like gold diggers to the billions of taxpayer dollars paid to nursing homes each year by Medicare and Medicaid.
Ashwin Gandhi, a professor and faculty associate at the UCLA Center for Health Policy Research, said nursing home operators often have multiple related companies that do business with each other, and they sometimes work together to obscure true profitability. “tunneling” practices.
By way of explanation, he told me that a nursing home could sell its building and land to an affiliate company, and then pay increased rent to that company. Or it may contract with another affiliate for management services and pay increased rates. The same can be done with food services, say, or laundry services.
This is a creative way of hiding profits by transferring assets into businesses that are less regulated than the healthcare industry, and at the same time, creating an argument against government interference.
Too bad it seems that nursing home operators are unable to summon the same energy and creativity to reduce the number of nursing home deaths linked to pressure ulcers, also known as bedsores: The Department of Health and Human Services estimates that ” About 60,000 patients die each year as a direct result of pressure ulcers.”
“Disguising profits as costs, thereby obscuring true profitability, may deter regulators from enforcing strict quality standards and encourage public payers to raise reimbursement rates,” says one. recent study Gandhi and by Andrew Olensky, assistant professor of economics at Lehigh University.
“Our estimates show that in 2019, 63% of nursing home profits were hidden and passed on to related parties through inflated transfer prices,” the study said.
And that’s money that can be used to increase staffing and raise salaries enough to recruit new employees.
in the matter of Sam Rios, Attorney Ed Dudensing, a former Sacramento State professor who died of complications from pressure sores after a stay in a Roseville nursing home, didn’t just sue the nursing home. He sued its partner companies, including a private equity firm, arguing that the group was highly profitable and paid executives high salaries while nursing home patients were at risk due to understaffing.
A jury agreed early last year to award $5.9 million in compensatory damages and $25 million in punitive damages. Dudensing told me that the cries of poverty in the nursing home industry are easily dismissed by the fact that “private equity money, venture capital” and other investments “are still flowing into these facilities at record rates…and It is very easy to manipulate the balance sheet.”
The Biden order, introduced by Vice President Kamala Harris, was two-pronged, including easier access to home care for the elderly and a plan for better workforce wages. I’ll save that aspect for another column, because as I has already been reportedIn one of the greatest unanswered crises of our time, millions of people either do not get care as they age, or they cannot afford it, or they become unable to pay for it.
But getting back to staffing, the new order requires facilities that receive federal funding to provide approximately 3.5 hours of nursing, approximately a half-hour of RN coverage and approximately 2.5 hours of nursing support coverage per patient per day. Is., And an RN must be on duty 24 hours a day.
California already requires 3.5 hours, but RN requirements will improve, it says Tony Chicotel, Senior staff advocates in California advocate for nursing home reform. But he added an important caveat.
“The main thing California can do is impose standards,” he said. “We have publicly available data through which we can identify facilities that are short staffed for a long time but nothing happens to them. …There has never been any pressure to enforce our state standard, so compliance has always been spotty.
Speaking of the lack of urgency, patient advocates in L.A. County — the only county in California with its own enforcement branch — are still long overdue from a consultant appointed to analyze oversight and enforcement lapses identified during the pandemic. More than 3,600 patients and staff have suffered COVID-related deaths as reports are awaited.
I attended a Jan. 29 forum hosted by L.A. County Supervisor Katherine Barger, in which patient advocates railed against the delay and a Department of Public Health official said the $349,455 study — first recommended in late 2021 — could be completed soon. Will be done. Nearly three months later, it still isn’t complete, and Barger’s staff told me it appears it will take another two months for the report to be completed and publicly disseminated.
Molly Davis, The president and CEO of Wise & Healthy Aging called the delays surprising and troubling and said that after all the public interest in nursing homes during the pandemic, residents have again been “orphaned” in deaths.
Davis, whose nonprofit sends an ombudsman to L.A. County nursing homes to monitor conditions and investigate complaints, said, “People in skilled nursing need to take over this powerful industry and improve regulatory enforcement and oversight. It takes a champion.”
Well, his agency is short of staff and in this regard, he is also short of funds. Davis said he fears that given the budget deficit, efforts to release more state funding for such efforts appear far-fetched.
The county health department needs to step up, and Barger and other supervisors need to shake a stick at both the county and state levels.
Hard-working low-paid workers, as well as the elderly, disabled, sick and vulnerable, deserve no less.
