Nursing homes’ profit motive

With Federal and State laws mandating levels of care from nursing homes, the question most often raised is: « Why does abuse still exist inside our nursing homes? ».

Budgets & profits

Unfortunately, many times profits take a higher priority than patient care when it comes to nursing homes that are being run for a profit. Many nursing homes are run by large corporations that own multiple facilities across the United States. The individual home ends up being run from the board room rather than from a patient focus.

In addition, many of these nursing homes are budget or census driven. The administrators want to come in under budget to make more profits for the corporation. This desire for profits translates into less staffing; less training for the staff that they do have; less food – or a lower quality of food – for the patients; and less management and oversight. Therefore, there a conflict arises between saving dollars and providing good care.

Even an established system of « pool nurses or nurse’s aides » are difficult to find in nursing homes. Each nursing home should have some type of « pool » available to them in case of call-offs, holidays, etc. Why isn’t this system established’ It would cost more money. Instead, nursing homes run under-staffed. There would be a much higher level of care given to patients if adequate staffing were provided.

The effects of Understaffing

How understaffing effects malnutrition and dehydration

The medical director

In many instances, the Medical Director of a nursing home benefits from the amount of profit generated by the nursing home they manage. A moral and ethical conflict then arises for Medical Directors. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.

Hospital care vs. profit

Sometimes patients don’t receive the hospital care they need because of profit concerns. This practice ranges from which ambulance service the nursing home calls, to whether or not a patient even goes to the hospital. Nursing homes may contract with an ambulance service that is further away from the home because they got a better deal on rates. Also, nursing homes don’t like to send patients to hospitals because they don’t receive any money for the time the patient is in the hospital. Also, the more skilled care needed for that patient, the more money the nursing home receives from Medicare.

In addition to financial gains, hospitals also immediately run lab reports on any patient that is admitted to their facility. These lab reports provide a snapshot of information about the patient. Along with impaired nutrition, a simple blood test can show if the patient has a low protein level, indicating malnourishment and thus, is prone to skin breakdown which results in pressure sores.

In a nursing home, the standard is a yearly complete blood count. Family members should ask the doctor to check blood work more frequently, especially if they are concerned if the patient looks like they are losing weight, has pale skin color, etc. Most nursing homes bring medical personnel in to the home to do the lab work and x-rays so that the patient doesn’t have to go to the hospital at all.

Unfortunately, nursing home abuse may occur because of the desire for profit. Those caregivers who work in nursing home facilities are often stretched beyond their ability. They try to do the best job that they can; but oftentimes, the lack of additional support restricts what they can do to help patients. Be sure to investigate any nursing home you are considering for your loved one.

Can a resident be treated differently based on their source ?

If the nursing home is certified, it agrees to treat every resident equally once admitted, regardless of financial source of payment (private pay, Medicaid, Medicare, etc). It must promise its applicants, its residents, along with federal and state governmental entities that the home will at least comply with federal and state regulatory standards relative to nursing home care. (Minimum government standards pursuant to the Omnibus Reconciliation Act of 1987 or OBRA.)

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998)

What’s a plan of care ?

Under the federal Nursing Home Reform Act of 1987, nursing homes are required to develop comprehensive individualized care plans for residents. This is a written plan stating what kinds of services and care a person needs for a specific health-care problem. Plans of care must include measurable objectives and schedules to meet each resident’s medical, nursing, mental and psychosocial needs as identified in the a comprehensive assessment. The comprehensive assessment must be completed within 14 days of admission. The plan of care must then be developed within 7 days after completion of the assessment. The plan of care must also detail the services to be provided. It must be periodically reviewed and revised by a team of qualified persons after each comprehensive assessment.

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998)

What rights do nursing home residents have ?

Under the Nursing Home Reform Act of 1987, nursing home residents have many rights, including the right to receive quality care and live in an environment that improves or maintains the quality of each resident’s physical and mental health. Nursing homes accepted Medicare and Medicaid are required to promote and protect the rights of each resident and place a strong emphasis on individual dignity and self-determination. Under Pennsylvania law, Pennsylvania nursing homes must meet the federal requirements.

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998)

Sexual abuse negligence

This section answers our frequently asked questions regarding sexual abuse in nursing homes. If your question is not listed below, you can check the categories to the left, or scroll down to email your question to us.

Are incidents of elder sexual abuse in nursing homes frequent?
Why does sexual abuse occur in nursing homes?
Are some nursing home residents more vulnerable to sexual abuse than others?

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998)

Nursing home negligence

Mental abuse negligence

This section answers our frequently asked questions regarding mental abuse in nursing homes. If your question is not listed below, you can check the categories to the left, or scroll down to email your question to us.

What are the signs of mental abuse in a nursing home?

What should I do if I suspect my loved one is the victim of mental abuse?

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998)

How long do I have to file a claim ?

The Statute of Limitations for an adult to file a personal injury lawsuit in Pennsylvania is two (2) years from the date of the accident or from the date when you learn you have an injury. For example, if your broke a leg in a fall, the Statute of Limitations for a personal injury lawsuit to be filed would start running on the date the injury occurred. Although you have two years to file a personal injury lawsuit, we recommend that if you are hurt in an any type of accident that you consult with an attorney as soon as possible.

If you are under 18 when you are injured, you have two (2) years from the date of your 18th birthday to file suit, unless you were emancipated from your parents at the time of your injury.

Remember, Statute of Limitations vary by state.

What’s a plan of care ?

Under the federal Nursing Home Reform Act of 1987, nursing homes are required to develop comprehensive individualized care plans for residents. This is a written plan stating what kinds of services and care a person needs for a specific health-care problem. Plans of care must include measurable objectives and schedules to meet each resident’s medical, nursing, mental and psychosocial needs as identified in the a comprehensive assessment. The comprehensive assessment must be completed within 14 days of admission. The plan of care must then be developed within 7 days after completion of the assessment. The plan of care must also detail the services to be provided. It must be periodically reviewed and revised by a team of qualified persons after each comprehensive assessment.

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998).

How prevalent is understaffing in nursing homes ?

Very prevalent. A recent congressional report shows that more than half (54 percent) of American nursing homes are understaffed. Understaffing leads to nursing home neglect and abuse, including increases in bedsores and malnutrition and dehydration . In Pennsylvania, there were 784 licensed/certified nursing facilities. Each facility averaged 109 clients. These facilities each averaged about 44 nurse’s aides, 15 licensed practical nurses, and 10 registered nurses for all shifts. On average, each patient was provided with less than 3 ½ hours of direct care per day. This isn’t a lot of time to spend in a 24-hour-day, especially when these nursing home residents need assistance with an average of about 4 activities of daily living.

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998).

What should I look for in a nursing home ?

You should consider a variety of factors, including location and visitor’s policies, the patient-to-staff ratio, the experience and training of staff members, the appearance of the nursing home and the residents, sleeping accommodations, activities, dining facilities and menus, health-care issues, day-to-day living issues, what the agreement says, and how the nursing home is operated. The list of considerations is exhaustive.

Sources: Service Employees International Union Report (1999); Health Care Financing Administration’s Online Survey, Certification and Reporting Data (March 2000); HCFA’s National Restraint Reduction Newsletter (Summer 2000); Philadelphia Enquirer, Report Criticizes State over Nursing Homes (March 11, 1998).