The number of people in nursing homes declined while the number of complaints spiked 33 percent between 2011 and 2015, according to a new report from the U.S. Department of Health and Human Services (HHS).
According to study results, patients receiving care in for-profit institutions showed more signs of neglect than patients residing in non-profit and assisted living communities.
About the For-Profit Nursing Home Study
A study conducted by the University of Chicago – Illinois assessed the relationship between nursing homes and signs of clinical neglect. The study, which later became the basis for the HHS Office of Inspector General report, showed the proportion of serious complaints had nearly doubled.
Published in the journal Gerontology, the study included data from the medical records of just under 1,150 patients aged 60 and older from five hospitals in the Chicago area between 2007 and 2011. Researchers used the Clinical Signs of Neglect Scale (CSNS), which was developed by the lead author, Lee Friedman.
The scale quantifies care and health outcomes among individuals living in private homes, nonprofit nursing homes and for-profit nursing homes. It lists two dozen conditions, ranging from constipation and dehydration to more serious issues such as severe bed sores and broken catheter tubes.
The two most serious classifications increased from 55 percent to 59 percent during the study period. The number of immediate jeopardy complaints, the most severe type, nearly doubled from 2,844 to 5,341.
“Nursing home residents are a vulnerable population, and states serve as the front-line responders in addressing concerns raised by residents, their families and nursing home staff,” the report concluded.
The most serious signs of neglect included dehydration with the presence of gastrostomy, not being provided basic medications to manage chronic conditions, stage 3 or 4 pressure ulcers and complications with urinary catheters or feeding tubes.
The proportion of patients who died by the end of the period of follow-up was highest among those living in for-profit facilities (82.9 percent) followed by low-functioning community-dwelling individuals (77.5 percent)
Part of the problem, Friedman said, is that administrators in for-profit homes are paid more, and staff at non-for-profit homes are underpaid. Staffing levels at for-profit homes may also be lower.
However, numbers from the latest Nursing Home Salary & Benefits Report, published by the Hospital & Healthcare Compensation Service, indicate that administrator salaries are close to equivalent. Administrators at for-profit nursing homes, for instance, earned about $112,000 on average, compared to $118,000 at their not-for-profit counterparts.
Many studies show that neglect of nursing home residents is often overlooked because of its muted nature yet it is the most common form of elder mistreatment. What makes neglect difficult to identify is that the clinical signs the same as disease symptoms and can occur as part of the dying process. In this study controlling for potential confounding associated with the process of dying as well as comorbidities, the association between residence type and clinical signs of neglect persisted.
“There needs to be better staffing and training for enforcing these measures. Performance improvement programs and quality assurance and assessment committees, tighter adherence to federal law by Central Management Services that ties Medicare and Medicaid reimbursement with quality of care, and pressure from insurance providers to limit costly outcomes could help reduce the unfortunate diagnoses we saw in our study,” said Friedman.
Types of Clinical Neglect
- A lack of awareness of the problem
- Unfamiliarity with the reporting process
- Fear of lawsuits
- Lack of institutional protocols for identifying mistreatment
- Lack of training on related issues
- Feeling uncomfortable talking about mistreatment because of poor training
- Potential conflicts of interest when the physician is employed by both the hospital and nursing home
ACHA Says Results Are ‘Faulty’
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) found the study’s conclusions to be “faulty.” The study “incorrectly compares very different populations of individuals with vastly diverse clinical conditions and functional abilities, along with inaccurate sample sizes,” said AHCA Associate Vice President of Quality & Clinical Affairs Holly Harmon.
The sample size of for-profit homes used in the study was also six times the size of the non-profit sample. The community population studied was comprised of about 80 percent high-functioning individuals compared to about 20% low functioning, which is not typical of most nursing homes’ census.