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Nursing home neglect
A BOSTON GLOBE EDITORIAL, 3/3/2002
IT IS NOT surprising that a study commissioned by the federal
government
shows tha nine out of 10 nursing homes are understaffed.
These essential institutions rarely get the attention they deserve from
families until a prospective patient is elderly, infirm, and not in a condition
to
shop for adequate care. Younger people need to demand better staff ratios
and reimbursement rates if conditions are to improve for their parents and,
eventually, themselves.
The report, ordered by Congress, recommends a standard of 4.1 hours of
care on average for each resident a day - 2.8 hours from nurse's aides
and 1.3
hours from registered nurses. Those staffing levels translate to one nurse's
aide for every five or six residents from 7 a.m. to 11 p.m. Many nursing
homes make do with one aide for every eight to 14 residents.
When staffing is short, residents linger in their beds without proper care
for bedsores or incontinence. They risk falls when an aide is not available
to help them get about. They are denied frequent baths or showers. The
quality of their last days is irretrievably diminished.
The report estimates that it would cost the government $7.6 billion a year
to increase staffs to adequate levels. Nursing home finances consist of a
mishmash of state and federal payments under the Medicaid and Medicare programs
with a bit of money from private payers. The Bush administration has no intention
of asking for extra funds given its devotion to tax cuts, increases in military
spending, and the lack of public pressure.
Policy makers need to be thinking now about improving the system, not only
for the sake of the 1.6 million people now in nursing homes but the many
more who will need care once baby boomers reach old age. Medicaid rates,
which are set by the states, need to be increased. In Massachusetts, Scott
Plumb of the Extended Care Federation estimates that they are $20 below cost
for each patient per day. These rates will always be vulnerable to
the pressures of recession and other demands on the state budget, and nursing
homes will be under continuous cost pressure unless new sources of money
are found.
Federal and state government ought to encourage people to buy long-term
care
insurance, and regulators ought to make sure that the policies are
clearly written and contain provisions to protect coverage against inflation
or the bankruptcy of the insurer.
But in the short term, the government needs to provide more money, and once
that is coming into the system it would be appropriate for government regulators
to set minimum staffing requirements and establish programs to train people
for this demanding but low-paying work. Improvements in nursing homes will
come when the wider society pays proper attention to an institution that
cares for people at the margins of life.
This story ran on page D6 of the Boston Globe on 3/3/2002.
© Copyright 2002 Globe Newspaper Company.
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