Elderly poor are tortured to death in US nursing homes, concludes a
Clinton Administration report, released after... eight !!! years of
study, right before the Democratic Party Convention. Hard not to
be cynical about this fluff piece to highlight a new Clintonite health
offensive against the Republicans.
TORTURE........ isn't that too severe a word to used here? Not if
you consider not giving the elderly food and water, and not turning the
immobile on a regular basis, to be a very real torture.. This is
TORTURE, and I'm sorry if it is impolite to say so. Want to lie
in those beds? Want to not be suctioned as you choke constantly
in your own phlegm?
I first became exposed to the US torture of the elderly when I was hired
as an.. Ass Wiper Line Worker.. in a Seattle nursing home in the Central
District. They issued the too few of us roller skates and rags, and
pointed down the hall, and said....start cleaning.... and I did. It
was a most aerobic exercise (and anaerobic, too).
This was factory medicine at its most basic. And things have gotten
a lot worse due to the pathetic pretense of Clinton's health care
proposals.
This report is a sham and fraud. As were the earlier 'reform'
efforts. It is simple enough to announce that the United States
government is going to make sure that bed sores are eliminated, and that
all nursing home residents will get adequate food and water. And
to just do it.
Instead Clinton/ Gore prefer to do this big joke, of doing battle with
the evil Republicans, that just won't allow reforms to be implemented.
All that is needed is to pay for enough CNAs to get the job done.
And make sure that the nursing home administrators don't pilfer the
money away. The Clinton government has been as unwillful as the
Republicans. And only the most gullible can think otherwise.
Yes, there is torture in the United States of America.
...................................Tony Abdo
_______________________________
July 22, 2000
U.S. Recommending Strict New Rules at Nursing Homes
By ROBERT PEAR
WASHINGTON, July 22 -- Federal health officials have concluded that most
nursing homes are understaffed to the point that patients may be
endangered. For the first time, the government is recommending strict
new rules that would require thousands of the homes to hire more nurses
and health aides.
In a report to Congress based on eight years of exhaustive research, the
Clinton administration says that understaffing has contributed to an
increase in the incidence of severe bedsores, malnutrition and abnormal
weight loss among nursing home residents. Many of the patients end up
hospitalized for life-threatening infections, dehydration, congestive
heart failure and other problems that could probably have been prevented
if the homes had more employees, the report says.
Nursing homes with a low ratio of employees to patients are
"significantly more likely to have quality-of-care problems," the study
says, and "substantial increases" in staff may be required to ensure
that homes do not endanger the safety or health of patients. The
200,000-word report is to be sent to Congress this month.
It recommends new federal standards to guarantee, for example, that
patients receive an average of two hours of care each day from nurse's
aides. It says that 54 percent of nursing homes fall below this
"proposed minimum standard."
The quality of care depends not only on the number of nurse's aides, the
lowest-skilled workers, who help feed and bathe patients, but also on
the number of registered nurses and licensed practical nurses, who
supervise the aides, the study says.
Accordingly, the report says that nursing homes should have enough
registered nurses to provide at least 12 minutes a day of care to each
resident, on the average. But, it says, 31 percent of nursing homes do
not meet that standard.
The government emphasized that the proposed levels of staff were not the
optimal levels, but the minimum needed to prevent patients from being
exposed to "a substantially increased risk" of poor-quality care.
The report, from the Department of Health and Human Services, was
required by a 1990 law and was originally supposed to be completed by
Jan. 1, 1992. But health officials experienced many delays, and the
scope of the project grew as they conducted more research and analyzed
huge amounts of data from nursing homes around the country.
Federal researchers said they found that staffing levels were much
higher at nonprofit nursing homes than at for-profit homes. Large
nursing home chains that had financial trouble in the last two years,
including chains that filed for protection under the bankruptcy law,
have cut staff to control costs, the report said.
The cuts come when nursing home residents are typically sicker than in
the past, with more serious disabilities.
Hospitals have reduced the length of stays, releasing patients "quicker
and sicker." Many people with less severe conditions, who might have
gone to nursing homes 15 years ago, now receive care in their own homes
from visiting nurses and aides.
Nursing homes said it was unrealistic for the government to specify
minimum levels of staff when it was providing what they called
inadequate payments under Medicaid and Medicare, the programs for
low-income people and those who are elderly or disabled.
In addition, nursing home executives said it was hard to attract and
retain good workers in a booming economy, when the unemployment rate is
at a 30-year low and other industries offer less demanding,
better-paying jobs. Nurse's aides provide more than 70 percent of the
hours of care given to nursing home residents.
The American Health Care Association, a trade group for the industry,
said it could not support "minimum staffing ratios" unless the
government agreed to help pay the additional cost, which could total
several billion dollars a year.
A report finds a dangerous shortage of nurses and aides.
About 1.6 million people receive care in 17,000 nursing homes
nationwide. Ninety-five percent of the homes participate in Medicaid or
Medicare and are therefore subject to federal standards. But, the report
says, the federal law and regulations are "too vague" to guarantee an
adequate number of employees.
The law, adopted in 1987, says that nursing homes must have enough staff
to provide services enabling each patient to achieve "the highest
practicable physical, mental and psychosocial well-being." Neither the
law nor the rules indicate the minimum or appropriate numbers of
employees.
Congress could amend the law or health officials could revise the rules
to set tougher, more explicit standards.
Nursing homes, like hospitals and other health care providers, are
lobbying Congress to restore money cut from Medicare in 1997. Senator
Charles E. Grassley, the Iowa Republican who is chairman of the Special
Committee on Aging, said he would consider earmarking some of the money
to ensure that nursing homes hire additional workers.
"More than half of the nation's nursing homes don't meet a minimum
benchmark for staffing," Mr. Grassley said. "That means residents don't
get fed enough. They don't get turned to prevent bedsores. They end up
in the hospital much more often than they should."
The report found that nursing homes with low staffing levels tended to
have large numbers of residents with nutrition problems. Many frail
elderly patients need help with meals but do not receive it, and their
health declines as a result, the study said.
When employees are in short supply, they often prod patients to eat
faster, forcing "huge spoonfuls of food into their mouths," so the
patients cough and choke, the report says.
Statistics compiled by the government show that 47 percent of nursing
home residents need some assistance in eating, and 21 percent are
totally dependent on assistance.
To prevent severe bedsores, also known
as pressure ulcers, patients must be turned or moved every two hours,
the report said, but this is unlikely to occur in homes with low numbers
of nurse's aides. The sores can be painful, become infected and damage
underlying muscle and bone.
The General Accounting Office, an investigative arm of Congress, said
last year that more than one-fourth of nursing homes had deficiencies
that "caused actual harm to residents or placed them at risk of death or
serious injury."
Charlene A. Harrington, a professor at the School of Nursing of the
University of California in San Francisco, said, "Medicare payments are
calculated on the assumption that nursing homes will have certain levels
of staff, but the government does not require homes to have the amount
of staff they are paid for."
The report said the staff-to-patient ratio was lower in the United
States than in other countries like Britain, Sweden and Spain.
Nursing homes in Delaware, Maine, Alaska and Hawaii consistently have
high ratios of employees to patients, the report said. Staffing levels
are low in Oklahoma, Kansas and Iowa. New York, New Jersey and
Connecticut fall in between.
Medicaid pays for the care of 68 percent of nursing home residents. A
1980 law required that such payments be "reasonable and adequate" to
cover the costs of "efficiently and economically operated facilities."
Many nursing homes invoked that law to get higher reimbursements. But in
1997, Congress repealed the law, at the behest of states, which share
Medicaid costs with the federal government.
The report said that repeal of the law had put downward pressure on
nursing home payment rates in some states like Oregon.
Several nursing home chains have filed for bankruptcy protection in the
last two years. They include Sun Healthcare, Vencor, Integrated Health
Services and Mariner Post-Acute Network.
Charles Leonard, a spokesman for Sun, said, "There has been a reduction
in therapy provided to patients in our nursing homes, and we've had a
significant reduction in therapy staff, because of Medicare policies
that sharply reduced the amount of therapy for which the government will
pay."
In 1999, the Clinton administration gave inspectors new guidance on how
to determine if a home had sufficient nursing staff to meet the
residents' needs. But even with this guidance, the report said, there is
"no evidence" that inspectors can actually determine whether homes
comply with the general federal requirement to have sufficient staff.
Inspectors are supposed to make unannounced visits to each nursing home
at least once a year to assess compliance with federal standards. But,
the report said, patients "report a fear of retaliation from staff or
other residents" if they express concern about the staff, and employees
"have also voiced the fear of losing their jobs if they discuss staffing
issues with the survey team."
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