Health Care/Joan Retsinas

Back to the Future: Nursing Homes Unfettered

“Unloving Care.” “Old Age: The Last Segregation.” “Too Old, Too Sick, Too Bad.” “Tender Loving Greed.”

These are not modern television serials of a dystopian future, but exposés of abysmal nursing homes of the 1970s. (Bruce Vladeck, 1980; Claire Townsend and Ralph Nader, 1971; Frank Moss and Val Halamandaris, 1977; Mary Agnes Mendelson, 1974).

In the Ralph Nader horror-tale, students from Miss Porter’s School in Connecticut interviewed scores of residents; in others writers went “under cover,” to compile the not-hidden abuses, ranging from sheer cruelty to mismanagement of medications, meals, sanitation.

The public outrage sparked governmental action. Congress passed stringent regulations - more stringent than many state legislatures. Medicare, which paid for a portion of nursing home stays, made clear its desire for higher standards.

The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987. Pub L. No. 100-203) spelled out a commonsense rule of compassion: nursing home residents had the “right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion” (42 CFR Ch. IV (10-1-98 Edition) §483.13 (b)).” President Nixon established a national structure for oversight, including ombudsmen.

Sadly, abuse and neglect did not instantly disappear with Uncle Sam’s oversight. In 2000, the Atlanta Long Term Care Ombudsman Program surveyed 80 residents in 23 Georgia nursing homes: 44% of residents reported “abuse.” (Atlanta Long-Term Care Ombudsman Program, 2000); yet the arc of progress moves toward compassion. At least we hope so.

Today most of those tales have receded into the archives. Nursing homes may be over-regulated, sterile, may carry more than a whiff of bodily deterioration; but the horrors of the past are in the past. At least we like to think so. Today some people call nursing homes the second most regulated industry, after nuclear power — an overstatement, but one which highlights the strong federal presence. Admittedly, nursing homes face a plethora of bureaucratic paperwork, which has made some software companies rich; but at the same time, journalists intent on Pulitzers are not going undercover to compile exposes.

The reason does not lie with the benevolence of homes’ owners: many are corporations intent on minimizing costs. The owners of the worst of the nursing homes knew they were operating abysmal facilities; they also knew that cruelty was often legal.

Into this arena our president has boldly stepped, intent on squashing all those tiresome regulations that fetter an industry. Anybody who read newspapers from the 1970s to 1990s, who visited friends and family as residents during those years, who gleans the need to protect vulnerable, sick “clients” understands that even in Adam Smith’s paradise, nursing home residents are ripe for abuse if that abuse can translate into profits. As our president knows, these “homes” are businesses, with payrolls to meet, loans to re-pay, and profits to distribute to investors.

The President-as-Candidate faced a coterie of nursing home owners intent on “relief” from the onerous oversight. In 2013, Medicare cited four of every 10 homes for a “serious violation”; two-thirds of the miscreants incurred fines of $41,260 under President Obama.

So in a bold move our president, oblivious to the scandal-ridden past, is hurling us back to the future. He has moved to slash nursing home fines to $28,405.

The lower fine in and of itself will not change homes’ operations; but the move marks governmental neglect — the neglect that segues into abuse — of nursing home residents, as well as government obeisance to an industry screaming for “relief.”

In this great America, whom does Uncle Sam watch out for: elderly residents, or corporations? Their interests do not dovetail, but clash.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, May 1, 2019

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