Nursing homes are supposed to be a safe haven, a place where beloved family members can spend their final years in peace and safety. However, this is an ideal that does not match up to reality. In June 2023, the New York attorney general claimed that four of the major nursing homes in New York had misused more than $83 million of taxpayer money, leaving the elderly in horrific situations, such as being forced to sit in their own waste. The families of these elderly people were entirely unaware of the environment their loved ones had been living in.
While there are inspections of nursing homes throughout the country, they have often been proven to be ineffective. Many nursing homes are let off with a warning, or the citations are ignored.
The government website Care Compare, contains information about nursing home ratings and citations. A nursing home’s rating out of five stars would be brought down by reports of residents being put in danger or being kept in inhumane conditions.
Even when inspectors do make a citation, they often go unreported. There are many different reasons for citations not ending up on the Care Compare website. Inspectors could choose not to report citations if they do not see them as sufficiently serious. These can range from employees not washing their hands to physical abuse.
The Medicare system, a federal health insurance for elderly people aged 65 and older, controls Care Compare. While it is meant to assist the elderly and their families, it seems to be designed to benefit nursing homes. If a citation does end up being issued against a nursing home, it can be privately appealed by said nursing home. If the citation is held up, it can be privately appealed again. This means that even when a citation is seen as serious enough to be made by an inspector and is found to be valid in court, nursing homes can stop that citation from negatively impacting their ratings. Because 75% of nursing homes in the U.S. run for profit, these nursing homes are willing to spend millions of dollars in order to maintain their high ratings.
The government even grants nursing homes immunity to penalization. During the pandemic, nursing homes spent over $4 million lobbying the Senate for legislation that would prevent them from being sued for patients passing away due to COVID-19. This attempt was largely successful, with over 20 states passing bills that limited the ability of families to sue nursing homes over COVID-related neglect of their patients.
But the nursing home industry’s abuse of power is nothing new. In 1974, muckraker and investigative journalist Mary Adelaide Mendelson wrote a book called Tender Loving Greed: How the Incredibly Lucrative Nursing Home “Industry” Is Exploiting America’s Old People and Defrauding Us All, which details the corruption rooted in the origin of these facilities.
Mendelson investigated over 200 nursing homes and reported that out of all of these nursing homes, she could only call one a ‘good home.’ The rest suffered from financial manipulation, with patients being left to starve and not receiving quality care.
This is rooted in a 1950 amendment to the Social Security Act, which allowed nursing homes to collect money directly from their residents. The allure of money attracted members of the Syndicate, a group of unethical businessmen. Many of these members owned nursing homes. This group was made famous by Bernard Bergman, an Orthodox Jewish rabbi who was able to make around $100 million off of nursing homes by 1975.
Decades later, these problems continue to persist in our nursing home industry. The Department of Justice reported that every year, one in ten people over the age of 65 are abused, and this number is likely low due to underreporting of this type of abuse. Half of all nursing home staff have admitted to abusing patients, with the majority of the maltreatment being done by orderlies and aids. Coupled with neglect, this abuse can be financial, psychological, and physical.
When looking through the citations issued throughout January 2024 on the Citation Code Look-up, the major deficiencies include emergency preparedness deficiencies, like not having emergency preparedness policies and procedures, or lacking emergency prep training and testing. Residents’ rights deficiencies include coercion, lacking information on health status, being forced to take part in treatments or experiments, or not being allowed to manage their own money. Freedom from abuse, neglect, and exploitation deficiencies come in the form of physical restraints, restraining drugs, or hiring workers with a history of abusing patients. These are just a handful of the 642 reported violations.
The issue of corruption also remains relevant. Nursing homes being charged with fraud by Attorney General Letitia James were all run by Centers Health Care, such as Holliswood Center for Rehabilitation and Healthcare in Queens, Beth Abraham Center for Rehabilitation in the Bronx, Martine Center for Rehabilitation and Nursing in White Plains, and Buffalo Center for Rehabilitation and Nursing in Buffalo. Despite all of these homes being publicly funded, the $83 million worth of taxes were put in the pockets of the Center’s Chief Executive Officer Kenneth Rozenberg and the Center’s Chief Financial Officer Daryl Hagler, instead of being used towards the care of the residents.
Previously, these same nursing homes were the plaintiffs in a 2021 lawsuit against a New York state law, which required that facilities spend 70% of their profits towards residence care and that only 5% of their profits were kept, with the rest being returned to the state. These nursing homes claimed that had this law been set, they would have to give back $824 million instead of being able to spend that money on residents. It was also suggested that having to return that money would lead to nursing home staff receiving inevitable wage cuts. However, in the context of James’s 2023 charges, these past concerns lose much of their legitimacy.
In 2019, the New York Health Department published a report on New York nursing home complaints. Out of the 13,154 complaints received, 866 were deemed allegations of abuse. Of those, only 20% were sustained. The report offers the explanation that there had recently been a high turnover rate of staff, leading to a lack of eyewitness testimony on the complaints. Regardless, it is clear that the Health Department does not have the necessary resources to thoroughly investigate these hundreds of complaints of abuse, allowing many of them to fall through the cracks.
Considering the long history of corruption within nursing homes, conversation has turned to proposed alternatives. Home Care is always an option, which involves an agency providing caregivers with necessities like food and housekeeping for elderly people. In New York City, these services cost an average of $22.71 an hour. Medicare PACE is a federally funded version of Home Care, but it does require those using its services to use a PACE doctor instead of a doctor that they might already be familiar with. Respite Care allows for professionals to take over the role that families often hold in elderly care, which can include having an elderly person enter a senior living community on a short-term basis.
As of 2023, over 1.3 million people, or 2.3% of the elderly population, live in nursing homes. In theory, they provide medical care for one of our most vulnerable populations. In reality, 10% of nursing home residents will experience some form of elder abuse in any given year. It has been proven time and time again that both federal and private nursing homes are either not equipped to respond to abuse complaints or simply brush these complaints under the rug. Until there is any form of regulation passed to effectively inspect and keep nursing homes up to health standards, thousands of elderly people will continue to suffer every year. It is time that we demand better for our families.
Considering the long history of corruption within nursing homes, conversation has turned to proposed alternatives.