Legislature must act to improve nursing homes

Published 11:21 am Friday, October 12, 2018

Imagine being in pain or afraid, and your cries for help go ignored.

If you’re in a Kentucky nursing home, you’re ignored because there are too few nurses and nurse’s aides to go around. No one — not even in the nursing home industry — disputes that.

Why the legislature ignores the cries for help is harder to fathom.

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As John Cheves’ powerful reporting reminds us, legislative leaders have long been stubbornly incurious about how to improve care for the elderly and disabled, even though the state is responsible for overseeing nursing homes and holds their purse strings via Medicaid.

Two government insurance plans — Medicaid and Medicare — provide nursing homes with most of their revenue. Medicaid puts $1 billion a year into caring for roughly 12,500 residents of Kentucky nursing homes.

Cheves documented horrifying consequences, deaths and avoidable suffering because of routine understaffing: A 45-year-old man killed when his wheelchair crashed down stairs, undiscoverd for nine hours. A patient whose cries of pain prompted staff to mute him by shutting off a voice valve in his throat and who later was hospitalized because of a neglected catheter. Infirm residents forced to soil themselves because no one can help them to the bathroom.

The only nursing home executive who would talk to Cheves cited Kentucky’s long-running freeze on Medicaid reimbursements to nursing homes as an obstacle to raising the low wages that guarantee constant turnover and low morale.

You’d think lawmakers would want to examine the funding available to care for our elders. They should want to know how minimum staffing mandates have worked in other states, whether anti-psychotic drugs are being over-prescribed. After all, demand for long-term care among their constituents is only going to rise as the baby boomers age.

To gain an accurate financial picture, nursing home companies would have to open their books. Because most in Kentucky are privately held, they have no obligation to do that. Unless they voluntarily go public, we can only guess at their profits and whether increasing staff would push them into the red.

We do know from government data that non-profit nursing homes are better staffed and also tend to provide better care than for-profit nursing homes.

Home and community-based services are cheaper than institutional care and help people remain in their homes. Besides having one of the nation’s highest concentrations of substandard nursing homes, Kentucky also trails in the portion of Medicaid funding devoted to caring for people at home. Would it be possible for more Kentuckians to age in their homes?

Shamefully, our legislature has done more to protect the nursing home industry than to protect the Kentuckians who live in nursing homes. A “tort reform” law enacted in 2017 makes it harder to sue nursing homes for negligence and abuse, even though families often go to court to hold negligent nursing homes accountable and spare other people from the torment endured by their loved ones.

We don’t expect easy solutions. The nursing home industry is a powerful lobby. But for the legislature to keep ignoring the problems in the face of so much suffering is cowardly and wrong and must end.

Lexington Herald-Leader