State's frailest at risk in cost-driven system - Nursing homes get bonus, despite deficiencies
Based on several articles written by Carrie Teegrardin, a Journal-Constitution Staff Writer

Minimal wage employees at nursing homes across the country are expected to take care of 15-24 people a night according to administrative expectation. Studies say a nurse's aide working an evening shift should be assigned only seven to 10 residents. At 3.3 hours per patient a day, staffing at Georgia nursing homes ranks 5th lowest in the nation. The average nursing home in Georgia spends about $4.50 a day on food used to prepare resident's meals. Insurance policies do not cover long-term care. Most people assume they do. One in four people who reach 65 will spend at least a year in a nursing home. In Georgia, the number of homes threatened with closure due to severe violations in tripled last year. "In the typical U.S. nursing home, most experts agree, the staff is stretched so thin that aides must routinely ignore residents who need help with meals, exercise, grooming and many of the simple tasks that give them a sense of personal dignity."

Carrie Teegardin, exposes many interesting aspects of the nursing home industry that should disturb anyone living within this State. She confirms that not only does Georgia not care if you get good or bad care in a nursing home, but it has set up an incentives program which actually encourages neglected care. The in depth analysis exposes clearly that major nursing home players care only about expense and profit, not about the quality of care for residents, or the fact that their cost cutting measures create the environment for the many violations they receive every year for harming residents. Her recent work allows us to take a comprehensive look into what is really going on in this State.

"Four of the nation's largest nursing home chains run many of the worst homes in Georgia. Their homes also appear to have the largest operating margins - an average of $784,000 per home, compared with about $93,000 for other smaller for-profit-mom-and-pop-facilities." In Georgia it does not matter whether you provide quality care or harmful care to residents, reimbursement rates are the same. For instance, a Jonesboro home run by Beverly enterprises reports one of the highest operating margins in 2001, but in the same year, the home is cited many times, owning one of the worst records in the State for harming its own residents.

Sunbridge Healthcare, where the Carr brothers were murdered, operated 6 nursing homes in GA with daily staffing levels below minimal standards required by Medicaid. When Carol Carr shot her son's there 2 months ago, Sunbridge was found to be understaffed more often than any other home in the state, but instead of being fined, "the state paid tens of thousands of dollars as reward for keeping costs down." 5 of their 6 homes grossed $300,000 the same year. Ansley Pavilion, one of Georgia's worst homes until it closed in December 2000, received incentive payments for keeping staff and other costs low, even while inspectors cited the Midtown Atlanta home for insufficient staff, patient abuse and neglect.

"3 of every 4 nursing homes in GA are run by national chains. Georgia and other sunbelt states have some of the highest concentrations of for-profit-homes in the country." The AJC analysis found after analyzing data that the system rewards nursing homes that keep their patient care expenses down. Trying to save tax dollars, Georgia's Medicaid program each year doles out hundreds of thousands of dollars in bonus payments as an incentive for homes that spend the least. Those bonuses are paid even where government inspectors have found residents in danger. The current system offers no bonuses to homes with the best record of quality care.

Staff at Savannah Home Kindred Care neglected to call a doctor more than 36 hours after a resident began vomiting violently. The man died in September, a day after going to the emergency room for a broken hip, bowel obstruction, and high white cell count. State inspection records cited Kindred Homes 80 times for actual harm in the past 4 years. A Jonesboro home run by Beverly Enterprises, was cited when an inspector found a woman with numerous bedsores lying in linens soaked with urine and feces that had contaminated her wound dressings. Staff did not even immediately address the problem even after being pointed out the problem. Beverly Homes was cited 78 times for harming residents in the past four years. A Rome home run by Sunbridge Healthcare was cited after a resident reports being sexually molested twice, by a staff member who drew curtains around her bed at night, to kiss and fondle her. Sunbridge's homes have been cited 68 times in past 4 years.
"Staffing was so thin at 33 homes on average that they violated minimal daily staffing levels every day last year, and never had to pay any retribution because state regulators never enforce the requirement. Medicaid officials promised in December to demand accountability, but have yet to enforce the minimums." In Georgia, we have some of the lowest-trained, paid, and educated people, doing bedside care. Most don't stick to their jobs because of the overwhelming workload and low hourly wages. No two people anywhere can properly attend decently, the needs of 15 to 24 people a night, day in and day out. Only four other states have average staffing levels of nurses and nurse's aides that are lower than Georgia's. Nurse's aides here earn an average wage of $7.40 an hour, among the lowest in the nation. Fast-food cooks make nearly as much -- $6.56 on average.

"In Georgia, where for-profit-homes dominate the industry, nursing homes have the goal of making money." The analysis shows that facilities operated by four national chains earn much higher operating margins and poorer inspection records than the other nursing homes. State inspectors wrote up the five national chains' homes for substandard care 65 percent more often than the cited other for-profit- homes over the last 4 years. When Governor Barnes took office, he increased state payments to nursing homes operators, who so happen to have been a major contributor in his past campaigns, donating $1.1 million dollars to both his 1998 and 2002 campaigns.

Back in 1997, Bob Kafka of ADAPT, did a similar insightful comparative study, but instead of nursing homes he compared states, expenses for community and institutional placement. He then released the information in a "10 Worst in the Nation list." Georgia ranked 7th on that list allowing 85% of the Medicaid Long Term Care dollar to be used in nursing facilities. 7 of the 10 worst states were in the southeastern sunbelt region, with Tennessee topping off the list as being the absolute worst in the nation using 93% of its Medicaid long term care funds to support institutional placement.

Georgia was thrust into national limelight again when the following year, the U.S. Supreme Court decided to hear the case, Olmstead vs. L.C./E.W. challenging State's rights to decide institutional placement and whether it was fair according to Title II of the Americans with Disabilities Act calling for "most integrated setting." Independent living advocates favored community based services wanting the case to hopingly establish a written agenda for alternatives to institutional placement. The fact that things were so biased here actually helped the U.S. Supreme Court side with people's rights.

This decision set new precedence in long term care policy, forcing State's to create and have a plan for community based care as well as initiative to transition people out of institutional placement into community services, however though the decision gave us a strong foundation to sue States for violating people's civil rights, the enforcement of such litigation is still being pursued. And that's where we're at and why MiCASSA is not yet passed and Georgia can continue its long history of violating citizen's rights.

As long as long-term care policy is directed for the profit of a few, many will continue to suffer. Some advocates like myself don't want to shut down all of the nursing homes in the country. We just want to guarantee quality service and choices. Smaller scale nursing homes like Presbyteran Village mentioned in the AJC report, do honor their residents who enjoy assembly with others of similar circumstance. People find comfort with those experiencing like situation. Even for me, back when first injured , the idea of living amongst a group of young people with disabilities seemed very appealing, therapeutic. Group settings for some, means they are not alone against the world. It's the scariest thing, to be a freak among the masses, always looked at and made fun of.

There is no reason why the nursing home industry, cannot be a inclusive part of the healthy holistic world of long term care serving the elderly, disabled populations in a inspiringly beneficial way. That and the inclusion of community based services nation wide, and enforcement of accountability should force for-profit-harmful-to-resident nursing homes to shut down. They will no longer serve as dumping grounds for people who have nowhere else to go. Community services and facilities providing beautiful space, where individuals can face disease, age, and disability with a clear knowing that their last years will be of comfort and resignation, worry free of neglect, abuse, and enduring pain, will be the ones to survive the weeding out process. Besides wasn't that the promise, wok hard until your 65 so that you can finally settle to pleasurable living

Sources of information referenced by the Sunday articles include:

www.medicare.gov/ inspection data for every nursing home in the nation

http://www.accessatlanta.com/ajc/metro/nursinghomes/index.html
inspection data for Georgia and financial data nowhere else available