Greed, Understaffing, Lies, and the Nursing Home Industry

Recent news accounts have served as stark reminders for nursing home patients, families of patients, and everyone else that the nursing home industry is corrupted by a culture which brazenly chooses profits over patients, and chooses cover-up over accountability. It is a culture that too often tolerates under-staffing to extract more profit, and lies about it to cover the trail.

We already know that nursing home neglect and abuse is shockingly common according to reports from patients, investigators, and even nursing home employees. One study involving investigative surveys of certified nurse aides (CNAs) found that an overwhelming 81% of them had observed — and 40 percent had committed — at least one incident of abuse during a 12-month period. In another study that included focus group interviews, surveys, and individual interviews of nursing home patients, a startling 95% of nursing home residents interviewed reported that they had experienced neglect or witnessed other residents being neglected.

So the question is not whether nursing homes are allowing patients to be neglected at such an alarming rate, the question is why?

The answer seems clear. Money.

The single biggest reason nursing home patients are neglected is that those responsible for nursing homes choose not to hire enough staffing for their nursing facilities. They choose to divert resources needed to care for patients to their own bottom line to boost their profit margins.

Two recent news reports represent an important commentary on the nursing home industry, and the willingness to conceal their efforts to prioritize monetary gain.

First is the in-depth article from Kaiser Health News which discusses how newly available payroll data from nursing homes demonstrates that many nursing homes commonly under-reported (i.e., lied about) their actual staffing levels when reporting those levels to the federal government. These exaggerated staffing reports commonly resulted in misleading ratings on websites used by consumers to evaluate the services provided by prospective nursing homes. Before the Affordable Care Act, nursing homes were trusted to “self-report” their staffing levels. Only recently, has the Act allowed the government to review actual payroll records to verify staffing levels, and discover the wide-spread mis-reporting by the nursing home industry. These attempts to conceal and mislead the government and consumers are despicable, yet pervasive in the nursing home industry.

The second recent news item of interest is the sentencing of the convicted criminals associated with the multi-million dollar kickback scheme allegedly orchestrated by the former chief executive of Indiana’s largest chain of nursing homes, American Senior Communities, according to the Indianapolis Business Journal. The government’s sentencing memo stated that the executive “funneled $19.4 million to himself and others, nearly $10 million of which belonged to Indianapolis’s public health system…he bought a vacation house, diamond jewelry, private jet flights, and gold bars and gold coins—all for no other purpose than pure greed,” according to the article.

One has to wonder, why do so many corporate decision-makers in the nursing home industry believe they can get away with understaffing the nursing homes in order to enhance their profit, knowing that patients will be the ones put at risk for pressure sores, dehydration, malnutrition, preventable falls, and other harm that foreseeably results from not having enough staff to meet the patients needs? Why do so many corporate decision-makers in this industry have so little concern about being held accountable that they choose to flat out lie to the government about their understaffing? Why do executives making million dollar salaries feel so emboldened to defraud the government out of millions of dollars that could be going toward patient care, just to they can buy diamonds, jets and gold bars?

Why? Because many within the nursing home industry know that they so often can escape any accountability. Many calculate that understaffing, lying about it, and defrauding patients is worth it. After all, when bad acts go unpunished, they are repeated.

This industry has shown that it will not adequately hold itself accountable. To whatever extent this industry will be held accountable, it will depend upon the persistence of others. We can all do more to help hold this industry accountable. Anyone with concerns about neglect or abuse in a facility can file a nursing home complaint with the state that WILL prompt an investigation. It is important to know that filing a nursing home complaint can make a difference. It’s up to all of us to help make a difference.

Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable. Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.