Opinion | Nursing Homes: The Good and the Bad

To the Editor:

Re “To Lift Ratings, Nursing Homes Shroud Neglect” (front page, March 14):

I am an elder-care specialist who has witnessed firsthand the less than optimal conditions in nursing homes and long-term care facilities, some of which have even earned five-star ratings.

The information on the Medicare website that tracks these facilities can be misleading and distorted. A lack of surprise inspections and reliance on self-reporting lead to limited disclosure about staffing, infection rates, medication errors, neglect and abuse.

I urge families to research the facilities through in-person visits to observe the environment, ask questions about care and activities, and promote discussions with resident family members.

The pandemic has illuminated deficits in long-term care facilities that must be addressed. Our seniors and loved ones are vulnerable and deserve more than fanciful reports and stars that are ultimately meaningless.

Teri Koff
New York
The writer is a social worker.

To the Editor:

Other developed countries support the elderly at home as part of their social safety net, saving lives and taxpayer dollars, and also uplifting the wages of home health workers. What it does not do is line the pockets of owners and shareholders of nursing homes.

It’s not rocket science; using Medicare for more comprehensive home health care for the elderly is not as complicated as sending people into outer space. Let’s get on with it.

Anna T. Meadows
Philadelphia
The writer is a retired pediatric oncologist.

To the Editor:

As a physician who consulted in nursing homes for more than 30 years, primarily to treat pressure injuries (bedsores), I’ve seen the good and the bad.

Low reimbursements are a major issue. Most bedside care is performed by certified nurse assistants under nursing supervision. The nurse assistants barely make living wages, and have inadequate training in many cases, resulting in high turnover rates, which lead to inadequate and inconsistent care.

In addition, too many nursing home administrators do not focus enough on quality and accountability. Inspections mostly depend upon review of the chart documentation, which often does not reflect the actual care given.

For example, preventing pressure injuries in bed-bound patients is one of the most challenging aspects of nursing home care. It requires trained, knowledgeable staff, specialized pressure-reducing mattresses and repositioning patients every two hours.

This type of care too often is not performed, resulting in severe wounds, infections and often death.

Legislators, state and federal, as well as society must decide how important care for our elderly is, how much we are willing to invest to support our loved ones and how we will all be held accountable.

Kenneth Olshansky
Glen Allen, Va.

To the Editor:

Your article about nursing home ratings doesn’t recognize the heroic efforts of long-term care providers to care for our most vulnerable citizens during the pandemic, let alone our industrywide efforts over the last decade to make real, measurable improvements in quality of care.

Independent research has found that outbreaks were tied to high spread in the surrounding community, not quality ratings, previous infection citations or staffing.

When it comes to abuse or neglect, such cases are rare. We must foster an approach where providers and regulators have a shared responsibility to do what is best for the residents, recognize good-faith efforts and remedy issues.

Our industry has maintained that star ratings can be a helpful tool, but consumers should not rely exclusively on five star or any other measure when choosing care. The long-term care profession supports legislation to publicly report more quality measures, including adding customer satisfaction to five star.

Long-term care providers have been calling for help since the beginning of the pandemic, especially with staffing. Let’s not diminish the extraordinary efforts of our health care heroes who put their lives on the line to fight the virus, provide more one-on-one care, and help fill the void of loved ones by treating our residents like family.

Mark Parkinson
Washington
The writer is chief executive of the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 skilled nursing centers and assisted living communities.