Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, July 10, 1990 TAG: 9007100457
SECTION: EDITORIAL PAGE: A6 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Long
The answers are: It easily can happen. It cannot always be prevented, but it can be made much less likely. And a lot can be done, depending on the effort the rest of us are willing to make.
Only about 5 percent of America's elderly, 1.5 million people, live in nursing homes. But these are individuals who need regular attention and care. They may be confined to beds or wheelchairs, crippled, senile, incontinent, unable to feed or bathe themselves or to take needed medication. At worst, they may comprehend nothing of what is going on around them and be unable to communicate with others.
Often, such nursing-home residents are alone in the world. Or they may have relatives or friends who are able to visit only infrequently. They are among society's forgotten people.
As a nation, America is growing older. The fastest-growing segment of our society are those aged 85 years and over. Before another 15 years have passed, the number of senior citizens needing nursing-home care could more than double. Strains in the system could become much worse.
Living in a nursing home can be expensive; charges of $20,000 a year and up are common. Medicaid pays about half the nationwide costs of nursing-home care. (Medicare covers only brief stays.) But despite the expense, care may be poor and workers inadequately compensated. Staff turnover tends to be high. Starting pay is often minimum wage.
The tendency in our society is to underpay for work that requires a lot of care and devotion. Some stick with these jobs because they are caring people. Others take such work for different reasons, and if they are not adequately supervised, the situation is ripe for abuses. The wonder is that there are not more.
The commonwealth of Virginia has jurisdiction over 286 long-term-care facilities, including 222 nursing homes. By law, the state's Department of Health must inspect each one at least once a year; 12 positions are assigned to do this. Mary Francis, director of inspections, says visits are unannounced and may also be made in response to complaints. Normally, two inspectors will spend two to three days at the task.
That is all very well, but obviously, a lot can go unseen when inspectors are not around - or even when they are. Heretofore, the fitness of a nursing home has been judged by externals: how much staff it has, how much equipment, how able it is to render a certain level of care. Not enough attention has been paid to whether the home actually provides that care. Not enough time has been spent talking to patients and their families and friends.
Change is on the way, although its pace is uncertain. Federal legislation passed in 1987 and taking effect Oct. 1 requires a more probing and thorough approach to inspection. Officials must talk more to patient counselors, the patients themselves, and family members.
This will, of course, require more personnel and more funds. The legislation provides for a temporary increase in the federal share of matching funds (now about 55 percent), and Francis does not anticipate difficulty in filling additional positions.
Once in place, such a process holds real promise for nursing-home care in Virginia. But with less than three months remaining before the new process is to be put into effect, federal regulations still are not in final form.
Unfortunately, this is all too typical of Uncle Sam's approach in this field. Three years ago, John Heinz, R-Pa., declared that "The federal government has created a deaf, blind and mute robot, called it the `enforcer' and set it loose with a twig instead of a stick to monitor the nursing-home programs." Too many facilities have continued to receive Medicare and Medicaid money despite repeated violations.
The remedy is not all that easy, either. Nursing homes that lose federal compensation usually shut down, leaving residents with no place to go. Most states have shortages of nursing-home space - partly because state governments have tightly controlled the number of beds in an effort to contain Medicaid costs. This is just one more area of health-care spending that will demand continuing and larger infusions of public funds.
A more personal, consumer-oriented approach to government regulation of nursing homes will help. So will more at-home care for the elderly who cannot help themselves. That leaves a lot for the rest of society to do. Most residents of the homes do not have enough visitors; most nursing homes welcome their having more. Churches and other organizations have volunteer programs to encourage visitation.
Regulators cannot shoulder the entire responsibility of assuring that nursing-home residents get quality care; others must step in to give attention to the forgotten people. This is an area where President Bush's "thousand points of light" could shine.
by CNB