Profit nursing homes

I have to reply to two of my classmates for each discussion 200 words each

Based on,Elder Abuse in Nursing Homes and Fighting Nursing Home Abuse

  1. What observations can you make regarding elder abuse in nursing homes?
  2. How would you address the problem?
  3. What are specific issues with for profit nursing homes?
  4. Based on information provided in the articles, how does NY fare compare to other states regarding elder/nursing home abuse? (Identify specific cases and studies).

What observations can you make regarding elder abuse in nursing homes?

According to Schub (2017), observations that can be made regarding elder abuse in nursing homes are that of the abuse and neglect allegations cases reported, 50% abuse and 11% neglect.  Furthermore, at least 40% of the abuse and neglect incidents were perpetrated by staff.  Neglect is the most common form of elder abuse.  It arises from staff failing to meet the clients’ physical (food, water, or hygiene) or psychological needs (leaving a client unattended).

Most elder abuse goes unreported by staff members, the client, and family members.  Only half of the facilities report abuse and neglect allegations. Some factors that inhibit reporting include fear of retaliation, lack of education, and overworked staff.  Moreover, social workers may fail to report due to ‘obligation dilemma’ and conflicts with nursing home managers.

How would you address the problem?

One of the problems recognized at for-profit nursing homes is the lack of staffing.  It is unclear whether the understaffing is due to a shortage of skilled workers, poor recruitment and hiring decisions, or both.  Nevertheless, the problem continues to persist despite poor ratings from abuse and neglect allegations, lawsuits, and negative media coverage.  The for-profit nursing homes have no incentives to improve their staffing deficiencies or spend more funds on training and skill development.  Management could remedy the problem by creating employee incentive programs.  Additionally, CMS could also offer an incentive program for nursing homes to hire more skilled workers or train the existing employees.

Another major problem is the reporting deficiencies.  I believe the fear of retaliation is the biggest factor among the residents and the staff.  Due to understaffing, vulnerable residents could be further victimized by the wrongdoers.  And staff may also fear reporting will create a hostile work environment.  Furthermore, social workers should act with neutrality rather than based on conflicting interests.  Additional training or reporting requirements may be needed in this job category.

What are specific issues with for-profit nursing homes?

Shilling (2017) discusses the specific issues with for-profit nursing homes.  In New York, about one-quarter of the for-profit nursing homes are ranked as the lowest quality facilities in the state.  Abuse and neglect allegations continue to increase annually due to low quality of care and staffing deficiencies.  In Pennsylvania, for-profit facilities have similar issues with the quality of care and understaffing.  These facilities also claim to have inadequate Medicare/Medicaid reimbursements.  In Massachusetts, low disbursements per patient were also a factor in low quality of care.

Based on information provided in the articles, how does NY fare compare to other states regarding elder/nursing home abuse? (Identify specific cases and studies).

New York is ranked as one of the worse states regarding elder/nursing home abuse.  The other states mentioned have similar issues regarding lack of care, understaffing, and reporting deficiencies, etc.  However, Shilling (2017) details a three-part series report from the political website City & State New York about the decreasing quality of care in for-profit nursing homes.  What further distinguishes New York from other states is the lack of DOH inspections due to understaffing, wrongful evictions of residents, and overall lack of state oversight.  Shilling (2017) also discusses Friedman v. Hebrew Home at Riverdale negligence case.  Hebrew Home is noted for thirteen wrongful death claims and residents ‘eloping’ or leaving the facility undetected.  It is also important to note that both the Schub and Shilling articles do not take into account reporting deficiencies or incidents during a pandemic and New York’s covid-19 nursing home deaths.

References

Schub, T., Uribe, L. M., Spears, T.-L., & DeVesty, G. (2018). Evidence-based care sheet. Retrieved from https://canvas.sjcny.edu/courses/29731/files/2422503/preview

Shilling, D. (2017, Summer). Fighting nursing home abuse. Criminal Justice Research Review. Retrieved from https://canvas.sjcny.edu/courses/29731/files/2422503/preview

Example of someoe reply

Hi Catherine,

Great post! I especially liked your resolutions to the problems which were presented at for-profit nursing homes.  Shortage of skilled workers is an issue which can create an unhealthy environment where abuse or neglect can present itself. The idea of creating an incentive program for nursing homes to hire more qualified workers and to increase training would greatly improve the issue at hand. It was sad to read in the article that only 53% of organizations reported abuse and neglect allegations, although it is federally mandated to do so (Shub,2018).  An abundance of issues which lead to the lack of reporting are lack of education of staff in determining abuse, mental compromise of abused residents and fear of retaliation. The implementation of additional training for staff members on how to properly report deficiencies could make a positive change as well. Reporting within the nursing homes is decreased due to the lack of knowledge and understanding of how important it is that the state know what is occurring in these organizations. The data collected can aid the state in understanding what areas are causing issues of neglect and abuse and what type of neglect and abuse is continuously happening. Training would alleviate the dismissal of reporting due to lack of knowledge.

What observations can you make regarding elder abuse in nursing homes?

One observation I made regarding abuse in nursing homes:

1: Abuse is more likely to happen in nursing homes where there is a high staff-client ratio (Lowenstein 2010) That would make sense for the following reasons; poor management which leads to staff being overworked and thus be stressed out and can intentionally or unintentionally let that stress out on residents.

Another observation I made was that abuse often goes under reported by the facility, resident or family members, Only 53% of facilities reported abuse (office of inspector general 2014) This is most likely due to the fact that the parties involved are afraid of retaliation by their co-workers, managers etc.

How would you address the problem?

A simple fix would be to improve staffing. While that is not always possible to fix right away, perhaps incentivizing the staff with a bonus for working understaffed can help alleviate some of the stress.

Fixing the problem of lack of reporting of abuse can be done by reviewing the resident rights with them and their families and by constantly educating the staff of the facilities of their mandate to report abuse immediately to their supervisors.

What are specific issues with for profit nursing homes?

For-profit nursing homes tend to worse staffing than non-for-profits. Although there is a federal mandate for nursing home staffing, that tends to be less than what is really needed to care for the acuity level in nursing homes.

Another issue is that for-profit often spend less on resident care than their not-for profit counterparts (Lazar 2016). For profit facilities spend on average $4000 less on resident care, such as food and other vital items than not-for-profits.

How does NY fare compare to other states regarding elder/nursing home abuse?

NYS nursing homes seem to be trending to lower quality of care as there are more for-profit facilities around. There have been audits and reports of how the DOH is not holding these facilities accountable partially due to lack of staff. There was one incident in which a resident had a doctor’s order to sleep while on a ventilator but the staff failed to do so and the resident died. The facility tried hard to cover up the reason for the resident’s death but eventually one of the staff was convicted of negligent homicide. (Runyeon 2016)

References

Schub, T. (2018). Elder Abuse in Nursing Homes.

Shiling, D. D. (2017). Fighting Nursing Home Abuse .

Hi Menachem,

Great post. In the reading they also explained other specific reasons why for profit organizations care isn’t the best. It is explained that patients often times need more care than they can give and this impacts them greatly. The ratio from staff and patient is completely off and this causes increase abuse due to the tedious nature of the job and no assistance they feel like they are getting. Also, in the second question it stated many examples on how the states are regarding elder abuse is that they find ways to save money such as hiring unlicensed contractors that will do the job for less but may not provide the best work. This can cause unsanitary living environments for the residents

Discussion 2

Based on, How Do Race and Hispanic Ethnicity Affect Nursing Home Admission and textbook Chapter 13 : Ethical Issues in Long-Term Care

  1. What ethical issues are raised in the study?
  2. How should these issues be addressed?

According to the article Thomeer et al. (2014) explains the ethical issues that are raised in the study is that health and disability factors relating to nursing homes admission being low and the question whether minorities aren’t getting into nursing homes the way caucasians are. However, statically hispanic and non-hispanic black people have more health issues that is relevant to nursing home care being needed eventually than the article goes to describe that minorities may not have the same resources as non-hispanic white people. Another reasoning that is raised is that hispanics are able to stay with family until they are old and can avoid institutional care. Also through the statics shown in this article hispanics are more likely to have a caregiver. Also income could be a huge factor especially because nursing homes are so expensive to pay for especially if the patient does not have insurance. Also it is shown through culture that nursing homes are looked down upon in preferences for non hispanic black and hispanics.

According to Chies(2021) these issues of ethical issues should be addressed by being able to access the care. Being able to get medicaid and medicare and afford the difference that insurance isn’t able to pay makes a big impact. It is noticed that people who have no other resources have a hard time in deciding vital steps for their long term goals and care. Most seniors will need the governments assistance and because everyone is looking for the care it becomes harder to get and if the person qualifies. Than it becomes so what level of care should they receive such as a nursing home, assisted living, in home care etc. The decision is supposed to be based on what is better for the patient but most times its what can be affordable. However, certain situations especially people who need that 24/7 care may not have mad options and have to go to an institution to give them the best quality of life.

References:

Chies, S. (2021). Pratt’s long-term care. Managing across a continuum:(5th ed.) Jones & Bartlett ISBN: 978-1-284-18433-4.

Thomeer, M.B., Mudrazija, S., & Angel, J.L. (2014). How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study. Journals of Gerontology Series, B: Psychological Sciences and Social Sciences, 70(4), 628–638, doi:10.1093/geronb/gbu114. Advance Access publication September 9, 2014

Hi Jasmin,

I enjoyed reading your post! There are several grey areas in nursing care when it comes to the issues you discussed. The first issue is that there isn’t enough evidence to support that systemic racism exists across the board. Like you mentioned, there are not enough numbers to prove anything one way or another. In addition, the idea that healthcare is a luxury is also not ethically sound. As you mentioned in your post, the white population in general is more able to afford to pay for healthcare at least in the form of co-pay. Although it is true that the government pays the bulk share of skilled nursing services, the rest is left to the individuals and the insurance companies. In a sense, that has racial undertones. The whole healthcare system is designed to be less accessible to minorities. Blacks, hispanics and other minorities have more health-related problems and have less access to healthcare as well. To be honest, there is very little in terms of options for those individuals healthcare needs. I support the idea of having a profitable healthcare business but it has to be solvent for the care recipients as well. Change needs to happen in order for the system to be equally accessible to all who need it.

Based on, How Do Race and Hispanic Ethnicity Affect Nursing Home Admission and textbook Chapter 13 : Ethical Issues in Long-Term Care

What ethical issues are raised in the study?

The studies conducted show that hispanics and non-hispanic blacks are less likely to enter nursing homes than non-hispanic whites. The reasons for this phenomenon are not as clear. While it is evident that hispanics are less likely to be in nursing homes, some argue that their culture dictates the lack of need for those facilities. It may also be that hispanics are viewed differently than white Americans. Society views Hispanics with questionable immigration status and therefore view their rights to be treated equally with tainted glasses. The true reason why hispanics are not commonly entering nursing homes may not be clear but one thing that is clear is that we need to allow all humans regardless of ethnicity equal rights to have top notch healthcare. (Thomeer, 2014)

How should these issues be addressed?

The book “Pratt’s Long-Term Care” discusses the issue of “Ethics Of Rationing”.  The discussion has been ongoing for generations. It is no longer just an ethical discussion but also a political one. It is a very controversial subject that can raise heated debates. The debate typically involves the question of governments role in healthcare and whether or not they should be playing a role in the decision-making process of healthcare recipients.  (Chies, 2021) Ultimately, there would be enough supply to meet the growing demand for good healthcare, but the reality is not quite there yet. So, when assessing whether one patient is more eligible to receive care based on their skin color or race is beyond disturbing. Healthcare officials need to put policy in place that will not only ensure equal care for all but also put penalties in place for those who don’t abide.

References:

Thomeer, M. (2014) How Do Race and Hispanic Ethnicity Affect Nursing Home Admission. Oxford University Press.

Chies, S. (2021) Pratt’s Long-Term Care. Managing Across the Continuum. (5th ed.) Jones & Bartlett ISBN 978-1-284-18433-4

Example of reply

Hi Shimon,

I also agree that the study is basically about hispanics and non-hispanic blacks usually not admitting into nursing homes compared to non-hispanic white people. It explains how statically it should be more of the minority population being admitted due to health issues and other causes that may need them to get care. A lot of factors came to play throughout this article was it that hispanics and non-hispanic blacks aren’t getting access and the same resources to know the different insurances that are provided to them? Is it that non-hispanic blacks and hispanics moving in with their family members oppose to going into a facility? Or is it that other ethnics do not have the income that the non-hispanic whites are exposed to? Personally, being half hispanic I noticed that the article is right about how family orientated we are. We will have a older cousin take care of a grandma and take turns paying for her health as a family. My family would never allow my grandparents to go into a facility no matter if her health deteriorated. I believe greatly culture and beliefs defiently have a factor in if a family member goes into a facility.

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