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For quality care
© St. Petersburg Times, published July 29, 2000
America's nursing homes are becoming holding pens for the sick. According to a new federal study, nurses care for patients only several minutes a day. Nurse's aides -- the ones who bathe, clothe and feed -- spend less than two hours daily with most patients. No wonder the elderly are hurt and killed in preventable tragedies.
In an exhaustive report to Congress, the Clinton administration blames understaffing at the nation's 17,000 nursing homes for the rise in bedsores, malnutrition and injuries among the 1.6-million nursing home patients. Some patients lie in bed too long. Others are essentially force-fed by harried nurses' aides who clip through their backlog of work by, in some cases, stuffing "huge spoonfuls of food" into a patient's mouth.
Not only are patients hurt and humiliated by such inadequate care, but they often end up at hospitals needing emergency treatment. Last year, the General Accounting Office, an investigative arm of Congress, reported that problems at one in four nursing homes had "caused actual harm to residents or placed them at risk of death or serious injury." The government, which pays the bulk of nursing home costs and which often acts as the sole guardian for infirm patients, has a legal and moral obligation to improve staffing levels and foster quality care.
The nursing industry blames low staffing levels on paltry government reimbursements. The companies have a point. Several large chains have declared bankruptcy in recent years; in Florida, troubled companies operate roughly 20 percent of the beds. States and the federal government, which share nursing home costs through the Medicaid program, need to require homes to increase staffing and help pay the costs.
Many recent tragedies in Florida were caused by patients being left unsupervised or poorly attended by nurses and nursing home assistants. The Clinton report underscores how the nation's dysfunctional system for financing nursing homes compromises quality care. The rise in home health services, the aging population and the prospect of Medicare adding coverage for prescription drugs mean that the people entering nursing homes in the years ahead will be older and sicker than ever before. A system that forces people to go into poverty or to hide assets as part of receiving nursing home care will never induce the profit or responsible corporate behavior to raise medical standards within the industry.
Nursing home operators and the government have made reimbursement rates the issue in the standoff over quality care. That debate must change. Lawmakers must provide more money, operators must provide reasonable staffing levels and the states must move more quickly to sanction and close unfit providers. All sides wiping their hands won't resolve the problem.
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