Throughout the past year the Indianapolis Star has published a fine series of 11 major stories plus several follow-up and daily stories detailing the unsavory business practices of Indiana’s nursing facilities and the poor care delivered by many of them. The series was stellar, and no doubt opened the public’s eyes to the ugliness in nursing homes and the poor care residents too often receive.
What the series revealed is all the more crucial since during the pandemic year, nursing home residents have suffered disproportionately, accounting for nearly 40 percent of all COVID-19 deaths nationwide and 50 percent of COVID deaths in Indiana nursing facilities.
The Star summed up its findings at the end of last year:
County hospitals, which now own more than 90 percent of Indiana’s nursing homes at least on paper, “have been gaming the Medicaid system for years” receiving more extra Medicaid funds than any other state “but much of that money never reaches the nursing homes.” Instead, it has been diverted to other purposes like hospital construction.
Meanwhile, and more important for families of loved ones in facilities, the paper found “the diverted funds have left Indiana with some of the most poorly staffed nursing homes in the nation.” Indiana nursing homes ranked 48th in the nation in terms of total nursing home staffing, which studies show is a major reason for bad care. In the case of Indiana, facility inspections conducted before the pandemic revealed that adequate staffing could have prevented deaths and injuries such as festering bed sores, fatal head injuries and broken bones.
The paper also noted the state’s nursing home arrangements “were ripe for fraud” while county hospitals have used state laws “to keep information about their nursing homes out of the public eye.” In 2016 Indiana lawmakers passed a bill making county hospitals the only government entities that did not have to disclose salaries of employees to the public. The paper, however, got information through other sources showing several hospital executives “received big paydays as they gobbled up nursing homes.”
None of this is surprising since The Star’s efforts are the latest in a long list of exemplar reporting with similar findings reported by newspapers and magazines including Consumer Reports where I investigated nursing homes in the mid-1990s and again in 2006. Each of those exposes implicated inadequate staffing and documented poor care. One year I visited 53 nursing homes and observed questionable care in nearly all of them.
What’s new are some of the entangled financial arrangements that complicate the portrait of today’s nursing homes, like the ones that the IndyStar exposed.
Nothing much seems to have changed when it comes to residents’ care. “We don’t need any more studies that show staffing matters,” says Toby Edelman, a senior attorney at the Center for Medicare Advocacy in Washington, D.C., and expert in nursing home regulation.
Adequate and good staff is expensive, Edelman said, adding that “nursing homes do a lot of self-dealing and do business with companies they own.”
What about federal regulators? A comprehensive law passed in 1987 was supposed to provide good federal oversight of the nation’s nursing facilities. But nursing enforcement has never been robust and facilities often have had the upper hand when it came to tough regulation.
What’s happened since the pandemic began? In March, the Centers for Medicare & Medicaid Services announced it was suspending regular inspections of nursing facilities and would only be conducting targeted infection control surveys.
What have those surveys shown? The government’s December data showed that Indiana facilities had 252 deficiencies for infection control between March and November, one of the highest rates in the country. The data shows that few of the government found deficiencies resulted in any financial penalties.
Why don’t nursing homes deliver better care for all of their residents? Why have poor performing facilities become a media staple ripe for investigation for so long? Years ago, I put that question to a nursing home advocate in Texas who replied that if I would have found poor staffing and poor care in day care centers, the state and the public would be screaming from the rafters demanding change and state regulators would listen. It’s not the same with nursing homes, the Texan said. Nobody cares much about old people.
I asked IndyStar reporter Tony Cook if the paper would continue to follow the story. “Absolutely,” he said. Maybe more people will begin to care.
What have been your experiences with nursing homes during the pandemic? Write to Trudy at firstname.lastname@example.org.
Hoosier Health column is provided by the Hoosier State Press Association Foundation as a non-partisan look at health care issues affecting Indiana residents.