Monday, July 14, 2014

People With Disabilities Institutionalized in Nursing Homes, Information Bulletin #394 (7/2014). Think about the warmth and coziness conjured up by the term “nursing homes.” Much of the public and as well as the press think that “nursing homes” are the places where people must go in order to receive intensive nursing care. Let’s take a look at the extremely effective branding of a product: nursing homes. As of December 2013, 69.4% of the nation’s 15,666 nursing homes were classified as “for profit,” only 24.7% were classified as “nonprofit,” and 5.9% were classified as “government/public facilities.” In Alabama, Arizona, California, Connecticut, Louisiana, Ohio, Oklahoma, Oregon, Texas and Utah, more than 80% of the nursing homes are “for profit.” More than 55% of these 15,666 facilities were owned by multi-nursing home chains and corporations, with each corporation having two or more nursing facilities under one ownership or operation. Nursing homes have not been “mom and pop” operations for many years. Nursing homes are a $74 billion Medicaid funded industry. Medicaid certifies about 90% of the nursing facilities. Most of these facilities are BIG BUSINESS funded by public taxes and dollars. Think BIG LOBBIES using people with disabilities as cash cows to make profits. Most of these are large institutions – not “homes,” not even “group homes” of only a few people. This is not surprising since “for profit” means making money for the owners. That means meeting the interests of the owners and not the residents in terms of size and scale. The “nonprofits” are really not that much different from the “for profits” with regard to their size. They are not “homes.” Don’t be fooled by the label “nonprofit.” Executive Directors’ salaries in nonprofit nursing homes can be hundreds of thousands of dollars or more. Senior staff in “nonprofits” also make a lot of money. What about the residents in Medicaid funded-nursing homes? They are all people with disabilities. Regardless of their age, in order to be eligible for Medicaid funded nursing homes, people must meet the State’s criteria disability consisting of physical and/or cognitive impairments that limit activities of daily living. Elderly people cannot just decide that they want to enter a Medicaid-funded nursing facility, like they would a hotel. They must have a certain number of impairments, just like younger people with disabilities. With regards to the alleged doctors, let’s examine their affiliations with the facilities. Most people in nursing homes do not know they can have their own doctors continue to treat them there. Rather, the nursing homes have an understanding or deal with certain doctors who “care for” all the residents. The result is that the doctors in nursing homes are beholden to the nursing facility, and the residents/patients in these facilities are cash cows for the doctors. These doctors do not view the residents as their patients because in order for the doctors to continue to be reimbursed, they must cater to the nursing home proprietors. We have seen the “drive by” medical care that these alleged medical professionals provide. They bill Medicaid for hundreds of alleged patient visits, as well as care and treatment for all the nursing home patients just in a few hours. In reality, they rarely even see the patients but just sign hundreds of charts. What about the “nursing” part of “nursing homes”? The general public, the press, and elected officials must think that people with disabilities, regardless of their age, really need to be in a nursing facility because they need direct care that can be provided only from well-trained health care staff in a nursing facility. Hmm. Let’s look at how much time measured in hours per patient per day residents actually receive “nursing” care and services. Nationally, the average of “total direct care” staff hours provided per patient per day is 3.71 – that a total for registered nurses (RNs), licensed practicing nurses (LPNs), and aides. However, of this average 3.71 hours per nursing home, less than half an hour is provided by a RN and about three quarters of an hour is provided by an LPN, who generally have only one year of training. Does anyone really think that a “visiting nurse” in one’s home could not provide the same patient care in the same amount of time, but much more cheaply? Who is providing this “direct care if not the RNs or LPNs?” It is the “aides.” These are the people who provide the assistance with residents’ daily living needs – transferring them from their beds, assisting them with toileting, showering, dressing, and other such needs. Yes, the assistance personal attendants provide in the nursing homes is the same assistance with activities of daily living that people with disabilities receive in the community. So why has the nursing home industry been so successful in deceiving the public? First, the nursing home industry is well-funded; they are active lobbyists and contributors to your State legislators and Governor. They play this system much better and more effectively than the community-based community-care providers. Second, advocates for the elderly and non-elderly disabled people have not developed or engaged in effective activism and advocacy. There have not been the press or television stories that were produced about institutions for people with intellectual or mental disabilities, showing how absolutely terrible they were. Third, once people with disabilities enter nursing homes, especially if they are elderly, they give up hope that they can live in the community. Their families do not know about or believe they can receive appropriate or the same services in the community that they think nursing facilities provide, and they do not fight for those services. We need a new Frederick Douglass. He knew that power concedes nothing without struggle. Where are you? Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins posted after 10/2013 can be found only at Information Bulletins before 10/2013 are available online at with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

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