Nursing homes, or “Skilled Nursing Facilities”(SNFs) as they are called, have seriously deteriorated in California, and also in other states around the US. This is a shame to our healthcare system, which used to be the best.
Many of my patients with Traumatic Brain Injury have to spend months, sometimes up to two years in skilled nursing facilities for rehabilitation. However, there is no distinction between rehabilitation facilities and long term residential nursing home facilities under state or Federal laws. Since they fall under the same roof, that means patients with dementia and terminal illness live under the same roof with patients needing just a few weeks of rehabilitation after an injury. It’s no wonder that even young patients under such circumstances become depressed and even suicidal during “inpatient rehab” compared to those who are able to rehab a home.
The saddest thing of all is that the quality of care in these facilities has deteriorated over the past 20-25 years. I have seen the sequence of events. When I first started doing nursing home care as part of my neurology medical practice in 1991, most facilities were either attached to hospitals, or in small buildings in the community, usually close to family members and in the patient’s own neighborhood. They were also called “Transitional Care” because the goal was that they would return to independent living in their own homes. These were separate from the nursing homes that offered long term care for patients with dementia or terminal illness.
During the late 1990s and especially in the 2000s, many small facilities were bought out by large companies that combined the nursing homes with the rehab centers under one roof, and under the same corporate leadership. These increasingly powerful companies were able to lobby governments at both state and Federal levels to reduce regulatory standards, easily outspending the smaller weaker patient advocate groups, (and no, AARP was not on our side!).
The corporations who now own over 90% of these facilities all over the US, including rural areas, focus on one thing: PROFIT, which means cutting costs, cutting nursing staff, reducing quality of care, even reducing the amount of food they allow for the patients!
I visited my own patients in such deteriorating facilities until about 2008. I wore a mask whenever entering these SNFs, not just for the usual infection control requirement, but an attempt to cover the stench throughout the facilities. Most of them had one bathroom shared by 30 to as many as 50 residents – yes, I mean ONLY ONE toilet, shower and bathtub for everybody to use, with no one cleaning it between one patient and the next. There were streaks of excrement on the walls, overflowing clogged toilets that had not been cleaned for days or perhaps weeks, and residents complaining of hunger and visibly losing weight because they were not provided sufficient food.
When I asked to speak with nursing staff, I usually could not find a nurse, not an RN or even an LVN on site. They were always “covering another facility,” I was told, and I could only speak to office staff who would take a message. But message after message without any return calls except by officious administrators who would literally hand up the phone in the middle of my questions.
An investigator from the OIG (Office of the Inspector General) told me that fraud here is so rampant, they have an out of state call-line for complaints about California facilities. With permission from my patients, I attempted to take photos at one facility, to show her the horrible conditions, but was “escorted out” by a security officer boasting the corporate logo on his ID and shoulder patch. I won’t say which corporation because now it’s really all of them. I could smell alcohol on his breath – shocking but not surprising even to the OIG investigator who had sent me.
I heard numerous reports from my own patients and families, brothers sisters, sons, daughters, nephews and nieces, who care about their loved ones who suffered in those facilities. One was an attorney who was horrified by the care his father received at a typical SNF facility. He tried to report the numerous deficiencies to the State Attorney General, but nothing was done, only a letter from the DHS stating that as long as they “meet government standards,” nothing would be done. The attorney’s father had been transferred to that facility by a reputable hospital, but there was nothing the hospital could do either.
Just yesterday I saw a young woman who told me that she had been sexually assaulted by a male nurse at the facility where she was sent for rehab. She does not have dementia, but was there to get Physical Therapy for a work injury, and I am now seeing her for follow up in my clinic. She called 911 immediately after it happened, but was told that the facility would have to agree to pressing charges.
I am sad to say that I was “shocked but not surprised” anymore. I advised all of them that it was safer to hire help to come to their homes
Families tell me that they do not want their loved ones to suffer like this, but they are tired of complaining and have learned to accept the situation. But this means that all of us, young and old have to accept the fact that we too will someday live in such conditions – because of government regulators who care more about the money they get from corporate lobbyists than about the people they are supposed to protect. Please make your voice heard, write to your Congressman, share this blog with friends and family. Even better, find out if there is a nursing home or “Skilled Nursing Facility” in your neighborhood and visit them yourself. Don’t let a superficial “tour” mislead you. When I visit as a doctor, the facility always looks clean and nice and with plenty of staff. It’s better to visit as a non-suspecting family member or friend, you will discover a lot more information that way. See for yourself and say something. Complaining about unsafe conditions on behalf of a fellow human being may be “politically incorrect” but it is morally the right thing to do.