Lawmakers expressed outrage at widespread reports of abuse and neglect in the nation’s nursing homes at a Senate Finance Committee hearing on Wednesday, noting that resident mistreatment has been a problem for decades despite regulatory reforms and attempts at improved government oversight.
“Seniors in nursing homes are among the people most vulnerable to the life-threatening consequences of abuse and neglect,” said Sen. Ron Wyden (D-Ore.), the senior Democrat on the committee. “Across this country, that vulnerability is being exploited in unimaginably cruel ways.”
That exploitation was detailed in statements from regulators, relatives of victims and other experts, and has included reports of medication mismanagement, neglect resulting in bedsores and other preventable infections, starvation, dehydration, sexual abuse and even death.
The hearing included testimony from two women whose mothers were victims of nursing home abuse: Patricia Olthoff-Blank, whose mother died as a result of alleged neglect at the Iowa facility where she lived for 15 years, and Maya Fischer, who recounted learning that her mother, a Medicare patient living with advanced Alzheimer’s disease, had been raped by a nurse at her Minneapolis nursing home.
“I still feel the guilt,” Fischer said, “of not being able to take care of her myself and having to entrust her care to others, only to have her subjected to this unthinkable assault.”
Committee Chairman Chuck Grassley (R-Iowa), who sponsored the 2017 Elder Abuse Prevention and Prosecution Act aimed at strengthening the federal government’s ability to curb elder abuse in a variety of settings, noted that the mistreatment of older adults in nursing homes remains a “systemic” problem. “Hardly a week goes by,” he noted, “without seeing something about nursing home abuse or neglect in the national news.”
The committee addressed a number of concerns related to quality of care, including issues with staffing and Medicaid funding. Wyden called proposed cutbacks to the program, which helps cover costs for 2 out of 3 seniors in nursing homes, “draconian.” The senators also discussed the unique challenges faced by those in rural communities
The panel also turned its attention to flaws in the five-star rating system and the Medicare.gov Nursing Home Compare tool that make it difficult for people to adequately evaluate nursing home quality. These tools, lawmakers noted, don’t measure how easy it is for consumers to use the tool or provide a way for consumers to give feedback about their experiences.
The Centers for Medicare and Medicaid Services (CMS) announced Tuesday that changes to the rating system will be implemented in April, including a lifting of the “freeze” on health inspection ratings that was instituted in February 2018. CMS said other improvements next month will include different ratings for short- versus long-term care, and the introduction of new quality measures, such as those covering a facility’s number of emergency room transfers.
When asked why regulations have been relaxed in spite of acknowledged gaps in oversight, CMS Chief Medical Officer Kate Goodrich responded that such loosening was aimed not at standards of care themselves, but at the “paperwork and administrative requirements” that “may be getting in the way of patient care.”
AARP Legislative Policy Director David Certner expressed support for strong federal nursing home oversight in a four-page letter to the committee in advance of the hearing. Certner wrote that “any weakening” of federal nursing home regulations will negatively impact the approximately 1.3 million Americans across the country who are currently receiving care at these facilities.
“CMS,” he said in the statement, “should maintain strong federal nursing home quality standards, oversight and enforcement to protect nursing home residents’ rights, health, safety and well-being.”