For-profit nursing homes are a bad deal for older Americans
NOTEmergency homes and palliative care are supposed to provide safe shelters for the elderly and those nearing the end of their lives. During the Covid-19 pandemic, they were the exact opposite.
Many nursing homes and hospice organizations are now for-profit institutions. There is plenty of evidence that they put profits before people and wreaks deadly havoc during the pandemic.
Nursing home residents make up 1% of the US population, but account for 35% of Covid-19-related deaths. Even in this incredibly high-risk group, living in a for-profit nursing home still increased the risk of Covid-19 infection or death.
To date, six studies have assessed the impact of nursing home ownership status on Covid-19. All six showed the risk of infection or death from Covid-19 to be significantly higher in for-profit nursing homes. Staff in for-profit nursing homes don’t fare much better: Not only do for-profit nurses have to care for more patients, they also have less access to nursing equipment. Individual protection.
Investing in private equity fundamentally changes retirement homes: it increases deaths among retirement home residents by 10%, while the quality of care, as evidenced by headcount and other metrics, declines even as costs rise for Medicare and patients. Conversely, when ownership changes from for-profit to non-profit, the quality of care improves. It’s also a matter of racial justice, as for-profit nursing homes and hospices are more likely to care for black and Hispanic patients.
Far from scrutiny, many state legislatures are successfully pressured by lobbyists to protect retirement homes from lawsuits. Even though they provide substandard care, many for-profit nursing homes have received millions of government funds to support them. Many private investors are now engaging in questionable business practices, such as buying retirement homes, then leasing the building to the operator of the retirement home and charging excess management fees.
Private equity has also succeeded in infiltrating palliative care. Palliative care is a service provided primarily at home by nurses and social workers for people expected to live six months or less. Born out of a movement to provide humane care to people and their caregivers at the end of life, two-thirds of hospice palliative care agencies in the United States are now for-profit businesses. Research that several colleagues and I published last year shows that although the cost of palliative care increases, the quality of care is falling.
It has to do with patients who receive care in for-profit hospices, which provide poorer staff, less benefit to the community, and recruit patients who stay longer in hospices and therefore generate more income, while requiring less intensive care, such as those with dementia. There is a growing convergence between for-profit nursing homes and hospices, as more than 20% of nursing homes and hospices now have common ownership, often as part of a chain.
As the Covid-19 pandemic has revealed, age is far more than a number and the elderly are among the most vulnerable members of society. Many are alone, with few friends or family to watch and defend them. When I care for patients in the hospital, even my most diligent work cannot say anything if they receive poor care in the nursing facility to which they are referred.
Nursing homes and hospices have not traditionally been looked at like hospitals or other health care entities. This must change. Evidence suggests that tens of thousands of individuals, many of whom were people of color, died during the Covid-19 pandemic simply because they were in facilities that took profits.
Instead of shielding them from scrutiny, lawmakers should do more to ensure that facilities responsible for caring for the elderly are operating at a high standard. In a new report, the New York attorney general recommended removing the immunity provisions for nursing homes so as not to waive liability. This would increase the transparency of the business practices of for-profit establishments.
And while the US Department of Justice has caught many for-profit nursing homes and hospices indulging in fraud, a more systemic effort is needed. Biden’s administration and Congress should prioritize studying for-profit business practices in elder care.
The Centers for Medicare and Medicaid Services have developed a scoring system to rank the performance of nursing homes. A study published in the Journal of the American Medical Association found that higher-ranked people, mainly due to better nursing staffing, had fewer cases of Covid-19. For-profit nursing homes are twice as likely to have lower rankings than nonprofits, arguing that these rankings should be tied to the reimbursements that nursing homes receive.
The hallmark of a strong and ethical country is the way it takes care of its elders. There has never been a more important time to stand up for them and oppose the interests of for-profit companies whose only interest seems to be getting rich instead of helping the elderly and those nearing the end. of their life.
Haider Warraich is a cardiologist, researcher, and writer at the VA Boston Healthcare System, Brigham and Women’s Hospital, and Harvard Medical School. The views expressed are not those of the employers.