Widespread Abuse Found at Nation's Nursing Homes

Nearly one-third of the nation's nursing homes recently violated abuse prevention standards, according to a congressional report.

According to the report, prepared by aides to Rep. Henry Waxman (D-Calif.), state inspectors cited nearly 5,300 nursing homes between January 1999 and January 2001. In more than 1,600 of these homes - one in 10 of the nation's nursing residences -- the violations were "serious enough to cause actual harm to residents or to place the residents in immediate jeopardy of death or serious injury."

The report said that the most common violations involved the homes' failure either to "properly investigate allegations" of resident abuse or neglect or their failure to ensure that their staffers didn't have documented histories of mistreating residents.

But the report added that many other incidents involved "appalling" instances of verbal, sexual, or physical abuse inflicted on residents by workers or by other residents.

According to the report, the percentage of homes cited for abuse has doubled since 1996. That may reflect tougher enforcement efforts, Waxman said, but may also indicate an actual increase in abuse that stems from 1997 congressional action that cut Medicaid payments to nursing homes.

There are about 17,000 nursing homes in the U.S. They house close to 1.5 million seniors and disabled individuals.

According to Nancy Walker, a certified nurse aide at a Hartford, Conn., nursing home, the average national wage for her position is just over $8 an hour. As a result, she said, "a lot of people leave nursing home work because they can earn more money working in a hospital or even a fast food joint." Walker said that because most nursing homes are for-profit operations, "they cut as many corners as they can" to maximize their profits.

Meanwhile, the homes can be stressful places to work. Richard Bardos, deputy director of Maryland's Medicaid antifraud initiative, noted that modern medicine has "allowed the body to stay able while the mind suffers from dementia. We now have a larger population of physically stronger but ... [mentally] impaired adults, many of whom, due to their mental disease, can be combative and verbally challenging."

In response to the report, Charles Roadman, MD, president of the American Health Care Association, said, "Our residents are like family, and incidents like those described today are extremely rare." Roadman's group represents for-profit nursing homes.

Bruce Rosenthal, spokesman for the American Association of Homes and Services for the Aging, tells WebMD, "We don't want people who need nursing care to be scared and believe that they should not go into a nursing facility." He emphasized that most caregivers are dedicated professionals. Rosenthal's organization represents nonprofit and religiously affiliated nursing homes.

"We don't condone the types of abuse that are addressed in this report," Rosenthal says. "We believe that nursing homes that exhibit consistently poor performance should either clean up their act or be put out of business."

But Rosenthal was critical of "punitive" government policies that restrict nurse-training dollars for homes with incidents of substantiated abuse.

Meanwhile, Waxman Monday introduced legislation that would increase both federal payments to nursing homes and nurse staffing requirements, toughen fines on homes that violate rules, and increase Internet disclosure about nursing homes' inspection records and complaints filed by residents and families. It would also mandate rigorous background checks for potential nursing home workers.

According to Waxman, "We, as a society, will be judged by how we treat our seniors."