Big Nursing Home Chain Holocaust on the Elderly - Too Strong a Term?

Huge national nursing home chains get most of their revenue from tax dollars, cry poor when it is suggested they should hire more nurses and aides, but lavish lavish millions of dollars on CEO's - testimony before a US Senate subcommittee.

I've been getting emails about nursing home problems from reform activists for a while now. Hundreds of them.
In January I got a couple more emails about about HCR ManorCare, one of the big national players in the nursing home bidness, from nursing home reform advocate friends to add to my large collection of such emails.

"Manor Care 2003 Rev UP By $124 MILLION To $3.03 BILLION"

"CA-6 NH's Say Violations Fixed (Operation Safeguard); All Repeat Offenders - [Both a ManorCare & a Life Care facility mentioned in article.]"

"NM-MANORCARE Settles Wrongful Death Suit"

"IL-Manor Care Resident Found Dead In Cold Street [20 Degrees, Windchill of 10]"

Those are subject lines from the HCR ManorCare emails I got in January, linking to press articles.

Last August I testified at U.S. Senate subcommittee hearing that Kit Bond held in KC. While I obviously have many areas of disagreement with Sen. Bond, I was convinced by other nursing home advocates that the legislation he was pushing with the hearings was worthy of support.

I kept meaning to write something up to post here about it, but time kept slipping away, and Mr. Bush's adventures kept grabbing my attention. But I think now I will just post the testimony. Here it is, with links at bottom to a couple of related articles:
*********************************

Tom Klammer
Testimony Before the Subcommittee on Aging,
Committee on Health, Education, Labor & Pensions
United States Senate
Hearing on "Elder Justice and Protection: Stopping the Abuse"
August 19, 2003

Mr. Chairman and members of the committee, thank you for giving me the opportunity to speak today.

I have no formal credentials related to elder care, but I work with a small, local group that advocates improved quality in Missouri nursing homes. We have held public meetings with area prosecutors, and others as speakers, urging the public to call 911 in cases of elder abuse, and to write letters to state legislators. Currently, we're preparing to listen to focus groups in order to get suggestions for reducing neglect and abuse from Missouri citizens who have had loved ones in nursing homes. We also meet with state legislators. While I believe all of these things are very important, I also think there are major systemic national problems.

My father went into a nursing home in 1998 after a series of strokes left him seriously impaired with dementia. Our experience with an HCR ManorCare facility is recounted in some detail in testimony before the Senate Special Committee on Aging in 1999, but I will just say that the care was not good, vital medications were allowed to run out with no notification to anyone, state agencies were of little or no help, and when I complained widely about the poor care, a ManorCare vice president found the time to call me at home and threaten me with a lawsuit if I didn’t stop. I am still complaining. And ManorCare, one of the largest nursing home corporations in the country is still providing poor care in many of its facilities. Among many examples I could cite, the company was featured prominently in the Pittsburgh Post Gazette last year for major and numerous problems in its 47 Pennsylvania homes, was singled out for poor care by an official with the state of Iowa, and entered into a consent order with the federal government in a case alleging violation of the False Claims Act. Recently the Kansas City Fox TV affiliate featured the facility my father was in when it did a piece on the area homes with the highest numbers of deficiencies on their inspection reports.

The next facility we put my father in was, for a time, wonderful. But this facility was purchased by another national chain, Alterra, and almost immediately things went bad. The administrator was forced out, aides were fired, or had their hours and benefits cut until they quit, and agency staff that didn’t know the facility or the residents were brought in to replace them. Confused residents, including my father, eloped undetected to wander along a very busy street until someone by chance brought them back. We found another facility to place my father, but not until after he had mysteriously acquired 5 broken ribs. Alterra facilities have also been prominently featured in the press for major problems.

Immediately after getting my father out of ManorCare, I began researching that company and the other big players in long term care. What I found was Enron and Worldcom. I looked at the SEC filings for the half dozen giants in the field and found that they all lavished multi-million dollar compensation packages on their CEO’s and other top executives. Integrated Health Services sought a $50-$60 million dollar golden parachute for departing CEO Dr. Robert Elkins who had led them to bankruptcy, and a federal bankruptcy judge approved it. In addition to lavish salary and bonuses, HCR Manor Care CEO Paul Ormond realized a gain of $23.7 million from stock options exercised in fiscal 2001. They all seem to have money to burn yet they continue to work together to lobby for more money with no strings attached, wrapping themselves in a phony free market flag while getting typically 70% or more of their billions of dollars of total revenues from tax dollars.

In 1999, I found that Gail Wilensky, then head of the congressionally mandated Medicare Payment Advisory Commission was also serving on the board and the audit committee of HCR ManorCare, as well as on the boards of a whole list of healthcare related companies. She later resigned from MedPAC due to the appearance of conflict of interest. But today we have former for-profit Hospital lobbyist Tom Scully as the Administrator of CMS. It seems all the corporate interests are very well represented.

An HHS study released in 2002 concluded that 90 percent of nursing homes in the U.S. have staffing levels too low to provide adequate care. Inadequate staffing contributes mightily to problems of bad care, abuse and neglect. The nursing home chains continue to cry poverty, but an analysis last year by US News debunked that claim and also said that even when they received higher payments staffing actually went down rather than up. They spent it on executive pork, union busting consultants, lobbyists, an expensive campaign to spread specious arguments for so-called tort “reform” to further limit their accountability in an environment that already has the deck highly stacked in their favor
– anything but more staff at McDonald’s level wages. When I asked Administrator Scully on a national call-in radio program about tying future increases in payments to staffing mandates he said, “we don’t believe in staffing ratios.”

Early on, I heard some advocates refer to the treatment of the nation’s elderly with terms like “holocaust.” I thought then that this was a bit of shrill, if understandable, exaggeration. I no longer think that. We are not talking about isolated incidents in a system that is generally working well. People like Tom Brokaw piously write about the “greatest generation”, waving the flag and praising their service in and out of uniform during World War II, and but then we turn our backs as many die untimely and needlessly miserable deaths in nursing homes. I am very troubled by how decisions are made to put our military personnel at risk, but I salute Senator Bond’s efforts to see that veterans and others are properly cared for. Still, too many of the greatest generation starve in nursing homes, some are beaten, some suffer pressure ulcers with flesh rotted to the bone and some, as in a St. Louis suburb case that I’m sure most of you are aware of, were allowed to cook to death one after another until paramedics refused to leave the facility. Many more suffer less dramatic misery, like spending hours in wet diapers.

Companies like ManorCare continue year after year to operate facilities with major problems related to quality care, accepting the imposition of fines and settling of lawsuits as a cost of doing business. CEO’s like Paul Ormond, certainly aware of these problems, continue year after year to pocket the big bucks rather than fix the problems and provide the care they are being paid to provide.

Given the political and social realities we live in I don’t expect to see it happen, but I can conceive of no logical, moral, legal, or ethical arguments against criminally prosecuting these people at the top, and sentencing them to hard time followed by a sort of parole as very closely supervised nursing home aides.

Thank you for your time.
See also:
http://www.bayarea.com/mld/mercurynews/news/politics/6576127.htm
http://www.findarticles.com/cf_dls/m1141/39_39/108050553/p1/article.jhtml
older but still pertinent links
http://kansascity.bizjournals.com/kansascity/stories/2000/08/14/editoria...
http://www.kcstar.com/item/pages/opinion.pat,opinion/377447fb.303,.html

and a new link on former Centers for Medicare/Medicaid Services [formerly HCFA] head Tom Scully
http://www.modernhealthcare.com/dailydose/2004-02-11_dailydose.html#ts6