Ageism: All Nursing Homes Are Not Equal

Six of a nine-part series of articles on ageism.

America is a country of laws that provides citizens just, equal treatment throughout their lives. That protection begins the day we are born and never expires while we are alive. Agencies treating vulnerable populations of all ages also have additional standards that they are required to meet. Unfortunately, there are those who are willing to break the law or not live up to the standards expected of them. That can result because of personal bias or organizational culture.

Take nursing homes, for example. Occasionally, there’s a news flash about something terrible happening to a resident in a nursing home:

  • “Bedridden nursing home patient dies after being bitten by hundreds of fire ants.”
  • “Nursing home patient freezes to death.”
  • “World War II veteran dies as nursing home staff laugh.”
  • “Nursing home patient dies due to complication of restraints.”

Some, but not all, discrimination against older adults in nursing homes falls under the category of elder abuse, which includes neglect. Although most incidents of elder abuse occur in the home by family members or caregivers, nursing homes have their share of problems with elder abuse. Regardless of the Civil Rights law stating nursing homes must not discriminate against a person based on race, color, national origin, disability, age or religion; some break the law.

At a minimum, federal law specifies that nursing home residents have the right to: be treated with respect, participate in activities, be free from discrimination, be free from abuse and neglect, be free from restraints, make complaints, get proper medical care, have a representative notified in certain mandatory instances, get information on services and fees, manage their own money, get proper privacy, property and living arrangements, spend time with visitors, get social services, leave for doctor-approved visits or move out, form or participate in resident groups, have family and friends involved.

If found to be in violation, nursing homes can be placed on a watch list, fined or closed completely. The Centers for Medicare and Medicaid Services created a five-star rating on which nursing homes are rated.

Older adults in nursing homes are particularly vulnerable due to their mental and physical dependencies. That’s why the government provides oversight, such as conducting audits and inspections. Other watchdog agencies grade overall nursing home care on an individual as well as a state-by-state basis. According to research, despite these efforts, most of the abuses that occur are under-reported. Many cases go unreported altogether.

In 2014, the Nursing Home Report Card by Families for Better Care, ranked states by the top ten, the bottom of the barrel, biggest improvement and biggest decline.

Minnesota didn’t make any of these categories and scored a grade of B, missing the top ten by only nine points (ranked 19th). North Dakota nursing homes scored a grade of A and were number 10 on the top ten list.

Unfortunately, too many states received a failing grade (F):  Georgia, Illinois, Indiana, Iowa, Louisiana, Michigan, Missouri, New Mexico, New York, Oklahoma, Texas. That’s too high – at twenty-two percent of all states in the U.S. As a country, we can – and we must – do better.

The states receiving the highest grade (A) were: Arizona, Delaware, Florida, Hawaii, Maine, New Hampshire, North Dakota, Rhode Island, Utah, Vermont.

Bullying in institutions, from our schools to nursing homes (yes, nursing homes), is a pervasive problem. If a person was a bully as a child, they are apt to continue being one as they age. In nursing homes, it can cause victims to become isolated and/or depressed. Depression often goes untreated in older patients. Hence, bullying must be addressed at all ages and all stages of life.

Many nursing homes are understaffed due to deliberate scheduling or workforce shortages. This can lead to the neglect of nursing home residents. One study showed that in some nursing homes there is an estimated one staff person assigned to every nine to up to 15 residents, depending on the time of day or night. This can lead to neglect resulting in malnutrition, dehydration, falls, and overworked staff resulting in medication errors, use of medications for restraints and more.

To be fair, “One of the challenges to providers is the narrow margins due to low Medicaid reimbursement rates, which is the root cause of staffing issues,” says G. Richard Ambrosius who was appointed by President Reagan in 1980 as the youngest member of the National Advisory Committee to the 1981 White House Conference on Aging, mentor and colleague of mine. Ambrosius believes if these low Medicaid reimbursement rates are not addressed, he sees a return to county homes in the not too distant future to replace Medicaid.

As with any service, especially service for vulnerable populations, it is important to investigate long-term care establishments thoroughly before choosing one for a loved one or yourself. Fortunately, there are many more ways to do that this day and age than in the past. The MN Nursing Home Report Card can be found on the internet at, nhreportcard.dhs.mn.gov. The MN Department of Health is currently working on an Assisted Living Report Card.

Our constitution protects justice for all citizens of the United States, regardless of age. That protection does not end if we become dependent.

See 2019 Ageism Series Bibliography for sources quoted.

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