ElderLaw Radio Podcast Transcripts: A Call For Reform

We recently posted a series of ElderLaw Radio podcasts that discuss nursing home abuse, the problems that can lead to it, and the best ways to pursue a nursing home abuse lawsuit. We now bring you the transcript of these podcasts so you can read along while listening in.

In “A Call for Reform,” Janet Wells, the director of public policy for the National Consumer Voice for Quality Long Term Care, speaks about the types of neglect and abuse she has seen in nursing homes as well as the ways that facilities are not taking the proper steps to make their residents safer.

To listen while you read, click here to open a link to the podcast in a new window.

Narrator: “This is an ElderLaw Radio special report on nursing home abuse. Are your loved ones safe in our current system? And now, your host, Rachel Gotbaum.”

Rachel: “For ElderLaw Radio, I’m Rachel Gotbaum. I’m speaking with Janet Wells. She’s the Director of Public Policy for the National Consumer Voice for Quality Long-Term Care. Janet, tell me some of the issues that you have found in these homes that concerns you and what your organization is working to change.”

Janet: “We’ve always said that, you know, that there are three things that happen. One is neglect, one is deliberate abuse, and the other is neglect so severe that it is abuse. When someone has, for example, pressure sores all over their body, and they’re not being – they weren’t prevented and they’re not being treated; families not being notified; someone’s in terrible pain and at risk of infection – then that rises to the level of abuse itself. We did a book called, Faces of Neglect: Behind the Closed Doors of Nursing Homes, and in that book we have residents who have pressure sores from one end of their body to the other, exposing the muscle and the bone underneath.

In that book, a man who had dementia was known to wrap his privacy curtain around his neck, and nobody did anything about that, and he actually hanged himself – something that could have been anticipated. We don’t have enough staff in nursing homes, there is a shortage of workers in the country, but there has not been a shortage of people available to be nurse aids, because nurse aids – being a nurse aid doesn’t require a lot of training. Federal law only requires 75 hours of training. A number of people will go into that field and be trained in the job, and then because of the low pay and the tremendously hard work, when they’re understaffed and the lack of respect that often workers are treated with, the people don’t stay in the job.

We get calls from nurse aids who are required to take care of as many as 30 residents on a shift. I mean, that’s just impossible. You know, the problems with bed rails, things that you’ve gotta’ anticipate – that, and yet, nursing homes will go on thoughtlessly, putting bed rails on beds and allowing gaps in mattresses – all the conditions that can lead to someone getting killed, just right in their own bed. We’ve had, since 1995, I think almost 7 or 800 deaths on bed rails; I can’t stress strongly enough how people ought to be very guarded about using those. After the Nursing Home Reform Law passed in 1987, there was a real movement away from using physical restraints; a lot more people were educated about their danger, and that there were better practices for taking care of people.

But what we’ve seen is a rise in the use of chemical restraints, and that is – NI-psychotic drugs that sedate people and they will sit calmly in their chair or lie in their bed, and there are no – the facility then doesn’t have to worry about them falling or wandering because they will stay put where they are because they are so heavily sedated. Of course any restraint means that somebody is going to become immobile, and in the case of chemical restraints, unable to speak out for themselves to say that they are in pain or to express what they need. It means that they’re going to be more likely to have pressure sores if they’re not moving around. Their muscles will atrophy; they become unable to walk. It’s just an illustration of you can’t keep people immobilized, either with physical or chemical restraints – it’s very dangerous.”

Rachel:  “What have you seen happens for families that have these issues? Where do they go and what happens generally?”

Janet:  “There is a national long-term care OMBUDS-man program. So every state has a long-term care OMBUDS-man. Although usually the OMBUDS-man can resolve a problem, there are many times that it won’t be able to. The next step is to go to your – probably it’s your state health department that does annual inspections of nursing homes. They also can and should respond to complaints, particularly if there’s a life-threatening situation they should respond immediately and do an investigation. What we find is often there are backlogs of complaints in the states. The states’ investigators are not adequately trained in doing the necessary investigations.

Frequently we just hear valid complaints, and I’ve made them myself, where there’s just no resolution. The state health department may come out and investigate, but doesn’t find the problem, or a serious problem is uncovered, but the penalty is so minimal that it’s just the cost of doing business for that company that day. You know, in that kind of environment, where complaints are not adequately resolved, sometimes residents suffer really serious medical problems, or even die, and the family will file a lawsuit -- if they can. In some states where we’ve had tort reform, it’s not longer possible to bring a lawsuit, and that’s been very unfortunate.”

Rachel: “What are the changes you would like to see, that you have been lobbying our Congress to make?”

Janet: “We’ve been advocates for 20 years at least for having the federal government establish minimum nurse staffing ratios in nursing homes; bills have been introduced over the past 10 years, have not gotten very far. We settled this year for just getting accurate staffing data on nursing in nursing homes, and we feel that is going to help make the case that nursing homes are not adequately staffed and we’ll be able to use that information to continue our advocacy for that. Of all the things that could be done, that would be the primary thing.

The other is we just really need better enforcement. In the healthcare reform law there was initially in that bill that was passed an increase in civil monetary penalties for nursing homes; it would have been the first increase in federal fines since the Nursing Home Reform Law was passed in 1987, and we lost it in the bill. We got some improvements in transparency; in this law we’ve seen some improvements in enforcement over the past few years. We’ve had some tremendous advocates in Congress, but progress is very slow. The last Nursing Home Reform Law passed in 1987; it took until 2010 to get these modest transparency improvements we’re getting in the healthcare reform law. So progress comes very slowly, and I think for baby boomers such as myself, who are getting older, it’s not coming fast enough.”

Rachel:  “Thank you very much, Janet.”

Janet:  “You’re welcome.”

Rachel:  “That’s Nursing Home Reform advocate, Janet Wells. For Elder Law Radio, I’m Rachel Gotbaum.”

Narrator: “Thank you for listening to Elder Law Radio, a production of Elder Law Answers. Elder Law Radio, sponsored by Sokolove Law at www.SokoloveLaw.com. For more Elder Law Radio, go to ElderLawAnswers.com/Radio.”

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