SRSLY: Homes for the Old Need to Learn New Tricks
https://www.propublica.org/article/srsly-homes-for-the-old-need-to-learn-new-tricks
Pearl S. Buck said that “our society must make it right for old people not to fear the young or be deserted by them, for the test of a civilization is in the way that it cares for its helpless members.” Hubert Humphrey put it differently, suggesting that “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life.” Figures from Gandhi to Winston Churchill weighed in similarly. Point being: a lot of people who are super good at quotes think we ought to treat the elderly with special respect. And, in a nice break from election news, there is some evidence we’re doing a bit of that. According to the Dallas Morning News, infractions for deficient care in nursing homes decreased by 8 percent nationally between 2010 and 2014. In Texas, however, infractions increased 20 percent over that same period. Your four Ws:
What?
… the heck is going on with Texas?? (And I’m not just asking because the Washington Post reported that it’s now a swing state. If you saw that one coming, time for a vacay to Vegas.) The Dallas Morning News reported that Texas’s 1,200 nursing homes also reported 3 percent more “severe deficiencies” in nursing home care from 2010 to 2014 — the kind that might lead to serious injury of residents — while the national number declined 16 percent.
Why?
The usual suspect: money. The new figures come from a report commissioned by the Texas Health Care Association, a trade group for nursing homes, which is concerned about a “crisis” in state funding. The Morning News reported that this is particularly notable, given the association’s “traditional reticence” to openly discuss nursing home inspections. Nearly 70 percent of the state’s nursing home residents are on Medicaid and Texas Medicaid reimbursements “are near the bottom in the U.S.” The lack of funding has left Texas nursing home residents with less attention from staff than is the case in other states. Texas nursing home residents get 3.59 hours of attention from staff per day, compared to 4.64 hours in Florida, which has far fewer “immediate jeopardy” infractions, the kind that “if unabated, will cause serious harm or death,” the Morning News says.
What now?
Probably it’ll get worse. The Morning News notes that the next two-year state budget won’t have the cash cushion of the previous two, so lawmakers will have to cut some spending. And however much we may care about the most helpless in society, it just seems like they perpetually stink at lobbying.
What else?
It’s not all bad. The report commissioned by the Texas Health Care Association concluded that, “Significant and decisive changes are necessary to avoid a potential collapse of the long term care safety net in Texas.” So there’s a silver lining; they said “potential collapse.” I mean, wake me up when collapse is imminent, amirite??
They Said It
“When you’ve got turnover rates that are 98 percent a year, you’ve got almost an entire building that’s turning over.” —Texas Health Care Association President Kevin Warren, on the extraordinary turnover rate of nursing staff employees at Texas nursing homes.
Filed under: General Problems
Texas also has a very high maternal mortality rate right now, and it’s directly from their dropping support of family planning clinics. When they cut abortion clinics they also cut the places that give a lot of prenatal care, to the detriment of society.
Credit for this life-ending achievement must go to former Governor Rick Perry. Long before his indictment on charges of felonious abuse of power and his leaving office, Gov Perry constructed a tort-reform statute and trail-bossed it through the Legislature. The good sheeple of the Legislature blindly obeyed their neocon shepherd, and imposed a provision stating that to prove a case for professional malpractice in Texas, one must first convince a judge that the alleged malpractice violates the existing Standard of Care, before one may legally seek a jury trial.
This statute has the effect of preventing Texans from exercising their right to a trial by jury. It shifts the power from patients, to the tiny oligarchy of providers who make these arbitrary rulings on what they imagine to be the standard of care.
That has balkanized the practice of medicine in Texas. Rural counties with few doctors, end up with a de facto standard of care, that’s whatever those doctors deliver. Urban counties get whatever standard of care the court-approved medico-legal experts want. Worst of all, there is no procedure by which ordinary Texans can demand that the standard of care be improved. Caregivers can volunteer to offer better care, but competitors are free to slap them down for it, and citizens may not access the courts, to assert their right to buy better care from those willing to provide it.
In any other line of business, a central authority that forcibly diminishes the quality of a product while gouging additional money out of the customers who need the product, would be prosecuted as an unlawful monopoly.
Because healthcare is sold as a quasi-socialistic enterprise that operates as a hybrid of a for-profit and a non-profit structure, we don’t always think about these financial issues, in the way we would think about buying an auto or a pair of leather boots. If someone tried to tell me that he was the only person in the county licensed to sell boots, raised the price of some hundred-dollar boots to five thousand dollars, and I complained about that, most folks would grasp why I was angry. But if someone tries to tell me that the only kind of elder care I can buy my dad in this county, is the kind that’s offered at the Dying Arms Home, the mere fact that some of the money to pay for his care, came from Medicare, is just confusing enough that people think maybe the standard of care is something best decided by self-appointed experts.
Under the Perry law, it’s hard to sue any healthcare institution for malpractice…especially if it fires employees for minor infractions of policy, never touching on standards-of-care issues that killed any patients.
Rick Perry adopted the Hillary Clinton phiiosophy of Don’t Ask, Don’t Tell. Texas nursing homes pretend to have standards of care because they fire workers for minor infractions. When patients die of complications, nobody can ever get the facts in front of a jury. The fired worker was fired for a different minor infraction, unrelated to the dead patient…and likely has no money worth suing for. Jurors never find any facts that establish what the standard of care actually is. They can’t ask. And no one tells them the answer.
Thanks, Rick Perry.