In M. Night Shyamalan's movie The Sixth Sense, a little boy says, “I see dead people.” Well, I see old people. At first I noticed them in malls, wearing white sneakers and colorful sweat suits and power walking in packs. Lately I see old people everywhere, getting off tour buses in Manhattan's theater district and on Martha's Vineyard, sitting on park benches with their companions and walkers. Maybe it's because I'm getting older myself: I look at my reflection in the mirror and at my husband and I realize we're now joining this senior group. I'm all too aware that getting “carded” has taken on new meaning—instead of proving you're old enough to drink, you're asked to produce proof of Medicare coverage before obtaining health care services.
By 2050, according to the U.S. Administration on Aging, over 20% of the nation's population (about 88 million people) will be ages 65 years or older; 4% will be ages 85 years or older. By comparison, in 2010 people in the former group made up 13% of the population (about 40 million people); those in the latter group, 2%. Granted, many older adults are living active, independent lives thanks to advances in medications and surgical procedures, social initiatives like Social Security and Medicare, and community services. Still, it's been estimated that two-thirds of today's 65-year-olds will need some form of long-term care services during their remaining years, with institutional care necessary for approximately 20%. Given the present state of long-term care facilities, this group can expect little in the way of high-quality care.
Last February, the Department of Health and Human Services’ Office of Inspector General conducted a study examining post–acute care in skilled nursing facilities, 90% of which are certified as nursing homes. It found that 33% of patients experienced adverse or “temporary harm” events. Physician reviewers determined that 59% of these events were preventable, and attributed much of the harm to “substandard treatment, inadequate resident monitoring, and failure or delay of necessary care.” The report also noted that hospital treatment costs for preventable harms in 2011 stood at $2.8 billion.
In a recent blog post for the New York Times’s blog The New Old Age, Paula Span pointed out that nursing homes all too often lack the presence of professional nurses, noting that the federal nursing home reform legislation that was part of the Omnibus Budget Reconciliation Act of 1987 requires an RN to be present just eight hours a day. While LPNs and nurses’ aides strive to provide excellent care, research has repeatedly shown a correlation between RN staffing levels and care quality. Indeed, Representative Jan Schakowsky (D–IL) has introduced legislation that would require all nursing homes receiving federal funds to have an RN on duty around the clock.
But will this really change anything? I asked Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing and a researcher of long-term care, what she thought. “Care in nursing homes is really bad and we're looking the other way,” she told me. She blames the for-profit model: “Most nursing homes are operating as for-profit companies and they keep labor costs as low as possible, especially RN hours because they are the most expensive. Until we have a minimum federal standard for staffing hours that includes clear minimums for RNs, I don't think quality will improve.”
Harrington advocates putting a 20% cap on profits and administrative costs, so that the remainder of funds would be spent on services. She also says nurses need to support better staffing regulations, because “we're dealing with huge corporations that monitor every dollar and nursing directors have no discretion in staffing.”
More RNs = better care. It always comes down to this simple equation, for which there is abundant proof. Because for-profit corporations prioritize profits, preventable adverse events are more likely to occur—and taxpayers end up footing the added costs of treating them. But the proposed new legislation offers a spark of hope. Nurses have an opportunity now to join with advocacy groups in demanding nursing home reforms. Let's create a firestorm of publicity backing this legislation. It's time to stop looking the other way.