By Erin McAuliffe and Daniel O’Boyle
The Milton Home in South Bend has been cited by Medicare 27 times in the last two years. These citations include poor food preparation, substandard care giving, bedsores, infection control, subpar hiring practices and lack in protection from abuse, physical punishment and involuntary separation from others.
But the Milton Home is not an isolated case in the state: According to Nursing Home Report Cards, 94 percent of nursing homes in Indiana had deficiencies in 2014.
The amount of people in the United States over 65 years old will nearly double by 2050, according to the United States Census Bureau.
Before the vote in 2015 to endorse a three-year moratorium on new nursing home licenses in Indiana counties with nursing home occupancy rates lower than 90 percent, Indiana nursing homes sat at an average 76 percent occupancy rate with more than 12,000 empty beds, according to according to a December 2014 report from the state Family and Social Services Administration.
The state was given an “F” rating in both 2014 and 2015 by Nursing Home Report Cards.
According to Medicare, the most rampant nursing home deficiencies in South Bend currently involve the screening, hiring and training of staff, infection and bed sore prevention, accident hazards and safe food preparation.
Jack Mueller, chief operating officer at Holy Cross Village, a nursing home and senior living community located near Holy Cross College and the University of Notre Dame campuses, spoke to the prevalence of nursing home deficiencies in South Bend leading to its low national ranking.
“Everybody has stuff they can work on,” Mueller said. “[Food preparation] is always the big one, always number one on the hit list. I’ve been doing this for 30-some years, I don’t know if [nursing homes] just haven’t gotten better at that or what, but it seems to be one that reoccurs every year.”
On the topic of inadequate staffing, Mueller stressed that homes need to be careful throughout the hiring process.
“That shouldn’t happen, but I know it does … sometimes people aren’t careful about checking the references or the criminal history,” he said.
Mueller applauded the steps the Community Foundation of St. Joseph’s County has taken to improve nursing home quality, noting the collaboration fostered through the Foundation’s educational programs and funding for administrator round tables.
Angela Workman, program director for the Foundation, said she was impressed with the way administrators from competing homes were able to cooperate.
“It’s interesting because at first glance, from an outsider’s perspective, that group may define themselves as competitors,” Workman said. “So maybe they wouldn’t want to get together in a group and share ideas about what’s working and what’s not. But I definitely have not found that to be the case at all. Those who have participated long-term have really valued the community of people and the support they can give to one another.
“We just want to come along with things that don’t feel like more work, but feel like things that would be valuable to them. We’re not interested in creating more work and making their lives more difficult — it’s already difficult.”
Mueller added that there has also been a recent national push toward nursing home improvements, initiated by the Center for Medicare Services.
“There were new rules put into effect [by the Center for Medicare Services] in November that we’re working on right now … They’ve expanded the resident rights for people in nursing homes.”
Later stages of CMS implementations for nursing homes include requiring Quality Assurance & Performance Improvement and disaster plans from each home. These rules will affect nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in Medicare and Medicaid programs, according to CMS.
Mueller said the new regulations were the most significant changes to federal law surrounding long-term care since 1989. However, the moves may be too little too late as new options present opportunities for elderly people to live more independent lifestyles.
“We’re all scrambling for people, for clients,” Mueller said of South Bend’s nursing homes. “None of us are full,”
It seems like a growing elderly population would directly coincide with more populated nursing homes, but as people age healthier they are turning towards assisted living. The trend is evident locally; Vermillion announced that it would build four assisted living complexes with one location in Mishawaka. Assisted living provides desired independence with a desired price tag: the average cost of a private room in an assisted living facility is $43,470, compared to $98,550 in a nursing home.
Assisted living will only become a more prevalent option with technologies like telemedicine and autonomous vehicles on the horizon.
Telemedicine, remote diagnosis and treatment of patients through telecommunications, is already practiced in South Bend. Indiana passed a telemedicine-focused law in July that made it legal for medical authorities to prescribe medication without an in-person visitation. In January, Beacon Health Systems launched a secure video doctor visit program to care for patients with minor ailments.
Mueller mentioned that CMS is currently pushing to have doctor visits done through telemedicine at nursing homes and assisted living facilities, noting its capabilities to save residents and staff expensive trips to the hospital.
Tim Balko, assistant professional specialist teaching Foresight in Business and Society at Notre Dame, said the trend has staying power.
“If you can reduce the amount of time that seniors take up in their day dealing with their health issues,” he said. “If you can take out some of that travel and time in-between with telemedicine, I think that’s going to balloon.”
Balko also predicted the industry-shifting effects autonomous vehicles could have on the elderly care industry, granting them the freedom to complete trips to the grocery without a valid license.
Currently, the most common reason elderly people enter nursing homes is some type of disability with activities of daily living, according to Health in Aging. Technologies that allow seniors to receive medical care at home and safely complete trips without driving delay the need for 24/7 assistance. Combine these trends with the rampant industry deficiencies and new assisted living facilities being built locally and the future doesn’t look so promising for nursing homes.
Workman worried about potential staffing crises threatening nursing homes’ futures as the aging population increases.
“That’s not even the question of quality, but having enough staff to take care of our community’s aging population,” she said.
A map of South Bend nursing homes ranked best (green) to worst (red).
Have you or a family member experienced nursing home deficiencies first-hand? Please comment below.