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Problems in Kentucky's nursing homes are matter of life, death. Time for state to act.

Lexington Herald-Leader - 10/5/2018

Oct. 05--If you live in Kentucky, there is a good chance you or a loved one will eventually spend time in one of the state's 284 nursing homes. So if you read nothing else this month, read a series by John Cheves, an award-winning investigative reporter for the Herald-Leader.

Cheves found that the U.S. Centers for Medicare and Medicaid Services has rated 43 percent of Kentucky's nursing homes either "below average" or "much below average," citing substandard care that in some cases has been fatal.

Kentucky's nursing homes collectively have been rated among the worst in the nation in recent studies by the Kaiser Family Foundation, the AARP and advocacy group Families For Better Care.

Cheves also explored the pay-to-play politics that not only help keep low-quality nursing homes operating but works to protect them from being held accountable for deaths, injuries and abuse.

Consider a few horror stories from state inspection reports:

A 45-year-old man in a Northern Kentucky nursing home fell down a stairwell in his motorized wheelchair and suffocated to death. It took nine hours for the staff to realize he was missing and look for him.

A frail woman in a Hodgenville nursing home spent the night on a toilet, shivering and shouting for assistance because no staff member came to help her back to bed.

A Paducah nursing home resident screamed in pain because of a neglected urinary infection that would later cause him to be hospitalized. A staff member dealt with the situation by removing a prosthetic in his throat to silence his screams.

The biggest issue Cheves reporting found was inadequate staffing. Smaller staffs mean lower costs and more profits for nursing homes. These businesses complain that they have trouble finding and retaining nurses and nurses' aides to do these difficult, unpleasant and low-paying jobs.

But rather than invest in more staff or higher wages, the industry protects profits by investing in politicians. The Kentucky Association of Health Care Facilities reported in 2017 that members had raised more than $170,000 in donations for state Senate and House races.

That seems to be why bills filed year after year to set minimum nursing home staffing requirements never see the light of day. When Rep. Rick Nelson, D-Middlesboro, proposed such legislation last year, it didn't even get a committee hearing. A bill by three Republican representatives to require nursing homes to follow state-approved guidelines for preventing bedsores also went nowhere.

But industry-friendly legislation has done well thanks to champions such as Sen. Ralph Alvarado, R-Winchester, who works as medical director for five low-rated nursing homes. The physician has pushed self-serving legislation to limit lawsuits against nursing homes and other medical providers to keep them from being held accountable for negligence, abuse and poor treatment.

Alvarado sponsored a 2017 law that requires malpractice suits to first go through a review panel of doctors. It has been challenged as unconstitutional and is now before the Kentucky Supreme Court. He also has pushed for a constitutional amendment to limit damages in malpractice suits and a cap on plaintiffs' attorneys' fees. The legislature's weak ethics rules don't consider this a conflict of interest.

The 34,000 residents of Kentucky's long-term care facilities are among the state's most vulnerable people -- physically, mentally, emotionally and financially. What is happening to far too many of them is a scandal.

It is not only abuse, but fraud -- against them, their families and taxpayers, who are paying big money for quality care and not getting it. Kentucky nursing homes receive about $1 billion a year from the federal-state Medicaid program.

Since this series was published, several lawmakers have called for public hearings this fall on the issue of nursing home staffing. Will that happen?

Nelson has pre-filed another bill setting minimum staffing requirements for nursing homes for the 2019 session. Will it go anywhere? I will predict this now: Without loud and sustained public outcry, it won't. The nursing home lobby is too powerful.

What can citizens do? Watch how your lawmakers vote, and listen to what they say. Do they talk about protecting patients, or protecting nursing home operators from "burdensome regulations" and "frivolous lawsuits."?

Go to the Kentucky Registry of Election Finance's website and see who is donating money to your legislators: Kref.state.ky.us/krefsearch. Support patient advocacy groups such as the Nursing Home Ombudsman Agency of the Bluegrass.

This problem is not just a matter of ethical business practices and good government. It is a matter of human decency, of life and death. Kentucky lawmakers won't change things unless you demand it. Think of it this way: The life you save may be your own, or that of a loved one.

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(c)2018 the Lexington Herald-Leader (Lexington, Ky.)

Visit the Lexington Herald-Leader (Lexington, Ky.) at www.kentucky.com

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