The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry. Will there be a revolution in health care? Will for profit chains dictate how the old and frail among us will conclude their lives?
A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility’s staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.
Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if — like Ms. Nguyen and the other Lodi residents — they depend on Medicaid to pay their bills, the officials and advocates say.
Assisted-living facilities have sprung up as alternatives for those who don’t require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks’ notice, with no appeal guaranteed.
In Florida, for example, the state’s 2,400 assisted-living facilities must give residents 45 days’ notice before evicting them, but don’t need to provide a reason or appeal process.
No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% — nearly twice the growth for complaints overall. Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.
And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution. Federal law — enforced by the states — says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days’ notice, explain their appeal rights, and put together a plan to make sure the move doesn’t harm them.
Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.
For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility — for renovations. All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.
Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital — who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)
In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn’t simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."
The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine’s 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.