The Washington Post had an interesting article on the unintended consequences of Trump’s decisions on nursing home residents.

In December 2017, Trump proudly “deregulated” the nursing home industry.  However, certain regulations were essential to protect vulnerable and disabled nursing home residents, and to prevent waste, fraud, and crime in Medicare payments.

Nursing homes regulations were always poorly enforced and few administrations made them a priority. President Obama attempted to craft policies to put pressure on poorly managed facilities. In 2014, he issued policy guidelines that urged regulators to issue daily fines against nursing homes for infractions until those violations were remedied. By 2016, that approach applied to two-thirds of cases. He also issued a rule that would have barred facilities from requiring that disputes with residents be settled in private arbitrations that limit the companies’  exposure.

Trump rolled back these policies. The number of per-day fines plummeted. The ban on mandatory arbitration was blocked. Trump delayed the enforcement of new health and safety requirements by 18 months, much to the delight of the nursing home industry. Less accountability for nursing homes that treat their residents poorly. 

“They were fighting it, and they got a lot of what they wanted,” said Toby Edelman, a senior policy attorney and expert on nursing home regulation at the nonprofit Center for Medicare Advocacy.

 The Kaiser Family Foundation published an analysis that found that under the Trump administration, the average fine levied against nursing homes that have endangered or injured residents dropped from a high of $41,260 in 2016 to $28,405 in the first quarter of 2018.   This is important because elder care is a multibillion-dollar field, and nursing homes have revenue in the millions of dollars. Small, one-off fines barely register in this context.

CMS’s record looks even uglier when it comes to how it’s regulating the worst of the worst in the industry — nursing homes known as “special focus facilities.” These are the nursing homes cited for a pattern of serious infractions: residents falling; medication not getting to patients; staff slapping residents for not cooperating with treatment; bed sores neglected for so long that they become gaping, bloody wounds.

Edelman has been closely tracking these nursing homes, especially those that the federal government classified as having “not improved” since they were first listed as special focus facilities. She has found that the Trump administration has largely pulled back its enforcement of them.

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