Several Kentucky lawmakers are sponsoring bills to improve conditions in the state’s nursing homes, which have ranked among the nation’s worst. But the powerful nursing home industry will fight any such legislation. The industry is a big campaign donor with too much political clout. The nursing home industry is represented in Frankfort by the Kentucky Association of Health Care Facilities, which has given several hundred thousand dollars in political donations in recent years. Overall, nearly half of Kentucky’s 282 nursing homes are rated as “much below average” or “below average” by the federal government based on poor scores for patient care, staffing and health inspections.
“Inadequate staffing is the basis for so many of problems that we see. Most nursing homes are owned by for-profit companies, and unfortunately, one way that you make a profit is to keep your costs down by not hiring as many people as you should,” said Wanda Delaplane, a nursing home reform advocate in Lexington who has testified to state lawmakers.
Among the proposals is House Bill 215, which would establish minimum safety staffing standards for nursing homes, such as at least one nurse’s aide for every nine residents during day shifts; for every 10 residents during evening shifts; and for every 19 residents during night shifts. The bill also would set rules for how many nurses would have to be on duty at different times to oversee resident care.
Federal law only requires that nursing homes have “sufficient” staff to meet residents’ needs, although states are invited to set their own more rigorous standards. Kentucky has chosen not to, and the state’s nursing homes regularly are cited and sued for neglect as unattended residents fall and get hurt, soil themselves in bed and suffer bedsores from lack of movement.
Two other proposals — House Bill 228 and Senate Bill 36 — would require nursing home staff to be training in properly caring for residents suffering from Alzheimer’s and dementia.
Sen. Reginald Thomas, sponsor of the Senate bill, said he was motivated by his study on a special legislative task force on Alzheimer’s and dementia. Many direct-care workers in nursing homes — who often are low paid and without much training — don’t know how to handle the unpredictable and sometimes aggressive behavior of these special residents, Thomas said.
“In the year 2020, the fact that they get no training in Alzheimer’s or dementia care really does surprise me,” said Thomas, D-Lexington. “This is not a new phenomena. This is a growing trend that we’re been facing with our aging population over the last 20 years.”
Meanwhile, a former executive of Signature HealthCare, Adam Mather, was politically appointed to be the “watchdog” for Kentucky’s troubled nursing home industry. Signature HealthCare is based in Louisville and owns more than two dozen low-rated nursing homes around the state. Mather will be paid $112,381 a year to oversee a state office that — among other duties — inspects several hundred nursing homes in Kentucky on behalf of the federal government, which pays for the bulk of residents’ care through Medicare and Medicaid.
A Herald-Leader analysis of 42 Signature facilities in Kentucky shows that 25 are rated as “much below average” or “below average” by the U.S. Centers for Medicare and Medicaid Services five-star rating system, which considers quality of patient care, staffing and health inspections.
Signature HealthCare at Jefferson Place in Louisville, for example, was hit with $140,421 in fines in 2018 after inspectors cited repeated cases of resident neglect that led to physical injuries and personal humiliation. It’s rated as one-star, or “much below average.” Signature executives alone have made at least $20,500 in political donations since 2015, according to state campaign-finance data.
“It’s troubling that someone from the industry now gets to oversee the industry,” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy in Washington. Edelman tracks problems with nursing homes nationwide.
“I don’t know him personally, so who knows, maybe he’ll turn into a whistle-blower,” Edelman added. “But generally, I think our regulators should be independent of the industries they regulate and not come from within their ranks. There should not be this revolving door between them, with people moving back and forth. Why not appoint an advocate, someone who cares about the residents and who has a track record of being a little more skeptical of the companies?”