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EJH, who has worked as an Occupational Therapist in nursing homes for over 20 years, has seen with her own eyes the pathetically poor care given to nursing home residents. As someone working within the for-profit sector of the nursing home industry, where financial profit is placed far above the desire to provide an excellent quality of care, she notes that “Very few understand just how bad it is.” How bad is it? Her description of the nursing home industry is quite chilling:

“The care of our elderly is embarrassing, even in the finest facilities (and there are very few of those). My son works at a kennel and those dogs get better care than nursing home residents – and that is in no way an exaggeration. I also feel it is not the fault of the CNA’s, but the corporations and health care system that are making money off of our loved ones backs.”

Animals receive better care than do humans residing in nursing homes. This is what happens when the focus is on maximizing financial profit instead of providing the highest possible quality of care.

very sobering example of the reality mentioned by EJH is the incredibly small amount of money for-profit nursing homes spend on resident food. An Extendicare-owned facility in Indiana reportedly “rewarded” their dietary staff with a dinner party for figuring out a way to reduce the cost of three meals and two snacks per day from around 85 cents per day down to barely 70 cents per day!

  • How much does it cost for a one day supply of decent dog food these days?
  • How much did you spend on food to feed yourself today?
  • How much would it cost to adequately feed an elderly parent most days?

Remember that Extendicare and the other for-profit chains wont stop whining about how woefully underpaid they are for providing nursing home care.  Medicare, Medicaid, other insurance companies and even nursing home residents are billed upwards of $175.00 per DAY for a semi-private room in most parts of the United States. Yet these corporations, with executives earning hundreds of thousands of dollars (or more) annually, can’t afford to spend more than 70 cents per day to feed a resident? Something is seriously out of whack here — something is downright obscene and even evil — with the way these for-profit corporations divert profits away from resident care (care that includes how much they spend to feed their residents). Profits are diverted into such things as executives salaries, designer decor for their buildings and other business interests that have NOTHING whatsoever to do with providing care for their residents.

We must give the for-profit nursing home industry an ultimatum: Stop stealing from your residents or you will pay by losing your licenses that allow you to run your facilities!

I find that most of the comments left on this website are worthy of being the focus of a new journal entry, instead of just a comment tacked on to at the bottom of a previously published entry. Such is certainly the care of what a reader identified as “L.C.” thoughfully wrote a few weeks ago. Remember this is a person who has worked in the nursing home industry, so her comments are based on her personal experience and first-hand observations. She writes…

“For almost 20 years I worked in nursing homes as a Restorative Aide. I began my career and received training in a wonderful facility in another state. We had a staffing ratio of 1 aide for every 5 residents. The facility was clean and bright and the staff was there to make sure those last years were the best they could make them. Even more surprising (in hindsight) was how well the management cared for the staff. We received the training, support and time we needed to give great care. I was proud to be working there.

Then I moved to another state where the acceptable ratios were 1 aide for every 10 residents (first shift),1 aide for every 15 residents (second shift) and 1 aide for every 25 residents (third shift).  The focus at this facility clearly was (finaincial) profit. The poorest quality supplies, never enough time, staff that was tired and discouraged…all of this leading to very poor care.

I remember starting to feed a sweet little lady one morning and wondering what she was chewing on. I cleaned her mouth with a toothette and found it was BOWEL MOVEMENT! No morning staff had any time to do oral care, so who knows how long she had this in her mouth. I felt so bad for her. This was just one example of the kind of thing that happens when staff does not have the time to do their jobs.

I remember one nursing home resident saying that no staff member took the time to look at her face. How awful is that!

I made it my mission to hug and talk to every resident I was with, but it was never enough. I feel that the aides I worked with did their best, often missing breaks and their own lunch time to take care of residents. I saw aides spend their own money on residents at holiday time, buying little gifts for someone because they needed a little extra attention.

It is so important to feel special and loved every day and aides try to fill that gap when family is not able to be there. They do all this without any help or support from the people who own and run these places. Owners rely on the goodness of the staff to make it look better than it actually is, yet the ones who pay the price for this are always the residents and the staff who struggle to care for them.

I eventually retired from the work. It just got too hard to do both physically and emotionally. Now we are trying to keep our own parents at home (in their 80′s) because we know what the world of nursing homes is like. I hope a truck hits me before I need a nursing home.”

What a powerful testimonial to the horrible nature of the corporate greed that controls the for-profit sector of the nursing home industry when someone with nearly 20 years job experience states she is doing everything she can to prevent her parents from ever needing to live in a nursing home AND that should would rather die than live in a nursing home!

My mother, who passed away on January 1, 2011, would scream at me — ordering me to leave her apartment on the occasions when I asked her to just consider living in a nursing home. She had seen the problems associated with the care of her own family members (problems that I hadn’t even noticed), so she knew that living in a nursing home would be a pathetic experience. For her it was. The corporate greed that lead to undestaffing of the facilities where my mother lived for nearly the last five years of her earthly life caused my mother new and more severe health problems than the diagnosis of dementia that lead to her first nursing home admission. My mother clearly knew what she was talking about and so does “L.C.”. Nursing homes that place finanical profit above quality resident care should be avoided at all costs.

The study linked below, published by researchers at the highly respected University of California at San Francisco, proves a point that I’ve made many times on this blog: for-profit nursing homes do NOT need more money from Medicaid or from their residents in order to improve the quality of resident care. Indeed it is the NON-profit facilities who overall provide a higher quality of care than the for-profit, greed-driven facilities!

So when the nursing home industry whines about needing more money to care from residents, make no mistake they are already earning enough money to provide a higher quality of care. The reality is that the executives and stock holders of these faccilities are (morally speaking) stealing from their residents by paying themselves handsomely and using their nursing home profits to fund other business investments.

Please click on the following link and learn the truth about the horrible impact of corporate greed on for-profit nursing homes: Low Staffing and Poor Quality of Care at Nation’s For-Profit Nursing Homes |

As the research study poinds out, “The 10 largest for-profit (nursing home) chains were cited for 36 percent more deficiencies and 41  percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.” The 10 largest for-profit chains in 2008 were:

  • HCR Manor Care,
  • Golden Living,
  • Life Care Centers of America,
  • Kindred Healthcare,
  • Genesis HealthCare Corporation,
  • Sun Health Care Group, Inc.,
  • SavaSeniorCare LLC,
  • Extendicare Health Services, Inc.,
  • National Health Care Corporation and
  • Skilled HealthCare, LLC.

Note that the study clearly makes a connection between inadequate staffing levels among the largest for-profit nursing home chains and a higher incidence of state-issued citations for insufficient care: “From 2003 to 2008, these chains had fewer nurse ‘staffing hours’ than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.”

So here is solid evidence that the greed that runs virtually unchecked in for-profit nursing home corporations — and NOT lack of adequate payment for services — is undoubtly the single biggest factor cuasing a serious crisis in the quality of nursing home care! So when the nursing home industry comes begging for more money from state legislatures in terms of Medicaid reimbursement and telling their sob stories to US Senators and Congressmen as they plead for more money from Medicare, just remember that non-profit nursing homes (including those run by government agencies) are currently doing a BETTER job of providing care (by having higher nursing staffing levels) without a bigger handout from the government.

Take a moment to look over the list of the Top 10 For-Profit Nursing Home Chains listed above — print out the list if you like — and remember that these are nursing homes to be AVOIDED based on their inadequate staffing levels and the resulting increased problems cited with the so-called quality of care they offer. Tell your friends about these corporations and, if possible, don’t allow your loved one to live in one of these facilities!

It isn’t hard to believe that the well-financed nursing home industry has “bought” the support of many state legislators around the country. The industry’s huge cash donations to legislators is well documented. In Iowa, Florida and a few other states, it also appears that the tentacles of the nursing home industry are firmly in control of the Governor’s office. Among other things, the Governor of Iowa has rewarded his nursing home buddies by making dramatic cuts in the number of state employees responsible for inspecting long-term care facilities!

Before I get into more specifics about the Iowa Governor’s role in protecting the nursing home industry, I wanted to share the following comment left on my blog from a CNA working in Iowa…

“I’m a CNA living and working in Iowa, currently studying to be Registered Nurse. I have been a CNA for nearly 10 years and have worked in many different settings, including nursing homes and assisted living facilities. Due to inadequate staffing levels, being a CNA at a nursing home is very hard, especially when it comes to working third shift (overnight). I’m currently dealing with a situation at an assisted living facility where most of my residents have dementia and need a more intense level of care, as provided in a nursing home setting.  I wonder how the state can allow this facility to continue operating while providing a much lower level of care than our residents need? All of the doors are alarmed and most residents require full care — even feeding. Just as in a nursing home, we are also required to wake up residents up on third shift in order to weigh them. I don’t understand how this is legal or ethical — but am having a hard time finding any laws or regulations to back me up. There needs to be rule that says staff can’t force resident to get out of bed before before 6:00am!”

Obviously this CNA’s comments point out several areas of concern about the situation in Iowa.

First, why does the state allow assisted living facilities to attempt to offer care they are neither staffed or qualified to offer? Oh wait: the assisted living industry also spends tens-of-thousands of dollars every year to lobby/influence the Governor and state legislators to do their bidding, which includes looking the other way when it comes to the types of residents allowed to live in an assisted living facility.

Second, no facility legally has the “right” to force residents to get out of bed at any time of the day or night. No nursing home and no assisted living facility can do this legally. Be it a nursing home or assisted living facility, nursing home residents have rights — including the right to refuse care. Why isn’t the state of Iowa doing something about this blatant abuse of resident’s rights? Again the people with the money (the industry) control the politicians and state employees (which are controlled by the politicians) to make sure that no serious infractions of state and federal regulation (like violating resident’s rights) are cited. After all, when a facility is cited for violating resident’s rights (or for not meeting other regulations), the state can assess and collect fines from the facilities. Of course the industry doesn’t want to part with one cent of their outrageous profits! So in Iowa you have a Governor-mandated cut in the number of inspectors and so fewer inspections take place and when they do, the overworked inspectors are much more likely to not have time to address all of the problems in the facility they are inspecting. The result is fewer problems identified, fewer fines assessed by the state, greater profit margins for the industry and even more inadequate care provided for residents.

Follow the money trail and you’ll clearly see who gets protected: the industry, not the residents. What can change this outcome so that resident care comes first? What must change is that we the people — instead of just the lobbyists who work for the filthy rich nursing home and assisted living industries — must be organized and have our voices heard by the politicians to let them know that they will “pay” (by losing our vote) if they fail to protect nursing home residents. “We the people” ultimately must make a difference!

Nursing Home News Watch

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