Nursing home care: A growing crisis for an aging America
America is about to be overrun. Not by new immigrants or millennials, but by nonagenarians and other seniors who will soon dominate the landscape demographically. We already are older than we have ever been as a country but, for all of the hype and hoopla surrounding the new generations, the older generations will need more post-retirement, nursing home and in-home care than ever before.
As a nation, we are totally unprepared for what is happening. By 2050, the population of people over the age of 65 will nearly double, from 47.8 million to 88 million, and 10 million of them will be over age 90. A category that was simply several hundred thousand a few years ago will mushroom into the many millions, and 90 may be the new 80 — but it generally requires a lot of help on any given day.
The number one growth job in America is the home health aide. The number employed already has doubled in the last ten years, and there are about 2.2 million people working as home health aides for the elderly. While fast-food workers have seen campaigns for a $15 minimum wage, home health workers have seen their wages stuck at about $10 — so the quality of the employee available for the job is declining. Yet, we will, in the coming years, need another million aides just to keep up with the growing demand.
There are about 16,000 nursing homes in the United States with about 1.4 million residents. As the senior population doubles, nursing home capacity will have to increase as well, and the outlook for that is not very promising. What is happening today is that more people are able to stay in their homes, which has reduced the nursing demand, leaving about 20 percent of current beds empty. At the same time, those admitted to nursing homes suffer from more complex medical conditions than in the past, as it is the housing of last resort for aging parents. Over half of those in California nursing homes are incontinent, for example, and the number of Alzheimer’s cases continues to grow as we do a better job at curing cancers and heart disease. So nursing homes today have fewer patients staying for a shorter time with more difficult problems and declining staff quality.
Unsurprisingly, we are once again seeing the kind of nursing home abuse documented in the past. Just recently Massachusetts settled cases involving premature deaths for failing to administer medications or to keep up with proper safety railings. It fined eight nursing homes after a statewide investigation uncovered significant care problems.
In 1973, Gov. Nelson Rockefeller (R-N.Y.) created the Temporary State Commission on Living Cost. Part of the commission’s role was to investigate patient abuse and massive Medicaid fraud in the New York state nursing-home industry—an investigation that revealed rampant corruption and sleazy side-deals at the expense of the elderly.
The report exposed unspeakably frightening conditions in nursing homes, all while the owners ran fictitious real estate schemes to defraud Medicaid and steal hundreds of millions of dollars in Medicaid reimbursements. Politicians were in bed with the operators and the system dripped of corruption.
The U.S. Senate Committee on Finance recently held a hearing on reports of abuse and neglect in some nursing homes — reports that were not all that different from what was found in 1974, despite massively increased legislation and regulation.
During one hearing exchange about allegations of sexual abuse, Sen. Chuck Grassley (R-Iowa) noted that a particular nursing home “received the highest possible ranking from the Centers for Medicare and Medicaid Services for quality of resident care, though it had been fined for physical and verbal abuse a year before.” So even the top-rated homes are ones with problems and abuse.
This is a mammoth challenge and, unless we tackle it, we are headed for an eldercare calamity. First, we need to have better safeguards for payments and insurance systems as they relate to longterm care. It is unacceptable that the current system complicates people’s personal and financial lives, often by categorizing people who need longterm care as day-to-day patients who are simply “under observation.” The government now pays for more than 80 percent of all nursing home care, which leads to tremendous opportunities for fraud at the same time that the programs attempt to squeeze every dollar out of the system — so false workarounds are rampant, defeating unsustainable controls.
Second, there needs to be more coordination with local, state and federal governments to ensure balanced geographic coverage in line with the care population so that families do not have to travel hours to see loved ones.
Third, technology is going to have to play a central role in managing and monitoring eldercare. We need to find the right balance between home care, nursing home care and hospice care. At the same time, we need to realize that sensors and friendly bots are going to have central roles in providing care, as we run out of home health aides.
Fourth, we need to balance the need for regulation and supervision without creating standards that can never be met and making running a nursing home an impossible task. We need a system of more uniform regulations and enforcement, rather than the crazy-quilt system we have now.
Finally, it’s time to form a national commission on eldercare to draw up a roadmap for how we not only root out fraud, waste and abuse, but also how we plan for a new future for the growing millions who will need compassionate, professional care. The growing ranks of nonagenarians can’t wait.
Andrew J. Stein is a former president of the New York City Council and a former president of Manhattan Borough.
Mark Penn is a managing partner of the Stagwell Group, a private equity firm specializing in marketing services companies, as well as chairman of the Harris Poll and author of “Microtrends Squared.” He also is CEO of MDC Partners, an advertising and marketing firm. He served as pollster and adviser to President Clinton from 1995 to 2000, including during Clinton’s impeachment. You can follow him on Twitter @Mark_Penn.
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