Sen. Bob Casey worries that nursing homes are ‘uninspected and neglected’
“It’s a really long-standing problem,” Casey said. “We don’t have the investment in quality that we should have.”
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Sen. Bob Casey worries that many of the 1 million-plus people living in 15,000 nursing homes across the United States are in facilities that haven’t been inspected for a long time.
About one in four nursing homes hadn’t been inspected in at least 16 months, as required by federal law.
As the chairman of the U.S. Senate Special Committee on Aging, the Democrat from Pennsylvania’s staff spent the last year investigating nursing home oversight. They found that state inspection agencies are chronically understaffed. The Pennsylvania Department of Health, for example, has been hiring retired inspectors on a limited capacity to try to fill in the gap.
“It’s a really long-standing problem,” Casey said. “We don’t have the investment in quality that we should have.”
The Inquirer spoke to Casey about the findings of the investigation, and why he fears the problem may worsen.
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A system stretched to the brink
Last month, the Aging Committee released a report, ”Uninspected and Neglected,” that outlines the finding of its investigation into nursing home oversight.
Every state has an agency charged with surveying conditions inside nursing homes. Inspections are supposed to occur at least every 15 months, and specific complaints should prompt additional inspections. Nurses and other health professionals typically are part of the survey team, which can vary by state.
Survey agencies are “stretched to the brink,” according to the report:
Most states have a surveyor vacancy rate of 20% or higher.
The average vacancy rate has nearly tripled nationally.
High turnover rates among surveyors often means the agency staff is inexperienced, with many on the job for less than two years.
The top reasons for staff turnover were low salary, retirement, burnout, and COVID-19 related concerns.
To deal with the shortages, half of states are contracting with private firms to conduct inspections.
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Pennsylvania has nearly 700 nursing homes with room for nearly 90,000 people, according to the report. The state has funding for 120 surveyors, or one for roughly every six nursing homes, but 13% of those positions are vacant. A third of surveyors have two years or less of experience.
The situation is more dire in New Jersey, where the surveyor vacancy rate is 53% and a quarter of staff is new.
One challenge to hiring is that surveyor salaries are not competitive, the report notes. For example, Pennsylvania pays registered nurses $62,000 for an entry-level job surveying nursing homes. That same nurse can earn an average $90,000 working at the bedside.
“These state survey agencies are underfunded,” Casey said. “That’s simply a lack of investment, a lack of focus as a nation.”
Parallels to 1998
Casey’s interest in nursing home oversight dates back to his days as Pennsylvania’s auditor general.
In 1998, Casey released a report that claimed the state Health Department “failed miserably” to ensure decent care in nursing homes. His office then identified short staffing as one reason that many complaints didn’t get a timely response.
In Pennsylvania, he also saw an improving system. Back then, the state invested in technology to manage complaints. The senator said that the change made a “huge difference” and helped increase the speed at which the state responded.
But more than two decades later, from a national view, he said some things haven’t changed.
“Every time we think we are making progress, we’re reminded that we have some of the same challenges today,” Casey said.
Solutions
Casey wants to see states get funds that allow them to hire more surveyors to ensure high level of care in nursing homes. He also believes in more funding for alternatives to nursing homes, such as home care and community-based services.
“There are just a lot of Americans who don’t want to be put in that predicament, where the only option for skilled care is a nursing home,” he said.
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Casey isn’t optimistic that such investments are imminent from what he saw during the recent debt-ceiling negotiations between the White House and the Republican majority in the House of Representatives.
But the senator said he will continue to work on solutions.
“If you’re a public official, you’ve got an obligation to help the most vulnerable,” Casey said.