LI's nursing homes need to be fixed

How often must we write about the tragic and horrific conditions in some of Long Island's nursing homes before change comes?

How often must we tell the stories of patients who die due to incompetence, miscommunication or errors in judgment, or hear about elderly individuals who are sexually assaulted or injured or not medicated properly? How often must we talk about the systemic issues, the need for proper hygiene, for better infection control, for protocol and standards, for more oversight and accountability?

The fact that we have to keep asking those questions means the answers are still out of reach. And Long Island's most vulnerable residents — who have nowhere else to go, who depend on nursing homes to keep them safe, clean, fed and provided for — remain unable to get the care they deserve.

The despair and disgust runs deep. The frustration is palpable.

Everyone, from state officials on down, knows that the current situation is unforgivable. Is anyone willing to broadly examine the current state of affairs and develop a more thoughtful, sustainable set of solutions, answers that would prioritize home health care when possible, while improving the nursing home industry by holding those facilities to higher standards?

For decades, too many nursing homes have provided substandard services, becoming a last resort for older residents and families who for many unfortunate reasons cannot make home health care or other alternatives a reality.

COVID EXPOSED PROBLEMS

The COVID-19 pandemic brought those issues into sharp focus, laying bare the many shortcomings of the long-term care industry, particularly when it comes to staffing, equipment and infection control.

Despite that spotlight, recent state Health Department inspection reports show that many of the Island's homes still are failing their residents in a host of ways. A recent Newsday investigation found that about a quarter of the region's facilities received fines ranging from $250 to $24,000 in 2022, for a wide variety of health and safety violations.

Among the most egregious incidents: Two different residents at two different facilities died after nurses incorrectly determined the patients had do-not-resuscitate orders. In another home, a male certified nursing assistant stuck his finger into the rectum of two residents, at least once while a resident was being bathed in bed, incidents that led to the assistant's termination and to an ongoing criminal investigation. In others, medication was incorrectly administered and a resident fell due to insufficient staffing while bathing.

Making these horrendous incidents worse, the punishments are absurdly insufficient; nursing homes only can be fined a maximum of $10,000 per citation, according to state law.

The state can start with relatively simple solutions: increased oversight; a focus on training, management and still-inadequate staffing levels; and much higher fines that would make violating state rules financially detrimental to facility owners and managers.

Part of that means greater investment. But more money will mean little if it's not used properly. And none of that goes far enough. Even existing inspection efforts and quality measures aren't sufficient. State and federal regulators have oversight functions, including the state Department of Health, the state Office for the Aging, and the federal Department of Health and Human Services, but none of them seems to have the staffing, power or tools to do what must be done. The federal star rating system, for instance, relies too heavily on self-reported data and isn't updated often enough. The inspection reports Newsday utilized are publicly available but not easily accessible, and often difficult to analyze. Providing simpler, searchable databases of the homes, their violations and the fines they've been assessed would be a good step. But in the end, only elected officials can demand answers and reforms in defiance of powerful lobbying to maintain the status quo.

URGENCY IS NEEDED

Beyond all of that, a more comprehensive, urgent approach is necessary, one that would assess what works and what doesn't inside the facilities themselves, take best practices and expand them, add far greater oversight measures, rethink assumptions, and examine how the state can better provide options for those who wish to remain at home.

That's not an easy task. Patient needs are great, as many residents of Long Island's nursing homes suffer from dementia or for other reasons require round-the-clock, intense care. New issues, like substance abuse, have added to the complexity. And nursing home staffing remains an enormous problem. These are incredibly difficult jobs with low starting salaries, few raises, poor management, and little incentive to provide the kind of care residents and their families deserve. All of that has to change if nursing homes themselves are going to become the facilities we need them to be.

None of this is new. We've been grappling with the same issues, the same complexities, for decades. To get to a point where we can stop wondering whether our loved ones are safe, federal, state, union and industry leaders must be willing to tackle these difficult questions and find answers that go far beyond a small fine and a star on a chart.