Nursing facilities that are found guilty of numerous breaches of health code and misconduct that places patients at risk of harm are often classified as special focus facilities and monitored more closely to make sure that they change their policies. Unfortunately, the changes are usually short lived and the negligent nursing homes have a way of returning to their original habits the moment they escape the scrutiny of the government agencies keeping them in check. What must be done to finally secure the wellbeing of our loved ones and to hold nursing centers to account when their actions harm other people?

How Facilities are Added and Removed from Special Focus Consideration

It is seemingly impossible for state and federal health departments to keep tabs on every single nursing home in the United States. This can be shocking when you learn that 92% of nursing homes have committed some sort of infraction since opening their doors. Most of these deficiencies are minor and can be corrected with minimal effort. However, there is a growing number of systemic abuses that can be linked to the prioritization of profit over the needs and interests of patients.

When multiple patients suffer harm at a nursing facility and it is determined that the center is responsible, that facility is deemed a special focus facility. This grants the health department the authority to scrutinize the nursing home more vigorously with random and frequent inspections to ensure that improvements are made to how the administration and workers address the needs of those they care for.

Nursing homes rely on Medicare and Medicaid for the majority of their revenue, which is why this program motivates homes through the threat of eliminating access to those sources of payment. Either the home complies with the health department’s demands, or it loses access to its most vital sources of funding. For the vast majority, losing Medicare and Medicaid funding would force a nursing home into bankruptcy.

For this reason, most of the nursing homes that are deemed special focus facilities go to great lengths to appease inspectors and meet the demands placed on them. This can lead to the notion that the lesson was learned and the abuse or neglect of the past will not be repeated. Once removed from the special focus facility list, however, most of the policies leading to the placement on that list to begin with are reinstated.

Most Facilities Fall Back Under Scrutiny after Being Cleared

A review of the facilities placed under special focus status has shown that very few will ever actually lose access to Medicare or Medicaid funding and over half will be found negligent in the future. A study showed that out of 528 nursing homes that were placed under strict oversight through special focus status, 275 were responsible for negligent or abusive behavior that resulted in injury after being cleared from the program.

Some suspect that this is because nursing homes under the threat of losing critical funding will undoubtedly put on a show for the people who are monitoring them, but that threat goes away the moment the inspectors do. There needs to be a better system in place for dealing with repeat offenders and punishments that will effectively deter homes from ever backsliding into their old ways.

The Impact of Abuse on Victims and Their Families

Elaine Fischer was a resident of a Parkview Healthcare Center in California. This facility had undergone over a year of monitoring while classified as a special focus facility and inspectors were convinced that the staff and administration had made adequate changes to prevent further injuries to patients. Only several months following the lifting of the classification, Fischer fell out of her wheelchair after a stroke rendered her unable to control the lower half of her body. This incident was the first of three— the last of which resulted in a fractured hip.

Had the nursing home followed through with measures it promised to implement to prevent further incident after the first fall, Fischer would not have fallen the second or third time. These measures included placing a nonskid pad on the back of her chair and monitoring her more closely. Parkview was fined $10,000 for this incident, but it was later found that this one violation was only one of ten new infractions occurring over the two years after the nursing home lost special focus status.

Elaine’s quality of life suffered greatly and her family watched as she withdrew from all of the things she once enjoyed. Once having played Bingo every day with the other residents, she now remained in her room most of the time. The painkillers she was placed on kept her drowsy and sedentary, a change from the active and social woman she was. Parkview was already considered near the worst of negligent nursing facilities to have earned special focus status to begin with and its return to the status quo has made it impossible for Elaine Fischer to ever return to the life she once knew.

The Cost of Doing Business

Since for-profit nursing home companies have taken over the market, it has become increasingly common for centers to brush off the fines they receive as just another expense. Over the grander scheme of things, it would cost them far less to pay the fines than to hire more staff members, invest in training and technology and to deliver the high quality care people believe they are receiving. Budget cuts have helped many of these nursing homes get away scot free because there are a limited number of homes that regulators can assign the special focus status to each year.

The one common denominator seems to be understaffing. Nursing homes that are routinely fined and found liable for injuring their patients lack nurses. It is suggested that nursing centers employ one nurse for every six patients, but most facilities keep this ratio at as high as twenty to one. Perhaps we need to start demanding that nursing homes be held to a higher standard by reviewing their hiring policies and finally forcing them to close their doors when they are found guilty of repeat offenses.