Why Dark Skilled Nursing History Could Repeat Itself

Various health care agencies and groups have expressed concerns over the effects of Obamacare repeal on Americans’ access to skilled nursing care, as well as the ongoing viability of SNFs as a business amid steep Medicaid cuts. At least one commentator also claims that the GOP health plans could lead to a return to the bad old days of widespread nursing home abuse.

“When austerity strikes long-term care, it pits the workers — overwhelmingly likely to be underpaid and overworked women and people of color — against the patients, with results that can be horrifying,” writes New York Times opinion contributor Gabriel Winant in a Wednesday piece.

Winant, a Ph.D. candidate in history at Yale, takes readers on a gruesome tour of skilled nursing conditions in the 1960s and 1970s, before long-term care was considered an enshrined part of the health care system. Faced with growing demand from Medicare and Medicaid recipients but burdened by other budgetary restrictions, SNF operators didn’t necessarily have the money to provide adequate staff and care — leading to widespread abuse and neglect.

In just one Pittsburgh-area facility in the ‘70s, Winant describes a host of indignities forced upon residents, from racial slurs to force feedings to threats of involuntary confinement. In New York, Winant quotes a doctor as saying, “If you mention to a colleague that a new arrival is a nursing home patient, it means he is a comatose patient who has bedsores, is dehydrated, and has pneumonia or urinary tract infection.”

But in Winant’s view, the blame didn’t rest solely at the feet of the employees. Stretched to their limits without adequate support or pay, the frustrated workers cultivated a culture where such unspeakable treatment could thrive.

“While the front-line staff were often the direct perpetrators of abuse, they did not cause the conditions that created it,” Winant writes. “The owners, administrators, and policymakers who determined the shape of long-term care did that.”

Winant thus draws a connection to today’s long-term care landscape, where SNF operators face deep uncertainty about the future of Medicaid coverage: Both the House and Senate’s plans to repeal Obamacare would slash hundreds of billions of dollars from Medicaid’s coffers over the next decade, leading a key player in the industry to deem the legislation “debilitating” for skilled nursing.

Winant does not mention that a variety of states and the federal government have all instituted stricter regulations for the skilled nursing industry since the dark days of the past — including the Nursing Home Reform Act of 1987 — along with harsh penalties for violators. But Winant still cautions that Medicaid cuts could force operators to find savings wherever they can, which could lead to understaffed SNFs with overworked employees.

“We will eventually need to expand and reinvent our elder care system to deal with these changes,” Winant writes. “We will need to pay more, not less, for care labor if we want something more humane than warehousing for our elders.”

Read the whole piece at the New York Times.

Written by Alex Spanko

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Alex Spanko
Assistant Editor at Aging Media Network
Alex covers the skilled nursing and reverse mortgage industries for Aging Media. Outside of work, he reads nonfiction, yells at Mets games from his couch, and enjoys pretty much any type of whiskey or scotch — often all at once.

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