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On April 21, 2015, the Long Term Care Community Coalition issued a 30 page comprehensive report to document and report on the state of the long term care community.  It was a report card of sorts, where the report notes “significant problems in resident care, quality of life and dignity are pervasive across the country.”  Indeed, the report gives a failing grade for enforcement of the robust laws that provide promises of dignity and superior care.  More specifically, the report notes that long term care facilities have “inadequate care staff” and provide subpar care, lacking in dignity “because there is nothing stopping them from doing otherwise.”  There are too often little or no consequences when the facility fail to live up to the standards that they are contractually bound to, even when these shortcomings result in “significant suffering.”   

The Coalition wrote an additional report focused on New York for various reasons.  New York’s findings can be found here.  The New York report is even more detailed, at least as judged from the fact that it is 18 pages longer than the national report.  


The report is a first of its kind, insofar as it measures the integrity and safety of the long term continuing care facilities with markers that are centered on residents as individuals.  The authors sought to assess facilities by connecting the relevant data to the residents wherever possible.  The report was animated by the spirit of the 1987 Nursing Home Reform Law, which changed the focus from the business to the individual.  


One particularly helpful tool is a state by state comparison on several important measures. Statewide citation rates, the number of fines, amount of fines and the percentage of times that state regulators found actual harm to residents when they found violations.  Data for many of the aggregate findings can be found here.  The total amount of fines imposed by a state for the three years from January, 2012 to January, 2015 is an interesting data set, as it shows perhaps a different legal method for enforcement or perhaps a total abdication of enforcement.  Three states stand out in this regards.  Specifically, North Dakota, South Dakota and Wyoming all imposed no fines and obviously collected nothing in return.  Montana imposed only six fines and collected less than $19,000 in fines.  


  • The use, or, as amply shown, the overuse of antipsychotic drugging is another measure that the report examined. By its own admission, the data set is incomplete, insofar as the data does not break out any statistics for inappropriate antipsychotic administration.  The data coding that is used only applies to “unnecessary drugging”.  
  • Failure to prevent and treat ulcers are another area of specific inquiry.  Most disturbing, when states do cite facilities for inadequate ulcer care or prevention, in only 25 percent of the circumstances will they code the fine as harmful to the resident.  
  • Finally, the report focuses on the adequacy of the care staff employed by a facility

In closing the report correctly points out that the nursing home community routinely claim that it is one of the most regulated industries in America.  If those regulations and laws, however, are not enforced, the claim is meaningless. Additionally, it presents several means by which the industry can properly address theses issues.  

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