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Nine out of ten American retirees say that they want to stay at home, to be cared for in their familiar surroundings. An AARP survey indicates that there is a trend toward more Americans staying at home.
Under the program known as the “Balancing Incentive Payment Program” which is one of several of the many Affordable Care Act (ACA) (OBAMA-CARE)programs, it is intended to keep as many people out of expensive long term care facilities as possible. A number of States are participating in the ACA program that provides funding for home care. It is seen as one method of making nursing homes the choice of last resort.
A recently published survey by the American Journal of Public Health concluded that “investor-owned nursing homes provide worse care and less nursing care than do not-for-profiot or public homes.” In this survey which analyzed 1998 data from state inspections of 13,693 nursing homes, investor owned facilities averaged 5.89 deficiences per home, 46.5% higher than non-profit facilities and 43% higher than public facilities.
Of the 13,693 nursing homes, 65.8% were investor-owned, 27.7% were non-profit and 6.5% were public. Nursing staff was lower at investor-owned nursing homes for each occupational category. Investor-owned facilities are usually part of a chain. Chain ownership is usually associated with a lower quality of care.
Nine out of ten nursing homes lack adequate staff. A Department of Health and Human Services study found that 90% of nursing homes in the U.S. had too few workers to take proper care of patients.
Dr. John F. Shnelle, co-author of the report said that nursing homes would be required to have one nurse’s aide for every five or six residents , from 7:00 AM to 11:00 PM. Most nursing homes have one aide for every 8 to 14 residents.
In 2000, 91% of nursing homes fell below the recommended number of staff. Approximately 40% of nursing homes would need to increase nurse’s aide by 50% or more to reach the minimum required levels of staffing. The Bush Administration made no effort to set minimum staffing levels.
Quality assurance must be guaranteed to residents of nursing homes, assisted living facilities and independent congregate living facilities as well as for persons receiving long term care in their homes. The Federal Nursing Home Reform Act guarantees a minimum standard of care for nursing homes. However, even though most states have enacted laws similar laws, government agencies have not been particularly active in enforcing these enhanced quality assurance standards.
Because of the repeal the Boren Amendment, requiring the Federal government to pay providers sufficient reimbursement so that they would make a reasonable profit, Medicaid and Medicare no longer pay providers sufficient funds to cover expenses. Due to Madicare rate reductions, this program no longer fully subsidizes the increasing Medicaid shortfall. The difference between Medicaid rates and allowable Medicaid per patient day costs can only lead to a poorer quality of care.