How many times do we have to write about the tragic and horrific conditions in some Long Island nursing homes before change happened?
How often do we have to tell the stories of patients who die from incompetence, miscommunication or misjudgment, or hear about older people who are sexually assaulted or injured or not properly medicated? How often do we need to talk about systemic issues, the need for good hygiene, better infection control, protocol and standards, greater oversight and accountability?
The fact that we have to keep asking these questions means the answers are always out of reach. And Long Island’s most vulnerable residents — who have nowhere to go, who depend on nursing homes to keep them safe, clean, fed and provided for — remain unable to get the care they deserve.
Despair and disgust run deep. The frustration is palpable.
Everyone from state officials to civil servants knows that the current situation is unforgivable. Is anyone willing to take a broad look at the current state of affairs and develop a set of more thoughtful and sustainable solutions, responses that would prioritize home health care where possible, while improving the nursing home industry in maintaining these facilities to higher standards?
For decades, too many nursing homes have provided substandard services, becoming a last resort for elderly residents and families who, for many unfortunate reasons, cannot do home health care or other alternatives a reality.
PROBLEMS EXPOSED TO COVID
The COVID-19 pandemic has brought these issues to the fore, exposing the long-term care industry’s many shortcomings, particularly with respect to personnel, equipment, and infection control.
Despite this spotlight, recent state health department inspection reports show that many homes on the island are still failing their residents in numerous ways. A recent Newsday investigation found that about a quarter of facilities in the area 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 received do-not-resuscitate orders. At another home, a certified nursing assistant stuck his finger in the rectums of two residents at least once while a resident was bathing in bed, incidents that led to the assistant’s firing and an investigation criminal in progress. In others, medication was misadministered and a resident fell due to understaffing while bathing.
To compound these horrible incidents, the punishments are absurdly inadequate; nursing homes can only be fined up to $10,000 per citation, per state law.
The state can start with relatively simple solutions: increased surveillance; an emphasis on training, management and still insufficient staffing; and much higher fines that would make violating state rules financially damaging to facility owners and managers.
Part of that means a bigger investment. But more money will mean little if not used properly. And none of this goes far enough. Even existing inspection efforts and quality measures are not enough. State and federal regulators have oversight functions, including the state Department of Health, the State Office of Aging, and the federal Department of Health and Human Services, but none of them they don’t seem to have the staff, the power or the tools to do what needs to be done. The federal star rating system, for example, relies too heavily on self-reported data and isn’t updated often enough. The inspection reports used by Newsday are publicly available but not easily accessible and often difficult to analyze. Providing simpler, searchable databases of homes, their violations, and the fines they have 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.
EMERGENCY IS NECESSARY
Beyond all of this, a more holistic and urgent approach is needed, one that assesses what works and what doesn’t within the facilities themselves, takes best practices and develops them, adds measures much larger oversight, rethink assumptions, and consider how the state can better provide options for those who want to stay in their homes.
It is not an easy task. Patient needs are great, as many residents of Long Island nursing homes have dementia or for other reasons require 24-hour intensive care. New issues, such as substance abuse, have added to the complexity. And nursing home staffing remains a huge problem. These are incredibly tough jobs with low starting salaries, few raises, poor management and few incentives to provide the kind of care residents and their families deserve. All of this must change if nursing homes themselves become the facilities we need.
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 if our loved ones are safe, federal, state, labor and industry leaders must be prepared to address these difficult questions and find answers that go far beyond a small fine and a star on a graph.
EDITORIAL BOARD MEMBERS are experienced journalists who offer reasoned, fact-based opinions to encourage informed debate on the issues facing our community.