What the OIG video leaves out
One might be forgiven for watching an Office of Inspector General video discussing nursing homes and wish it were about 10 — or 20 — minutes longer.
That's because the video, “Eye on Oversight: Nursing Home Abuse,” posted Thursday (almost as if any news related to anything other than James Comey was going to get lost in the shuffle) is under three minutes long. It tells, at best, about half of the story around the OIG and nursing homes.
The OIG in the Department of Health and Human Services is a critically important part of government for its role of investigations. In an ideal world, you should cheer the OIG going after the people in your industry who make everyone else look bad. The video's speaker, Brian Whitley, regional inspector general, is absolutely correct in noting three large causes of abuse and neglect in nursing homes: A lack of adequate or trained staffing, overmedication of residents, and individual bad actors. There's no doubt these are problems that the industry is constantly trying to make better.
But then the video heads into uncomfortable territory. State Medicaid Fraud Control Units reported more than 1,000 open abuse or neglect investigations into nursing and assisted living facilities, the narrator intones. It's relevant to note that there are 16,000 skilled nursing facilities nationwide alone. Add in 27,000 assisted living facilities, and one could argue that 1,000 cases is actually not huge.
But where I really take offense at the video is when Whitley says, “The scope of this problem is pretty large. In one recent OIG study, we found eight-five percent reported at least one allegation of abuse or neglect to OIG during a one-year timeframe.”
Any reasonable consumer listening to that is going to assume that nursing homes are horrible places. But let's parse that statement. Allegations don't always trigger investigations. We know that what family members may call “neglect” is related to their loved one's deterioration, despite the best medical care. Pressure ulcers, for example, can happen when people are getting the absolute best attention.
We also surmise that when consumers hear “abuse,” they have a vision of an employee hitting a vulnerable senior. This of course negates the instances of resident-on-resident abuse, not to mention the many definitions of abuse, such as verbal abuse. To be clear, we shouldn't tolerate that in our facilities, but the OIG also is playing on people's worst fears.
By banding “abuse and neglect” Whitley isn't wrong as much as he's not providing context. Facilities absolutely have a responsibility to protect residents from each other, but an average consumer is far more understanding of a fellow senior with dementia yelling at their loved one than they are a long-term care nurse slapping a resident.
I also rolled my eyes at the one bright spot that Whitley mentioned, which is the decrease in the use of antipsychotics. He says, “Use of antipsychotic drugs in nursing homes fell by 30% after the Centers for Medicare & Medicaid Services implemented OIG's recommendations to reduce overmedication.”
It is absolutely true that the OIG issued a scathing report in 2012 about the overuse of antipsychotics, and that the AHCA set its goal for antipsychotic reduction in 2014 in conjunction with CMS' National Partnership to Improve Dementia Care in Nursing Homes.
But to give the impression that the OIG saved the day is unfair.
For one, it gives consumers the impression that the government is able to easily fix major problems. Related, it ignores the massive amount of work providers did to find solutions to antipsychotics. Within four years the American Health Care Association members lowered their antipsychotic use rate by 30%.
The partnership between AHCA, CMS and LeadingAge, along with dozens of experts and thousands of individual providers, is an example of people working together for the common good. The heroes in the antipsychotic story are the nurses who talked a physician out of prescribing Seroquel, the administrators who made reduction a priority and the family members who began to understand why their loved one could be weaned off. It's even, arguably, the government going after pharma companies that inappropriately promoted the drugs. For the OIG to indicate that it alone saved the day is unfair.
All I'm asking for in these videos is a little bit of context, of a “Make sure you do your research,” or “To be fair, many long-term care providers are doing a great job. Here's how you know.” Otherwise, it seems as if the point is to scare consumers into keeping their elderly relatives at home, whether it's what is best for them or not.
One could argue that it's perhaps it's also unfair to parse a video so intently, and that the OIG is filled with public servants who, at their core, are trying to make nursing homes better. Listen to it yourself and tell me your reaction. You can use the comment box below.
Follow Elizabeth Newman @TigerELN. Email her at firstname.lastname@example.org.