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Legislation's demise means more preventable nursing home deaths will occur, advocate contends

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Lawmakers 'protecting old friends' in nursing home industry, state rep says

Editor’s Note: This is the first in a series of stories about Oklahoma’s nursing home industry and specific legislative reform attempts, litigation and ownership.

OKLAHOMA CITY – Thousands of preventable nursing home deaths will occur this year because reform legislation was squashed by state House leaders who sided with powerful lobbyists, a nursing home advocate said.

Prior to that decision, national nursing home rankings were released that show Oklahoma is one of the worst states in terms of patient care and staffing levels, according to Families for Better Care. The rankings reflect a grade of “F,” and dropped Oklahoma from No. 48 to No. 49 in the nation.

House Bill 1327, authored by Reps. Richard Morrissette (D-Oklahoma City) and David Dank (R-Oklahoma City) and state Sen. Kim David (R-Porter), would have required increased staffing levels, created family councils, provided the identification of all nursing home owners and required life support training in the use of crash carts and other emergency medical equipment.

“This is a bill that would have saved thousands of lives,” said Wes Bledsoe, nursing home advocate and president of the nonprofit A Perfect Cause. “There’s no mystery why Oklahoma has one of the lowest rankings. There are systemic failures in the nursing home industry.”

However, nursing home industry spokesman Sean Rose said the majority of the proposed legislation would likely benefit trial attorneys who would seek to sue facilities that failed to meet the bill’s requirements.

Bledsoe claims 3,500 preventable deaths occur in Oklahoma nursing homes each year, which is more than all of the combined fatalities from traffic accidents, homicides, suicides, accidental shootings, structure fires, tornadoes and lightning strikes.

“People are dying in Oklahoma nursing homes for ridiculous reasons,” he said. “Until the public stands up and grows a spine this carnage will continue.”

Some of the preventable deaths are caused by unchecked urinary tract infections, bed sore infections, falls, fecal impactions and malnutrition, Bledsoe contends.

He also claims one-third of all people admitted into Oklahoma nursing homes for rehabilitation have adverse effects that are preventable.

“They could either die or just get worse,” he said. “Many times they end up in long-term care because of what occurred at the nursing home. It’s safer if you play Russian roulette than going into a nursing home for skilled or rehab care.”

Playing politics

The bill was approved by the House Long Term Care and Senior Services Committee but failed to get a hearing on the House floor. Speaker of the House Jeff Hickman (R-Fairview) did not return a phone call for comment.

Rep. Doug Cox (R-Grove), a former nursing home owner, shares a residence with Hickman during the legislative session and was able to convince the Speaker not to schedule the bill for a full hearing, sources told Red Dirt Report.

“He (Cox) is just protecting his old friends,” Morrissette said. “I put this squarely on the backs of the Republicans. They would soon as well let senior citizens suffer in nursing homes than to force their friends who own these huge corporations to spend more money for patient care that saves lives. The Republicans won’t do anything because they’re protecting their cronies.”

Cox did not return a phone call for comment.

The bill could be revived during the 2016 legislative session, but Morrissette isn’t hopeful since it’s an election year.

“That would take some guts to bring it up again during an election cycle and remember the nursing home association is very politically active,” he said. “These nursing home owners are not doing what they do because it’s a calling. It’s a business. They’re into it to make money. They don’t have the guts or moral fiber to do what’s right.”

Rose, communications director for the Coalition of Advocates for Responsible Eldercare (CARE), took offense to Morrissette’s comment, claiming most people who labor in long-term care do so for the benefit of others.

“Owners, administrators and operators in our industry work to exceed the standards of care expected by our residents and their family members. Our residents always have been and always will be the focus of our work,” he said.

Sen. David was more subdued than Morrissette in her reaction to the bill’s demise.

“I’m going to assume it was not heard because of the increased costs,” she said. “However, I signed on to the bill to keep the conversation going. We pay them (nursing homes) a pretty low rate and costs have increased exponentially, but there are great reforms in the bill. Still, it’s a balancing act that nursing homes have.”

Its unlikely nursing home reform legislation will pass until it receives the endorsement of a large group of people, she said.

“It’s harsh to say it (bill) got lobbied away,” David said. “It was because it didn’t have enough backing. If you’re going after major reform, you have to build a coalition. As legislators, we may see a problem and know what the fix is, but it’s not that easy.”

Staffing requirements

However, Bledsoe believes it’s extremely easy to see that Oklahoma nursing home staffing levels are “deplorable.”

“That’s evidenced by people who check on loved ones and find them soiled and lying in feces for hours,” he said. “There’s not enough staff to provide a basic level of care.”

According to Families for Better Care, the Oklahoma nursing home industry scored below average or had failing grades in three of four staffing measures for the second consecutive year.

“The nursing staffing level is the key,” Morrissette told Red Dirt Report. “We’re asking for enough to protect the patients, but the nursing homes don’t want to do that because it cuts into their profits.”

Under the proposed legislation, nursing facilities providing long-term care would be required to have a registered nurse on duty for at least eight consecutive hours each day. Facilities providing rehabilitation services would need a RN on duty at all times.

The bill also would increase direct-care staffing levels for all eight-hour shifts at long-term care and skilled nursing facilities. For example, one direct-care staff member working the 7 a.m. to 3 p.m. shift at a skilled nursing facility would be responsible for three residents. The current staffing level is one staff member for every eight residents.

At the less intensive long-term care facilities, one direct-care staffer working the 3 11 p.m. shift would be responsible for eight residents as opposed to the current level of 12 residents.

However, Oklahoma’s nursing home operators found the proposed staffing level too burdensome, claiming the legislation would cost them more than $300 million statewide in added personnel and benefits.

Rose said the nursing home industry opposed the legislation because of unfunded mandates, particularly in staff requirements.

“The long and short of it revolves around funding and finding qualified staffing,” he wrote in an email response. “Finding individuals in Oklahoma that meet the criminal arrest check standards is getting difficult and finding qualified licensed/certified staff in rural areas is even harder. These (residents) are our state’s eldest and one of the most treasured generations. We only want the best for them.”

FKG Consulting, which touts itself as the largest and most experienced lobby firm in Oklahoma, represents the Oklahoma Association of Health Care Providers, a group that serves long-term care patients, their families and nursing home operators. FKG also represents the CARE Political Action Committee, which is linked to the nursing home industry.

FKG co-founder Jim Fried did not return a phone call for comment. However, sources told Red Dirt Report that FKG’s lobby efforts helped kill HB 1327 for this session.

The Oklahoma Association of Health Care Providers purports on its website to encourage nursing home operators and its employees to abide by an ethical code that addresses moral responsibility, good business practices, making difficult choices, acting responsibly, conflicting values, use of information, respect for others, fairness in competition and responsible advocacy.

Passing game

Bledsoe claims the nursing home industry in Oklahoma “gets pass after pass after pass” from Oklahoma legislators because of the powerful lobby that fights needed reforms.

“The nursing home industry owns the Mary Fallin and the Oklahoma Legislature,” he said. “This (bill’s rejection) was not a major step in the right direction. The Oklahoma Legislature does not have a clue about what they’re doing with safety for nursing home residents. How can this legislature make informed decisions about widespread systemic problems if they won’t take the time to hear what the problems are? How can you offer solutions if you don’t understand the problems?”

Bledsoe and A Perfect Cause were successful in educating a “handful” of lawmakers about the issues facing nursing home residents, but the majority of legislators ignored Bledsoe and his attempt to reach out.

“Judas sold his soul for 30 pieces of silver. We have lawmakers selling theirs for a lot less than that,” Bledsoe said.

Bledsoe questioned why non-controversial portions of the bill couldn’t have been saved this time around.

“Why couldn’t we have identified the medical directors? Why not establish family councils? What’s wrong with that?” he asked.

Bledsoe said only two of 300 nursing homes statewide have established family councils which can address problems and bring them to the attention of the owners and management.

However, Rose rejected that claim.

“To my knowledge there is no compendium or source that has on record which facilities have established family councils,” he said. “Our industry understands that they are required by law to allow for the formation of Family Councils and they wholeheartedly embrace that. I can say that most facilities have some sort of family group that meets monthly.”

He also claims state oversight agencies and families often do not know who the medical directors are at each nursing home.

“Another question is why aren’t nursing home medical directors required to have privileges at the nearest hospital?” he said.

In other instances, some nursing homes require their patients to use the medical director as a primary care physician, creating a substantial conflict of interest.

“Is the medical director more obligated to you, the patient, or the facility? You will leave eventually but the employer will continue to be there,” he said.

Oftentimes, Bledsoe said, the state oversight agencies responsible for nursing homes have a problem communicating. The health department has the task of licensing, annual surveys and investigations while the Department of Human Services is in charge of the long-term care ombudsman program. A third entity, Adult Protective Care Services, probes all abuse and exploitation allegations.

“More than not, they don’t know what the others are doing,” he said. “It’s like three blind guys trying to figure out what an elephant looks like. Nobody sees the full picture and knows what’s going on.”

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Tim Farley

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