Reporting nursing-home deaths to Pa. coroners is a necessary change | Editorial

By PennLive Editorial Board

Another year, another report on how too many elder-care facilities and oversight agencies in Pennsylvania are failing in their legal and moral duty to care for the state’s most vulnerable residents.

This month the failing grade comes from the state Inspector General’s office, which, according to the Associated Press, found that county-level agencies are doing a poor job of investigating elder-abuse complaints.

This follows a 2018 investigative report by PennLive, following up on a 2016 PennLive report and an Attorney General’s lawsuit, finding that, again, some problem nursing homes haven’t improved their care.

So now we have yet another report -- the Inspector General’s -- followed by more assurances of improvement, including from the Wolf administration (which hasn’t released the Inspector General’s full report).

Who believes that sustained improvement will happen? Likely not a person who’s had a family member in a nursing home and struggled with the maddeningly frustrating process of addressing even simple issues of comfort and dignity.

Something more concrete has been proposed, however. Admittedly it would be a baby step, and one that will meet self-interested opposition. But it’s valuable nonetheless.

Scott Grim, Lehigh County coroner and past president of the International Association of Coroners and Medical Examiners, proposes changing state law to require that nursing homes and assisted living facilities report all deaths to local coroners for potential investigation.

It seems only logical that they would, but currently nursing homes and assisted living facilities contact coroners only for deaths from suspected homicide, suicide or accidents, not those deemed to be the result of natural disease processes.

The nursing home industry points out that the state already requires licensed medical personnel to conduct an examination when a resident dies. Deferring to such “internal” judgment, however, provides a lot of gray area for a negligent nursing home to protect itself from the bother of independent review or the consequences of errors.

Under Grim’s proposal, nursing homes and assisted living facilities would be required to call their local coroner regardless of the cause of death. The coroner would ask a series of questions, such as how the patient died, their medical history and whether they experienced any trauma. Further, the coroner could choose to examine the body, review medical records and conduct a full investigation.

As part of the Q&A, a coroner should talk independently with family members also.

This still would leave too much control in the hands of not-disinterested facility managers but as we said it’s a baby step.

Grim’s proposal needs both the strong endorsement of the Pennsylvania Coroners Association and tireless legislative champions. This should not be a political risky proposal to get behind.

Coroners may be overloaded, especially with the opioid epidemic raging on, so the proposal must ensure they have the resources to provide this oversight. This function will only become more crucial in the future as the number of people in full-time nursing care continues to grow.

Many nursing home residents, unless they have extremely knowledgeable, persistent and available families, tend to be voiceless, with little capacity or opportunity (and sometimes little perceived credibility) to advocate for themselves.

Coroners, though, work for the public, and reviewing and investigating nursing home deaths is another important way for them to represent the public’s interests.

Who could object? While not specifically opposing Grim’s proposal, Adam Marles, president and CEO of Leading Age PA, which represents non-profit nursing homes, told PennLive, “We focus on supporting that family [whose loved one has died] and meeting their needs. Adding another layer of review could increase trauma for families.”

But what families of nursing home residents want most is to know that their loved ones are getting appropriate care and are treated with respect and compassion. And we suspect most would gladly trade a final layer of red tape for the indisputable assurance that their loved one didn’t die from lack of attention or in needless pain.

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Reporting nursing-home deaths to Pa. coroners is a necessary change | Editorial