False Hope Found in Nursing and Rehabilitation Centers

by Stephen Louis Krasner

Inundated with medical information, health updates and making decisions while serving as a caregiver to a seriously ill person is a tough position to be in for anyone. When it results in the loss of that person while being under the premise they would recover — the shock can be devastating.

Misleading Names and Messaging

It is reasonable to believe that most people would infer that upon the discharge of a patient from a hospital and into a skilled nursing facility (SNF) that they would be on the road to rehabilitation and recovery — heading home in the not too distant future. This is due in large part to information provided to caregivers upon plans made to have a patient admitted there.

A great number of these facilities have the word “rehabilitation” in their name — a look at New York’s statewide directory lists 622 facilities — with over half of them having “rehabilitation” in the title. Hence the very name of these places is misleading to some extent when evidence suggests a significant number of patients entering these facilities meet adverse outcomes — and never make it back home.

You Can Never Go Home Again

A study published in the journal Annals of Surgery examined the outcomes of patients admitted to these facilities in five states, being California, Florida, New York, Texas and Washington. It concluded that 41% of patients discharged into a skilled nursing facility never returned home.

It is often communicated to patients and families that discharge to an SNF is a step in the process of recovery, and because clinicians have very limited evidence about the natural history of patients discharged to SNFs, patients may be given an unreasonable expectation of return to home. This study demonstrates that a significant proportion (41%) never returns to home, and the 1- and 3-year risk of death is much greater than that in the general population.

Looking through the data in such a study brings up the question as to what other factors outside this study might also be contributing to large numbers of patients not making it home again. Examining the quality of care people are receiving, and the variables at play behind that care, provides some answers.

Money Versus Mission

Comparing these types of centers by looking at the non-profit sector versus those operating in the private sector is disconcerting.

In a 2018 report published in the journal Gerontology, findings involving for-profit nursing homes raise several red flags. In commenting on the report its lead researcher, Lee Friedman, stated the following:

We saw more — and more serious — diagnoses among residents of for-profit facilities that were consistent with severe clinical signs of neglect, including severe dehydration in clients with feeding tubes which should have been managed, clients with stage 3 and 4 bed sores, broken catheters and feeding tubes, and clients whose medication for chronic conditions was not being managed properly.

The motivations behind the nursing facilities in each sector likely play a role in the quality of care and qualifications of the staff working there — especially when one considers mission driven work versus the goals of profit driven work.

Touching on this Friedman said, “For-profit nursing facilities pay their high-level administrators more, and so the people actually providing the care are paid less than those working at nonprofit places. So staff at for-profit facilities are underpaid and need to take care of more residents, which leads to low morale for staff, and it’s the residents who suffer.”

With upwards of 70% of these types of facilities falling in the for-profit ownership category — one has to wonder as to the extent negligence plays a role for those patients that are never able to go home.

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False Hope Found in Nursing and Rehabilitation Centers