USA: Evicting the elderly

SAINT LOUIS, MO (St. Louis Post-Dispatch), August 22, 2008: Moving a parent or sibling into a nursing home is emotionally and financially difficult. Keeping them there may be getting even harder. The Wall Street Journal reports that increasing numbers of frail and sick residents are being forced out of nursing homes across the country. In some cases, they're asked to leave because they are difficult or expensive to care for. It violates federal law for a nursing home to evict residents for those reasons. In other cases, the Journal reported, patients are sent packing because Medicaid, which covers the cost of their care, pays nursing homes less than other insurance. No one tracks the number of elderly residents in nursing homes or assisted care centers who are evicted each year. But the number of formal complaints filed with the federal government about what's called "discharge practices," which include evictions, rose to 8,500 in 2006 — double the number in 1996. Such allegations have become the second most frequent type of complaint against both nursing homes and assisted-living centers, although the number of complaints is relatively low, compared to the number of people receiving care in the nation's 16,500 nursing homes and 39,500 assisted-living facilities. "It's happening [evictions] very often," said Richard Cavanaugh, who heads Missouri's long-term care ombudsman office in St. Louis. "Staffing is the biggest problem nursing homes face. Very often, we hear them say that this [patient] is taking up too many of our resources." Last April, a St. Louis County circuit judge ruled against Bethesda Meadows, an Ellisville nursing home, when it tried to evict 58-year-old Barbara Lindsey. Her son said he had been told to find another place for her after a billing dispute and other problems arose. Some of the problems resulted from errors made by the nursing home itself, Bethesda later acknowledged. Nursing home industry groups deny that evictions are a growing problem and insist that they strictly follow federal law. But a review of admissions agreements from 175 nursing homes around Missouri, conducted last year by lawyers for the National Senior Citizens Law Center, concluded that many homes are not following federal and state law. Jon Dolan, executive director of the Missouri Health Care Foundation, an industry trade group, disputed the law center's conclusions. "I do not find people being evicted or being treated unfairly," he said. But elder-care lawyers who reviewed the Missouri admissions agreements, which patients or their families sign routinely, found that about half of the documents either asserted a right to evict residents without stating a reason or listed at least one reason that is not permitted under federal law. One agreement claimed the right to evict patients who are unduly noisy, untidy or uncooperative. Some admissions agreements also limited the amount of care provided to nursing patients, putting family members in the position of having to hire private-duty nurses for additional care. But federal law requires homes to provide the amount of care each patient needs to reach the highest level of functioning possible. Federal nursing home standards are enforced by state health department inspectors who investigate complaints and conduct nursing home inspections. In Missouri, that oversight too often has been lax. Evicting frail, elderly nursing home residents can be just as deadly as neglect or abuse. Without adequate government oversight and increased consumer education, the number of tragedies is sure to grow. Copyright © 2008 St. Louis Post-Dispatch L.L.C