Milwaukee Journal Sentinel Series Examines Problems With Long Term Care in Wisconsin

The Milwaukee Journal Sentinel on Aug. 25 began a three-part investigative series examining the state of long term care in Wisconsin. Part one looked at assisted-living facilities, where "problems can be found in all parts of the state." The Journal Sentinel reviewed more than 400 state inspection reports on assisted-living facilities, and found that "hundreds of vulnerable elderly and disabled people have been injured or put at risk," and that more than 24 deaths between 1997 and 2000 were linked to poor care. Currently, about one million Americans reside in assisted-living facilities, and the number is expected to grow as the baby boom generation ages and life expectancy increases. But with this growth have come concerns that the medical care found in these facilities is often inadequate. Among the findings of Journal Sentinel report:

• 315 of 460 assisted-living facilities cited for violations in the past four years were "cited for caregiving issues related to untrained or insufficient staff, lack of activities, medication errors, not calling a doctor when a patient became ill, leaving residents alone, or abuse," and in 55% of these cases, "state inspectors documented actual harm to residents."
• The number of state inspectors assigned to regulate facilities "has lagged far behind industry growth," and "some facilities may not be visited for two years or more" unless a complaint is filed.
• State ombudsmen, who serve as advocates for the elderly and disabled residing in nursing homes and assisted-living facilities, are not allowed to investigate complaints from residents in residential care apartment complexes, the newest form of assisted living. The number of such facilities has more than quintupled since 1997 to 119.
• Some elderly residents in assisted-living facilities "are being evicted when they run out of money."

Waiting for Care
The second part of the Journal Sentinel series reports that more than 10,000 elderly and disabled Wisconsin residents are on waiting lists, which can extend up to 10 years, to receive long term care services. "Ideal[ly]," those who need long term care would be able to "receive an ever-increasing level of services in one facility," a concept known as "aging in place." Wisconsin, however, like almost every other state, cannot afford such services, as it currently spends more than $1.6 billion annually on long term care, and officials estimate that it would take $80.7 million more in state funds and $69.4 million in Medicaid funds annually to reduce the number of people on waiting lists. Health advocates say that Medicaid rules add to the problem. Under the program's rules, people who meet certain physical and financial criteria are "guaranteed a bed in a nursing home," but home health or communal care is "only provided through one of the state's Medicaid waiver programs." Maureen Arcand, a disability advocate, said, "That's one of the stupidest part of the whole thing. They'll pay for them in the nursing home, but they won't pay for someone to take care of them at home" (Held, Milwaukee Journal Sentinel, 8/26).

Nursing Homes in Crisis
The final part of the series examines nursing homes in Wisconsin, a "safety net" for those who need 24-hour-a-day care that is "rapidly becoming tattered," as many homes "are on the brink of collapse, and the future of the whole industry is grave." There are four main reasons behind nursing homes' current troubles:

• Reimbursements from Medicaid, which covers nearly 70% of Wisconsin's 39,000 nursing home residents, often do not cover the cost of patient care;
• Wealthier and more independent seniors and people with disabilities have moved into assisted-living facilities, leaving nursing homes with both less patients and the "most needy, sick, poor patients, who are also the most expensive to care for";
• Nursing homes are caring for sick patients for longer periods of time as hospitals discharge patients more quickly and medical advances extend life expectancy; and
• Nursing homes are largely underfunded and have difficulty remaining fully staffed. Twenty Wisconsin nursing homes, or 5%, have closed in the past two-and-a-half years, and another 14% "are operating under bankruptcy protection" (Manning, Milwaukee Journal Sentinel, 8/27).