Higher Quality Care: What’s Needed to Improve Maryland’s Nursing Homes

Over 1.3 million Americans live in nursing homes.  As the Baby Boomer generation reaches retirement age, most Americans will have loved ones or know someone whose loved ones have lived in a nursing home; adults aged 65 years and older are expected to comprise 20 percent of the U.S. population by 2030.

Assisted living facilities and nursing homes play a critical role in helping older adults live safely and comfortably.  Whether for permanent care or temporary rehabilitation help, 4.5 percent of Americans over 65 are living in a nursing home at any given point in time.  20 percent of Americans will spend the final months of their lives there.

Nursing homes are often the only option for seniors who need daily hands-on care but whose families are unable to care for them due to financial and/or time constraints.  Approximately 50% of older adults who need long-term care live in nursing homes.  Patients suffering from dementia and Alzheimer’s disease are especially reliant on nursing homes to provide them a safe, familiar living environment.

Entrusting one’s medical care to a nursing home is a tremendous investment.  The average private nursing home costs $83,000 a year.  70% of American nursing home residents rely on Medicaid to help finance their nursing home care, making it even more important that nursing home patients receive quality treatment.

The Office of Health Care Quality in the Maryland Department of Health and Mental Hygiene is spearheading initiatives to improve Maryland’s nursing homes for both residents and healthcare providers, but Governor Larry Hogan is stalling their efforts. Hogan should take two simple, concrete measures that will drastically improve the level of care provided in Maryland’s nursing homes.

First, Hogan needs to raise the minimum wage for nursing home staff.  According to the U.S. Bureau of Labor Statistics, the average nursing home industry professionals earned $31,640 in 2012, far less than the average U.S. individual salary of $45,230.  Grossly underpaying nursing home workers discounts the physical and emotional energy that is required to work in a nursing home.  Low pay creates low job satisfaction and high turnover rates.  This ultimately hurts nursing home residents, who benefit from consistency among their caregivers.  Better wages for nursing home employees will increase nursing home residents’ standard of living and the quality of care they receive.  We entrust our aging loved ones to hard-working nursing home staff, and they should be compensated accordingly.

Second, Hogan needs to implement a more rigorous nursing home ratings system.  Under Medicare’s nationwide Nursing Home Compare system, nursing homes receive ratings on a scale of one to five stars based on health inspections, staffing, and “quality of resident care measures.”  While the independent health inspectors verify nursing home facilities’ compliance with health codes, nursing homes can easily manipulate the latter two components of the current rating system.  An explosive 2014 New York Times report revealed that woefully understaffed nursing homes often hire extra employees shortly before their inspection date to create the impression that they are better staffed than they actually are.  Furthermore, the “quality of care” standards at the heart of the rating system largely rest on data reported by nursing homes themselves, not independent professionals.  Nursing homes have an incentive to inflate their ratings for profit; even though Nursing Home Compare provides insufficient information to make the important decision of choosing a nursing home, patients and their families and doctors rely heavily on these ratings when choosing a nursing home facility.  You wouldn’t buy a car based on its manufacturer’s self-reported safety ratings, so why would you do the same for your parent’s nursing home?

Maryland’s senior citizens deserve care from fairly paid workers in high-quality facilities.  Governor Hogan needs to quit beating around the bush and give nursing home workers a living wage and enforce higher standards to hold nursing homes accountable.