Companion content for the book, audiobook and e-book, Mary Regina's nursing home
Watch the video trailer by Rich Germaine (above) and download the audiobook. With the insights shared in this book, you can improve the outcome of a nursing home experience.
“Mary Regina’s nursing home” is a compelling, easy to read, informative journalistic novel hybrid assembled over 5 years of research by a retired former journalist and certified internal auditor, William J. Beerman, Sr. The author wants to share what he learned about nursing homes and the government’s oversight system for nursing homes.
Don’t wait until a loved one has an accident or suffers a sudden illness, and a hospital gives you one or two days to find a nursing home. Find out what you need to know now.
By the time William found out how the system works, it was too late for him to help his mother, who was sent abruptly to a nursing home after she broke her hip.
William is confident the information in this book will help other nursing home patients and their families avoid the ordeals that he and his mother endured.
The book is named after William’s mother, Mary Regina, who died after a short stay in a nursing home in Pittsburgh, Pennsylvania. William spent 20 days at her bedside observing what went on in the nursing home.
After Mary Regina’s death, William filed suit over the mistreatment his mother suffered, and he eventually began looking into how the government oversees nursing homes. What he found out was alarming.
This book presents in an easy-to-read, memoir-like framework, a three-part narrative: (1) the human-interest background story of Mary Regina and William, (2) details of Mary Regina’s hospital and nursing home experiences, and (3) what William learned about government oversight of nursing homes.
William reports on state attorney general (AG) lawsuits and AG research that encompass 65 nursing homes and more than 1 million patient-days of nursing home care. The investigations for the AG lawsuits elicited reports on nursing home operations from former employees who became confidential witnesses for the AGs. The investigations looked not only at how residents were treated, but at how the nursing homes interacted with oversight agencies and with their parent corporations. Audits of oversight agencies by state and federal auditors, and the work of a nursing home quality improvement task force, are also covered.
William grew up in a dysfunctional family, as many of us do. He had a strained relationship with his mother, largely because of a 13-year-long, scorched-earth divorce war that she waged against his father, who was a steelworker. William’s parents were children of the Great Depression, his father was a member of the Greatest Generation, and William is a Baby Boomer.
As Mary Regina grew older, she lived in Pittsburgh, Pennsylvania, and William lived 1,775 miles away in Las Cruces, New Mexico.
When William’s sister died young, he became his mother’s sole surviving offspring. And after Mary Regina broke her hip, William traveled to Pittsburgh and spent about 3 weeks observing what happened on the day shifts at the nursing home and listening as Mary Regina told him what happened at night.
William believed the state department of health (DOH) did not investigate satisfactorily his well-documented complaints about Mary Regina’s nursing home. As a former auditor, he believed that the methodology that the DOH used to investigate complaints about nursing homes was doomed to fail. The year-to-year statistics on DOH oversight performance verified this, in William’s opinion.
After resolving his lawsuit, William realized that he was just one of hundreds of thousands of people in the U.S. who had filed complaints about nursing homes. He decided to broaden out his research from his own case study of his mother’s experience. He looked into how the state and federal oversight systems worked for others, and he found that what had happened in his mother’s case was not at all uncommon.
William was unprepared and utterly incompetent to deal with the problems his mother encountered after she broke her hip, yet he faced extreme deadline pressure as he struggled to make decisions. If a nursing home looms in the future for you or a loved one, you can become a smarter consumer by reading this book. In addition to detailing William’s experiences, the book includes a chapter on an advocacy organization that will assist current and prospective nursing home residents and their families in finding help: The National Consumer Voice for Quality Long-Term Care.
Notable Issues
In the book, William reports that, for example:
Some nursing home administrators knew in advance when state inspectors were coming for “unannounced” inspections.
On September 28, 2017 the U. S. Department of Health and Human Services Inspector General reported, “Overall, states received one-third more nursing home complaints in 2015 than in 2011.”
State enforcement activity for nursing homes can fluctuate wildly and by political administration; over a 13-year period, annual enforcement actions in one state went from a high of 171 to a low of only two. The averages for selected high and low 3-year periods were 145 and 12, respectively.
In recent years, the number of complaints about nursing homes has risen while the number of citations and enforcement actions by government agencies has gone down.
The federal government’s ratings for nursing homes do not consider the opinions of the people who live in the nursing homes.
Lawyers and courts, in targeting specific nursing homes, sometimes seem to be more successful at holding nursing homes accountable than do the government oversight agencies, which must oversee all nursing homes.
Adequacy of staffing is a central issue. One state attorney general alleged in a lawsuit that certain nursing homes were “enormously profitable” but owners siphoned off money that should be used for resident care. Another attorney general said “Defendants’ staffing practices saved them the cost of labor but cost residents their dignity and comfort, and jeopardized their safety.”
Even when government lawyers contend that it was mathematically impossible for inadequately staffed nursing homes to provide the care required by law, lawsuits might be thrown out of court because of legal technicalities.
Keeping continent residents in diapers and changing them can be less expensive for nursing homes, in terms of staff-time cost, than it would be to have staff escort residents to the bathroom.
Nursing home operators make substantial monetary contributions to some politicians, and poor state oversight of nursing homes can become the subject of political finger pointing.
Nursing home operators contend that they are victims of excessive regulations and costly unfounded lawsuits, and that Medicaid’s rates for nursing home care fall about $25 per patient-day, or collectively about $7 billion per year, below the cost of providing proper care.
Nursing home lawyers argue that complaints about nursing homes — estimated to total about 60,000 per year in the U.S. — should be viewed in the context of how many people reside in nursing homes, which is about 1.4 million people every day.
Residents are still in jeopardy, as some unsatisfactory nursing home conditions are reported decade after decade.
The book is politically neutral. For example, it points out not only that enforcement actions in one state hit bottom under a Republican administration, but also that enforcement actions fell substantially at the national level under a Democratic administration.
