Mary Regina’s nursing home

. . . is a substantive 380-page 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.

By the time William found out how the system works, it was too late for him to help his mother, who had been sent abruptly to a nursing home after she broke her hip. William hopes the information in this book will help other nursing home patients and their loved ones avoid the ordeals that he and his mother endured.

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William J. Beerman, Sr. has more than 700 followers on LinkedIn, almost all of whom are in occupations related to nursing homes. His recent posts have been viewed by up to 400 readers.

The book is named after William’s mother, Mary Regina, who died after a short stay in a 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. (More)

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.
  • 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.

    Chart shows average number of deficiencies cited per nursing home inspection in the U.S. Updated statistics are published periodically on this website as they become available. For example, as reported in my “Archived Posts” (under CONTENT), the U. S. Department of Health and Human Services, Office of the Inspector General, issued a “data brief” on September 28, 2017 announcing that, “Overall, states received one-third more nursing home complaints in 2015 than in 2011,” while the number of nursing home residents decreased 3 percent.
  • 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.

Copyright © 2017 William J. Beerman, Sr., LLC