No Country for Old People — In These Times
Melvinteen Daniels may have been in the autumn of her life, but it shouldn’t have ended the way it did. At a county-run Pennsylvania nursing home, she perished from neglect, her body ravaged by malnourishment and blood infection, according to court documents. Her skin was marred by a pressure ulcer that had grown to about 11-inches wide.
Last summer, a federal appeals court judge allowed Daniels’ family to go forward with a civil lawsuit, which was, like thousands of other nursing home neglect cases, settled out of court. But the Daniels case was unusual for its legal rationale: by invoking an obscure civil rights statute in the 1987 Nursing Home Reform Act, the suit uniquely linked the concept of civil rights with the care of the elderly. Daniels’ death foreshadows a coming crisis in the healthcare system: As a massive number of older Americans — the “gray wave” — are absorbed into long-term care programs, can the system deliver what our elders need and deserve at the most vulnerable stage in their lives?
By 2030, the baby boom will be hurtling toward a senior bust. Nearly one in every five Americans will be sixty-five or older, up from about 13 percent in 2009, resulting in national demographics similar to those that currently exist in Florida. Despite the soaring need for long-term care that such an aging population is likely to entail — a 2008 study project about half a million new nursing home beds would be needed by 2020 — the number of nursing home beds has actually shrunk by 5 percent over the past decade. And as the system confronts a cohort of old people of unprecedented racial and ethnic diversity, it is likely that it is elderly people of color who will suffer disproportionately from these constraints.
Amid the structural challenges of the impending “gray wave,” newly emboldened Republican lawmakers want to gut the Medicare and Medicaid systems that support nursing homes and other long-term care services. Such cuts are likely to result in even greater racial and class inequities in long-term care.
As the budget standoff escalated in Washington this summer, keystone health programs — despite their vital role as social safety nets in a weak economy — became a whipping post for deficit hawks, particularly in light of the political uproar and budgetary pressures surrounding the new healthcare reform legislation. Now that both parties are embroiled in a race to cut the deficit, supposedly to shore up the country’s long-term finances, both Medicare and Medicaid have been hauled onto the table in the political horse trade. Some possible “cost-saving” measures include converting Medicaid to a flat-funded block grant program or restricting Medicare coverage based on the patient’s income. In the bipartisan deficit-slashing frenzy, healthcare cuts might also be compounded by the downsizing of Social Security and other federal programs that millions of poor and elderly rely on for survival.
Nursing home white flight
Stories like Daniels’ are rare, but such tragedies punctuate grim patterns of neglect baked into the country’s senior care infrastructure. The key factors determining the quality of nursing care tend to be outside of seniors’ (or their families’) control. For a senior living on a fixed income, the likelihood of winding up in a home where she can’t stand the food, is given the wrong medications, or has to sleep in a wet bed at night, may ultimately hinge on how much her family can pay. That has a lot to do with her race and where she lives.
A 2007 study by researchers at Brown and Temple Universities found that blacks were 40 percent more likely to live in a facility cited by federal regulators for posing an immediate health hazard, and 70 percent more likely to be put in a facility that ultimately lost its Medicare and Medicaid certification. A new follow-up analysis shows that, from 1999 through 2008, poor quality of care contributed to a rash of closures of nursing facilities across the country, resulting in a net loss of nursing home beds.