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Whose side are you on?
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It’s a debate now unfolding in courtrooms in Iowa and Texas: the needs and rights of nursing home residents and their loved ones vs. the needs and rights of nursing home owners and operators.
The issue: does the federal government, as primary payer of nursing home services (to the tune of an estimated 100 billion taxpayer dollars annually), have the authority to establish a rule that every nursing home in America, receiving Medicare or Medicaid funding, must agree to provide a minimum level of staff to serve residents?
The federal government says it not only has the authority, but also the obligation, to ensure that every nursing home resident is in a safe environment, free from abuse and neglect; that residents get timely and full attention to their needs and receive services in a dignified and compassionate manner.
The government is joined by numerous consumer advocacy groups in stating that a minimum staffing rule is needed because the current rule, which has been in place for several decades, has not worked. The existing rule states that every facility must have “sufficient” staff to serve residents. The problem is that there are as many interpretations of what “sufficient” means as there are nursing homes. The vague rule has allowed far too many facilities to routinely and intentionally have too few staff on duty; resulting in poor care, neglect, abuse, declining health and death of residents.
The nursing home industry’s position is represented by its two trade associations: Leading Age and the American Health Care Association, and 20 state attorneys general, including Brenna Bird. Kim Reynolds and 14 other Governors expressed their opposition to the minimum staffing rule in a letter to President Biden in November of 2023. Their position is the federal government does not have the authority to issue such a rule, the required staffing levels would be impossible to meet and cost-prohibitive, forcing many facilities to close. We refuted many of those assertions in a previous opinion piece Caring for your loved ones is their business, not their concern | The Gazette
The choice: to side with what’s best for nursing home residents, or to side with what’s best for the nursing home industry; to side with the vulnerable and voiceless, or with politically influential business interests?
For us, the choice is easy. We put the interests of residents ahead of business and political interests. Brenna Bird and Kim Reynolds do not.
The issue could soon be decided by the courts. It could also be decided by Congress, and there are indications it may attempt to do so in the next few weeks.
How would Iowa’s four members of the U.S. House vote? How would our two Senators vote? Iowans deserve to know whose side they are on.
Our request of Attorney General Bird, Gov. Reynolds and the elected officials who haven’t taken a position: put yourselves, or a loved one, in the shoes of a nursing home resident, in one of these real-world scenarios.
- You’re sitting in a wheelchair, alone in a room, wearing an adult diaper. You soil yourself, hit a call light, and sit in your waste for 45 minutes before someone arrives to assist.
- You’ve been told you don’t have the strength to get out of bed and walk to the bathroom unaided, but you do it anyway because your call light for help has not been answered and you need to go. Predictably, you fall, potentially breaking a hip or leg.
- You’ve been in bed for hours. You need to be turned over because you have bed sores. You are lonely, depressed and anxious. You’ve hit the call button repeatedly. No one is responding.
- In bed, you sense that you’re in the end stage of the dying process. You have no family close by. There is no staff available to spend time comforting you and holding your hand. You die. Alone.
Ponder how being neglected, alone or afraid feels. Understand that these situations are all too real for far too many nursing home residents because understaffing in nursing homes is a reality. A reality that the industry wants to sustain.
Whose side are our elected officials on? Whose side are you on?
John and Terri Hale own The Hale Group, an Ankeny-based firm advocating for high-quality nursing home care for everyone, all the time. Contact: terriandjohnhale@gmail.com
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