While the Republican-led Senate licks its wounds and regroups this weekend in order to plot new tactics for inflicting a grotesque, tax-cutting scheme disguised as a “health care plan” upon the American population, one group remains particularly vulnerable to physical and mental abuse likely to suffer as a result—the approximately two million elderly people now residing in this country's 15,600 nursing homes.
The health care bill currently before the Senate, if passed with its proposed cuts to Medicaid intact, is certain to produce drastic upheaval in the landscape of long-term care. That program is by far the largest source of funding for nursing home stays, supporting nearly two-thirds of long-term care residents. It is worth grappling with just how gruesome the results of cuts to it can be.
A massive wave of elderly baby boomers—many with only meager assets in the wake of the 2008 Financial Crisis to pay for long-term health care through their considerable remaining life spans—will come crashing down on this country’s system of nursing and “assisted living" homes over the next few years.
During the 1970's, a similar wave of demand for long-term health care, particularly in so-called "Rust-Belt" states, resulted in the propagation of long-term nursing home institutions, housing tens of thousands of elderly patients in need of care, whose children had long since fled those states for points South and West. With that new dynamic of care came a flood of reports revealing how old people, hidden away from public view in these homes, were being beaten and otherwise abused in filthy, degrading environments:
In a giant Pittsburgh-area nursing home, staff immobilized hundreds of patients every day because they could not manage their needs. If patients created “extra” work — for example, through incontinence — or spoke out about their treatment, they were subjected to punishment. Among countless such incidents, witnesses described seeing an aide spray cold water on the genitals of an African-American patient with diarrhea while insulting him with a racial slur. A woman named Dorthy, the neediest patient on her floor, had both diabetes and Parkinson’s... When she asked for care, “she was screamed at, slapped and told to ‘shut-up’ many times by the staff.”
Gabriel Winant’s Ph.D dissertation examines care labor conditions in post- WWII Pittsburgh, PA. Writing for the New York Times, Winant says we are once again entering an inflection point similar to the 1970’s where the economic conditions surrounding long-term care for the elderly point historically to a high potential for abuse and mistreatment, in a long-term care system once again subject to falling tax revenues, coupled with sharply increased demand for care:
Demand for long-term care was rising while public budgets were crunched under pressure from de-industrialization and falling tax revenue. This was a recipe for abuse. It’s a pattern that the political theorist Nancy Fraser has labeled a “crisis of care,” a recurrent phenomenon occurring at economic transition points.
Concern about elder abuse in nursing home facilities peaked during the 1970’s as horror stories began to emerge from these (at the time) largely unregulated institutions. Medicaid Fraud units were created in states like New York in the wake of widespread nursing home scandals during that time, in part to investigate patient abuse, and regulatory reforms were passed governing the operation of these places and (theoretically) requiring that even the most minor incidents be reported.
However the reforms did not stop the abuse. One study showed that in the years 1999-2001 elderly patients were continuing to be abused in one out of every three nursing homes. These included incidents of elderly residents being punched, choked, kicked, verbally abused, and sexually molested. Industry representatives blamed the problem on the inability to keep professional, quality skilled staff due to lack of funding. And government experts in health care issues agreed. As Representative Henry Waxman (D-CA) put it at that time: “"[U]nless we are willing to pay nursing homes enough to do their job, intolerable incidents of abuse and other types of mistreatment will continue to persist … "
By far the largest source of funding to America’s nursing homes is the Federal government, through Medicaid and Medicare. With the Republican “Health Care” plan, and its massive cuts to Medicaid, that funding disappears, with nothing to replace it. Winant foresees a huge increase of underpaid, in some cases incompetent workers dealing with a burgeoning population of weak and vulnerable elderly as an inevitable prelude to widespread physical, psychological and verbal abuse in these nursing homes. Without Federal funding there is simply no way to pay enough good, safe, decent people to do this work.
When austerity strikes long-term care, it pits the workers — overwhelmingly likely to be underpaid and overworked women and people of color — against the patients, with results that can be horrifying.
With the drastic Medicaid cuts planned in “Trumpcare,” states will be forced to cut back on their reimbursements to nursing homes. This will inevitably result in a “race to the bottom" by nursing homes in their efforts to cut back on both the equality and quantity of staffing. They will have no other choice. The “core dynamic” that leads to abuse in nursing homes, based on the history, is the juxtaposition between reduced funding and rising demand for care. And the effects of that reduced funding impacts all seniors in nursing homes, not simply ones who are receiving Medicaid.
That is the future that awaits the Baby Boomers as they enter their 70’s and 80's. You could not pick a worse time to gut Medicaid, but that is exactly what the Republicans are trying to do. The solution to widespread abuse is to pay quality people the money they deserve for this type of work. But that is never going to occur under Republican-dominated government which refuses to even consider raising the minimum wage, and whose philosophy is rigidly and ideologically opposed to social services in favor of tax cuts for millionaires.
If the Republican "TrumpCare” scheme passes and is signed into law, more elderly Americans will be forced to spend the last years of their lives in unfriendly, unfamiliar places where they will be ripe targets for abuse and mistreatment at the hands of incompetent and underpaid staff.
That’s not hyperbole. It’s just the way the system is designed.