Exploiting the Aged

Some nations, like the Scandinavian countries, take good care of their aged. But not the U.S., where about a million American elderly spend their last years in nursing homes. In these homes, says Mary Adelaide Mendelson, a Cleveland community-planning consultant who has spent the past ten years investigating the nursing-home industry, they are often ignored, sometimes mistreated and generally exploited. Despite the $3.5 billion in federal, state and private funds that are poured into U.S. nursing homes each year, she writes in her recently published book Tender Loving Greed (245 pages; Knopf; $6.95), conditions in many homes are so bad that they constitute "a national scandal."

Author Mendelson, who holds a master's degree in political science, is not the first to write critically about the nursing-home industry. But Mendelson, who was hired in 1964 by the Federation for Community Planning of Cleveland as a part-time consultant to study nursing homes in Ohio, has dug deeper and come up with more dirt than other investigators. In the past decade she has expanded her investigation to cover the entire country, visiting hundreds of the nation's 23,000 nursing homes and speaking to patients, operators and employees. The book that resulted is a strong indictment of private cupidity, professional complicity and official indifference behind wholesale cheating of both the patient and the public. Author Mendelson points a finger at:

OPERATORS. Some homes, run by churches and other charitable groups, get good grades. But these accommodate only a small percentage of patients. Privately run homes, which care for the majority, are a different story. A few honest owners may feel forced by the difficult economics of operating a nursing home to provide substandard care; others see their operations simply as opportunities for financial exploitation of people who have nowhere else to turn. Because the pay is so low, many homes are inadequately staffed, largely with unqualified personnel. The privately run homes also generally try to maximize profits by minimizing expenditures for food, offering meals that range from insipid to inedible; one operator attempted to feed his patients on 78-c- worth of food each per day.

These are not the only abuses. One owner, without bothering to obtain power of attorney, took over his patients' bank accounts, charged them a high private rate until their resources were exhausted, then kept them on at the lower rates paid by Medicare and Medicaid. Other operators increase their profit margins by tacking extra charges onto already high bills. Mendelson reports that one Virginia nursing home listed charges of $3 per day for care of bedsores, which probably resulted from staff neglect in the first place.

DOCTORS. Some physicians work closely with operators, who occasionally reward them--and give them an incentive for keeping the home's beds filled --by providing them with stock in the institutions. Some doctors make "gang visits," dropping in on a home, making a quick tour of the patients' rooms and charging all of them for individual calls. Physicians have also been known to cooperate with operators in a more nefarious practice, keeping patients sedated so that they will require less attention.

OFFICIALS. Those charged with overseeing the nation's nursing homes have done little to improve the situation. Government agencies generally overlook such obvious violations of state and federal law as inadequate staffing, lack of safety and sanitary facilities and irregularities in accounting procedures. Ohio officials, Mendelson reports, have failed to obtain the extradition of a confidence man who fled to New Orleans after bilking several patients as well as the Government of thousands of dollars.

The nursing-home industry has reacted strongly to Mendelson's attack. Derril Meyer, a spokesman for the American College of Nursing Home Administrators, deplored the conditions described in the book and insisted that his organization was seeking to improve care of the elderly. Wiley Crittenden Jr., president of the American Nursing Home Association, attacked the book as "biased" and branded its charges "unsubstantiated." There has been no adequate response so far from government officials. State and federal authorities have been aware for years that many nursing homes have been making enormous profits while providing substandard care. They need neither investigations nor tougher laws in order to bring these homes up to par. The regulations governing nursing homes are already sufficient to eliminate most existing abuses, and the laws against fraud are adequate to jail many operators. Unfortunately, as Author Mendelson makes clear, neither have been enforced.

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