A recent proposal by the Trump administration would grant immunity to many nursing homes found in violation of safety and quality standards. As reported by the New York Times, these safety and quality violations often result in “avoidable accidents, neglect, and mistreatment” of elderly and disabled patients. Under the Obama administration, nursing homes in violation of these standards have were subject to hefty fines. President Obama’s enforcement actions demonstrated a commitment to a system of policies and penalties designed encourage responsibility and maintain accountability across the nursing home industry, something that wasn’t always popular with the American Health Care Association (nursing homes’ main trade association). In contrast, the Trump administration has prioritized deregulation. Indeed, changes like this may have been what Trump was celebrating when he said last month: “the never-ending growth of red tape in America has come to a sudden, screeching and beautiful halt.”
In practice, these new guidelines will reduce the types of violations that are subject to penalties and the severity of fines imposed on the most appalling offenders.
As profit-driven businesses, nursing homes would be able to reallocate their resources to generating profit rather than adhering to safety and quality standards. If violations are no longer subject to strict penalty, then nursing homes can easily get away with lowering the quality of care offered to their elderly and disabled patients. Maintaining a high standard of care is critical in the nursing home industry because patients in need of intensive healthcare services are incredibly vulnerable and may not be able to advocate on their own behalf. Nevertheless, nursing homes may undertake cost-reducing measures which could compromise quality of care.
For example, nursing homes that are decreasingly concerned with adherence to regulations may decide to downsize their staff. This would impose heavier workloads on remaining staff, which could compromise attention to patient safety. Providers might find themselves with increasingly hectic schedules and expanding patient loads. While doing their best to care for each patient, the overburdening workload may mean skipping out on routine questions with patients or sanitizing one’s hands as thoroughly as usual before hurrying to the next room.
If the safety and quality of nursing home services decreases, elderly and disabled patients may seek an alternative means of care, such as that offered by in-home health. Home health providers can provide the individualized care that patients and their families seek, and they can often significantly delay an individual’s transition into a full-time care facility. If these new guidelines do indeed diminish the safety of nursing homes, this might present a burgeoning business opportunity for home health agencies and providers desperate to fill the gap with quality, attentive, and personalized care.
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