OPINION: Nursing Homes - The Places Nobody Wants To Go

By State Senator Roy Dyson (D-29th)

The aspect of getting old we all fear most is not death. It is disability to a degree that makes nursing home care necessary.

As a society, we are judged by the manner in which we treat our most vulnerable citizens - the very young and the very old. By that standard, we have set the bar relatively low.

Governor O'Malley recently signed into law legislation to determine if there is a link between nursing home ownership and the quality of care they provide. Such ownership ranges from small nonprofits to giant corporations with worldwide holdings, known as private equity firms.

Beginning in 2000, these huge private equity firms began buying nursing homes. The Carlyle Group, a private equity firm, paid $6 billion in December 2007 to purchase HCR Manor Care nursing homes.

Of Maryland's 233 nursing homes, HCR Manor Care owns 14.

This year, two Maryland nursing homes, Manor Care Rossville, owned by the Carlyle Group, and the Waldorf Center, owned by Formation Capital, were placed on the national federal watch list. This means that instead of one yearly inspection, these homes will have to undergo two yearly inspections and be subject to possible penalties.

According to a Service Employer International Union - SEIU - study, buyouts of two other nursing homes in the State have led to violation of state and federal law and paved the way for the creation of new business structures that limit the nursing home's liability and make it more difficult to track how federal Medicaid and Medicare funds are spent. Stephen Lerner, a spokesperson for SEIU, said, "Private equity (ownership of nursing homes) is corporate greed on steroids - how that melds with patient care is hard for us to figure out."

According to Wendy Kronmiller, director of the State Office of Quality Care, a task force with membership that includes representatives from nursing homes and consumer groups will examine and analyze data to see if there is a ling between ownership and quality of care.

Charlene Harrington, a professor at the University of California, referring to the Maryland task forced study, stated, "I am not sure they need to do another study." Professor Harrington asserted that national studies, with which she is familiar, reveal that for-profit nursing homes operate with lower cost and less staff than nonprofit nursing homes, which operate with larger staff and provide higher quality care.

Voices for Quality Care has been urging Congress to pass legislation requiring more transparency in nursing home ownership. The Group has noted a Nursing Home in Southern Maryland that has a high number of state and federal violations.

It is difficult to determine how ownership of some nursing homes are structured and who is responsible for what. Tracing corporate responsibility through layers of limited liability corporations is like pealing an onion. According to Jason Frank, Chairman of the Elder Law section of the Maryland State Bar Association, these complicated structures make it hard for nursing home residents to identify who to sue for poor care.

We owe our seniors who must seek nursing home care a better deal. As I see it, the further away nursing home ownership and liability get, the more likely it is that the quality of care will suffer. We cannot depend on huge corporate entities with worldwide holdings to be too concerned with nursing home quality of care. These businesses are concerned with profit, many times to the exclusion of what has to be done or not done to turn that profit. At the very least, Maryland has the responsibility to nursing home residents to pin down who the owner is and where the ultimate responsibility for care rests.

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