Nursing Home Costs Rise as Residents Lose Legal Protections

nursing home abuse

The price of nursing home care is rising at a much faster rate than other medical care, according to a recent study. The bigger out-of-pocket price tag is coming from an industry reeling from weekly headlines of abuse, neglect, and sexual assault. Private, non-profit, and Veterans Affairs (VA) nursing homes have all been implicated in behavior that is completely unacceptable.

Still, people are forced to pay more. Researchers from Georgetown University Medical Center found that annual out-of-pocket costs for nursing home care could easily top $70,000.

“Not many people have those kind of resources,” said Sean Huang, lead author of the Georgetown study, “and so it is important to understand how fast prices grow and how they vary.”

Costs differed widely from state to state. Per year, Texas nursing homes averaged approximately $48,000 in out-of-pocket expenses, whereas facilities in New York state cost more than $120,000.

According to Huang, only a small fraction of people have sufficient long-term care insurance to cover these types of payments. Instead, people who need nursing home care often “pay out of pocket until they run out of money.”

Well over 1 million Americans are residents of nursing homes. Millions more are projected to need long-term care services in the coming decades. The point of a nursing home is to help seniors live their lives in comfort. Instead, facilities are obliterating the life savings of families and, in too many cases, injuring and killing residents due to abuse and neglect.

In addition to staggering prices and concern for their safety, residents, and families considering long-term care now have to make life-altering decisions with fewer legal protections in place.

Nursing Homes Want Residents to Forfeit Their Rights

In July, the Centers for Medicare & Medicaid Services (CMS) announced a new final rule that lifts a ban on pre-dispute, binding arbitration agreements. If someone signs such an arbitration agreement as part of their contract with a nursing home, they give up their right to sue, regardless of what happens.

It’s how an 87-year-old nun was raped in her locked bedroom at a nursing home, and then disallowed from having her day in court. In the standard contract she signed – deep within the small-print legalese – was a clause that stripped the woman of her Seventh Amendment right to a trial.

What should have been an open-shut case was instead solved by an arbitrator. The facility was acquitted, the victim was silenced, and the attacker was never held accountable by the public. In the arbitration, hearsay from other employees was used as evidence to discredit the elderly witness. Such “evidence” would have been thrown out by a judge.

New Rule Lets ‘Criminals and Substandard Caregivers Off the Hook’

It’s easy to see why nursing homes favor arbitration. CMS has said that the final rule “puts patients over paperwork,” and supports individuals’ rights to make informed choices about their long-term care.

Critics of the new rule, which will take effect in September, see it as a dangerous gift to the industry. In his statement at a Senate Finance Committee hearing on “Protecting Americans From Abuse and Neglect in Nursing Homes,” Senator Ron Wyden of Oregon lamented:

“[W]henever I hear the Trump administration throw around the phrase ‘patients over paperwork,’ I think of how they’re letting criminals and substandard caregivers off the hook when they hurt vulnerable seniors.”

In their response to public comments, many of which echoed Wyden’s fears about the shadowy world of arbitration, CMS has said that the new rule has addressed all concerns.

As part of their revision to the final rule, nursing homes must, “Not require that a resident or his or her representative sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility.” The intent here is to make sure that no one is forced to choose between care and signing away their rights.

In addition, there is language in the new rule that ensures people will understand any agreements clearly and also prohibits nursing homes from preventing or discouraging people from seeking help from local, state, and federal officials.

The New Rule Does Not Put Patients First

The nursing home industry is certainly happy — CMS estimated arbitration would eliminate an “excessive burden” and save $616 Million in administrative costs for facilities. Will this savings result in lower costs and improved conditions for consumers? Or, will the excess cash make its way into the pockets of the people paying for this favorable legislation?

Lobbying groups for nursing homes and hospitals spend millions each year to make sure that rules are favorable for their businesses. Industry gets to keep more money while the people they serve must deplete their savings to pay their bills. None of this makes sense. It’s not the ultra-profitable companies who have the “excessive burden” in today’s healthcare climate.

“I spent a lot of time visiting people who lived in sordid conditions, who needed a lot of help just to get through the day, who were victims of scams and abuse,” Widen told Senate colleagues in his closing remarks. “For me, those memories still serve as a reminder that the job of working to ensure seniors have a dignified retirement is never complete.”

A dignified retirement does not mean starving your family of resources. It does not mean signing away your rights. Protect yourself and your family by learning more about nursing home abuse and your legal options.

Author:Sokolove Law
Sokolove Law

The Sokolove Law Content Team consists of writers and editors who work alongside the firm’s attorneys and case managers. The team strives to present the most accurate and relevant information for those who need legal help.

Last modified: July 29, 2019

View 8 Sources
  1. Center for Disease Control, “Nursing Home Care.” Retrieved from https://www.cdc.gov/nchs/fastats/nursing-home-care.htm. Accessed on July 27, 2019.

  2. Center for Medicare & Medicaid Services “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities Arbitration Agreements (CMS-3342-F).” Retrieved from https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-revision-requirements-long-term-care-facilities-arbitration. Accessed on July 27, 2019.

  3. Center for Medicare & Medicaid Services “CMS Rules Put Patients First Updating Requirements for Arbitration Agreements and New Regulations That Put Patients Over Paperwork.” Retrieved from https://www.cms.gov/newsroom/press-releases/cms-rules-put-patients-first-updating-requirements-arbitration-agreements-and-new-regulations-put. Accessed on July 27, 2019.

  4. Federal Register, “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements.” Retrieved from https://www.federalregister.gov/documents/2019/07/18/2019-14945/medicare-and-medicaid-programs-revision-of-requirements-for-long-term-care-facilities-arbitration. Accessed on July 27, 2019.

  5. Georgetown University Medical Center, “Nursing Home Care Cost Significantly Outpaces General Inflation and Medical Care Prices.” Retrieved from https://gumc.georgetown.edu/news-release/nursing-home-care-cost-significantly-outpaces-general-inflation-and-medical-care-prices/. Accessed on July 27, 2019.

  6. Human Rights Watch, “US Rolls Back Protections for Nursing Home Residents.” Retrieved from https://www.hrw.org/news/2019/07/25/us-rolls-back-protections-nursing-home-residents. Accessed on July 27, 2019.

  7. Time, “An 87-Year-Old Nun Said She Was Raped in Her Nursing Home. Here’s Why She Couldn’t Sue.” Retrieved from https://time.com/5027063/87-year-old-nun-said-she-was-raped-in-her-nursing-home/. Accessed on July 27, 2019.

  8. United States Senate, Committee on Finance, “Protecting Americans From Abuse and Neglect in Nursing Homes.” Retrieved from https://www.finance.senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-neglect-in-nursing-homes. Accessed on July 27, 2019.