An inspection of nursing homes in Michigan found widespread problems, many of which were related to understaffing and inadequate training. Some state lawmakers are now pushing for changes.
An analysis of 3,100 inspection records, court documents and death certificates released this week by Bridge Michigan, a nonpartisan nonprofit news organization, documents thousands of serious care-related deficiencies.
Bridge has identified nearly 30 resident deaths related to suspected neglect or abuse in the past four years alone. In total, state and federal inspectors have found about 15,500 nursing home violations ranging from missing documentation to inadequate care, including at least 5,915 cases of abuse, neglect, exploitation and inadequate care over the past several years.
Facilities do not have access to funding for training
The facility was fined $21.5 million over three years and lost more than 6,400 days of Medicaid reimbursement.
While many of Michigan's 420 nursing homes provide high-quality care, inspection reports have revealed persistent understaffing and poor living conditions in others, including unsanitary conditions, malfunctioning equipment and residents being isolated or inactive for long periods. Supporters argue that the situation reflects systemic weaknesses in the country's surveillance and regulatory framework.
Michigan requires nursing homes to provide just 2.25 hours of care per resident per day, a standard that has remained unchanged for decades and is far lower than the approximately four hours recommended by experts, the report said.
Meanwhile, training requirements for nursing assistants in Michigan are among the lowest in the nation. The state has a $35 million fund aimed at improving nursing home care, funded by fines for violations, but most of the money remains unused due to too many regulations and bureaucratic hurdles, which administrators say is nearly impossible to access.
transparency gap
The study also found significant gaps in transparency. The state report does not identify the employees involved in the misconduct, making it difficult for families and even nursing home leaders to learn about employees' past records. And families often do not know that their loved one's injury or death is under investigation, the report alleges.
The situation was far worse for for-profit beds, which account for more than three-quarters of all beds in nursing homes. For-profit facilities had an average of 43 percent more citations per bed than nonprofit or government-run facilities, according to the Bridge Michigan report. Government-run housing, of which there are only 39 in the state, has the lowest number of citations and the highest number of employees.
Local nursing home advocates acknowledge that abuse and neglect are unacceptable, but argue that the regulatory system does enough to identify and penalize offenders.
“We're not building widgets…and yes, mistakes happen. And mistakes happen in all environments,” Melissa Samuel, president and CEO of the Michigan Medical Association, told the news outlet, adding that news organizations often prefer to highlight negative stories. “It's not the positive story that people want to hear. It's the ugly story. I'm not going to defend it.”
But advocates point to insufficient regulation as part of the problem, arguing that since lawmakers cut mandatory inspections from once a year to once every three years in 2015, only one minor reform to allow cameras in nursing homes has been introduced. And even that hasn't made any progress.
Following the publication of Bridge's series of articles, Michigan members of Congress, including two gubernatorial candidates, expressed interest in improving conditions. Lawmakers' solutions include bills to tighten enforcement on troubled facilities and improve pay for front-line workers.
“I'm hopeful. It's been a long time since I've been hopeful,” Allison Herschel, director of the Michigan Elder Justice Initiative and a longtime advocate for improving nursing home care, told the news outlet.
Other Michigan lawmakers said they were interested in drafting future legislation based on actions in New Jersey, which stopped Medicaid payments to nursing homes suspected of chronic neglect or abuse, and in Connecticut, where the Legislature gave the state more power to improve care.
