Lies, Damned Lies, and Nursing Homes
I was all set to cite this New York Times article on violation rates in nursing homes simply in a “Questions” entry: Shouldn’t a supposed “right to health care” include a right to violation-free nursing home care? Etc.
But I’m changing tack after having read the whole piece:
More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday.
Gee, typical “greedy capitalist bastard” behavior, right? Well of course the government-run nursing homes are going to be so much better than the private facilities — just like public schools are so much better than private schools.
Reading a little further down:
The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.
I certainly concede the arithmetic that “94 percent” is greater than “91 percent.” What I do not concede, however, is that a three percentage point differential is significant. Stated differently, hyping the margin of error in your first sentence is dubious journalism at best and agenda-driven muckraking at worst.
More:
Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.
Statistically speaking, a violation is a violation, without any distinction for differing magnitudes. But who would seriously suggest that a stray bedsore is no different than a case of abuse?
Bruce A. Yarwood, president of the American Health Care Association, a trade group, said … that the inspection system was broken. “It does not reliably measure quality,” he said. “It does not create any positive incentives.”
…
Mr. Yarwood said: “Inspectors are subjective and inconsistent. They interpret federal standards in different ways.”
That wouldn’t surprise me at all.
(Note also that the 94/88/91 metrics treat a facility with one violation no different statistically from a facility with 100 violations: those ratios are also nearly equal at 7.6/5.7/6.3. Bottom line: The data are not particularly robust except as fodder for a cheap shot at private enterprise.)
According to the article, there are already 1.5 million Americans living in 15,000 nursing homes (not including assisted living facilities). That number will only rise as the baby boom ages. Medicare and Medicaid cover more than two-thirds of them, at a cost to taxpayers of $75 billion per year. Those numbers will also only rise.
Something to ponder in between news reports about the ($700 billion) Wall Street bailout scramble.
Filed under: Socialized Medicine
The plural of anecdote isn't evidence of course, but when I was a plaintiffs' PI lawyer we sued far more state affiliated nursing homes than private, and for grosser violations of the standard of care, like strapping an Alzheimer's patient down without turning him, until he developed bedsores which became the sort of thing people search for on rotten.com.