The Obama Administration saw a lot of improvement when it came to easier access to medical services, especially for low-income households. In the past, those who could not afford insurance, and much less expensive medical procedures, had a harsh reality of the unforgiving medical system in years past. However, with the arrival of Obama’s Medicare and Medicaid programs, virtually anyone could enjoy government-subsidized healthcare services regardless of their economic status.
While citizens now didn’t necessarily have to perform fundraising campaigns to cover for health problems that could’ve been solved had they been able to afford insurance, these programs also came with their fair share of flaws.
Nursing homes have always been the center of controversy when it came to positive patient treatment and caregiving. While these facilities have always served as great supports for senior citizens with degenerative, chronic, or terminal illnesses, as well as a great assistance for families who can no longer look after their loved ones, they are sometimes known for their negligent practices towards their patients, which is a problem the Obama Administration meant to address.
President Barack Obama proposed several guidelines, including the use of fines towards nursing homes to address and punish negligent practices of their personnel towards their patients. However, when the former president’s term ended and was replaced by the Trump administration, the nursing home industry submitted a formal request to the new president in order to scale back the use of fines proposed by Obama.
While negligence in nursing homes was definitely reduced through the fines established in the Obama Administration, the professional and medical growth in these centers stagnated as inspectors would focus excessively on catching wrongdoing and malpractices, instead of providing constructive criticism helping nursing homes improve.
In a letter addressed to President Trump from Mark Parkinson, the president of the American Health Care Association, the man stated that relief from these penalties are critical for the improvement of the industry, as inspectors were focusing too much on putting fines, instead of working alongside nursing homes to improve their services.
Since the year 2013, 3 years after the Patient Protection and Affordable Care Act was passed, federal records show that almost 6,500 nursing homes have been cited at least once for a serious violation. This number constitutes almost 4 out of 10 nursing homes currently operating in the United States, and the number of facilities that have been formally fined is almost two-thirds. The most common citation reasons revolved around failing to protect patients from avoidable accidents, as well as mistreatment, bedsores, and general neglect.
The new guidelines proposed by President Trump, in hopes of reducing these penalties, aim to discourage regulating agents from levying these fines in some situations, even when they sometimes may lead to a patient’s death. These new regulations might also lead to lower fines for many nursing homes in the country. These changes in policy coincide with the president’s message to campaign for less bureaucracy, regulation, government intervention in citizen’s businesses.
Dr. Kate Goodrich, the director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), and in alignment with President Trump’s modifications stated that an excessive amount of government regulation was the main source of conflict between healthcare providers and federal officials. She also says that, in efforts to comply with countless government regulations, healthcare providers are spending less time caring for their patients, without actually improving the quality of the service they give.
Despite the perceived improvements that these new guidelines will bring, there are those who refuse outright the changes proposed by Trump, as some state that, by reducing penalties and fines, the government is basically stripping patients of a valuable tool which was originally put in place to guarantee their safety. Toby Edelman, a senior attorney at the Center for Medicare Advocacy, claims that [they] basically emasculated enforcement, which was already weak enough.
Currently, Medicare has several different ways in which to apply penalties. For starters, it can emit fines for a particular violation. It can also assess and assign a fine for each day that the nursing home was in violation. Finally, it can deny funding for new admissions as well. With these modalities, the average fine in recent years was of $33,453. However, some nursing homes have accumulated federals fines, which surpass the $100,000 mark. Furthermore, in 2016, Congress increased accumulated fines to nursing homes to compensate for numerous years of inflation.
Since then, Trump’s new guidelines had been enacted gradually.
In October 2017, CMS had discouraged regional inspection offices from levying fines for one-time offenses, even if said offense had led to the patient’s death. Nevertheless, the new system frowns upon intentional negligence and punishes it to the full extent of the law. Moving on, in July, a memo from the CMS addressed to the directors of the regional agencies that survey nursing homes stated that fines for daily violations should be discouraged, and instead a one-time fine needs to be emitted for violations which were discovered to be happening before an inspection. Nevertheless, daily fines are still the penalty of choice for ongoing violations that are discovered in subsequent investigations.
These new guidelines are in place to shelter nursing homes from excessive fines, which will be limited to the maximum per-instance fine of $20,095, even for serious offenses.
Nevertheless, those who advocate for the rights of nursing home residents are enraged by these new guidelines, as they say that, by relaxing the penalties for negligence, a great threat to the progress achieved by the Obama Administration at deterring wrongdoing in these centers is perpetrated. According to Janet Wells, a consultant for California Advocates for Nursing Home Reform, the penalties imposed by the former president Obama served to finally penalize negligence in nursing homes at a level that gets the industry’s attention, instead of slightly shifting down the bottom line of private businesses that are, ultimately, just ‘in it for the money’.