Nursing Home Evictions: What this could mean for OT

Nursing Home Evictions: What this could mean for OT

Recently NPR ran a story discussing evictions from nursing homes and that this is causing patients to have costly hospital stays. The story focuses on one individual, Bruce Anderson, who began living in a nursing home after he suffered a brain injury due to oxygen loss during a heart attack. He had lived in a California nursing home until he was hospitalized for pneumonia. After his hospitalization, the nursing home told Anderson’s family that he would not be allowed to return to his home this has led to Anderson living in the hospital for 9 months. To read or listen to the original story follow this link: http://www.npr.org/sections/health-shots/2016/02/25/467958665/nursing-home-evictions-strand-the-disabled-in-costly-hospitals

The Issue

There are federal laws in place that are supposed to protect nursing home residence from being forcibly removed from their homes and placed into hospital care; this includes refusing to allow patients back into their home after a short hospitalization. Unfortunately these laws are not being enforced; there are no measures in place that will penalize these actions. Even when the state of California ruled that Anderson needed to be allowed back into his home, the nursing home did nothing.  This is an issue not only for individuals and their families but taxpayers as well, who are going to be responsible for covering the much more expensive cost of a long hospital stay rather than a nursing home.

System that should address the issue

The federal laws that have been put in place are not being enforced at the state level, this means it is necessary for federal enforcement of the laws. The Department of Health and Human Services Office of Civil rights is responsible for enforcing items such as HIPPA, and discrimination violations and this issue should be treated similarly.  The elderly and disabled are an at risk population and if laws are not being upheld at a state level, laws must be created instituting a penalty that will be enforced by the Office of Civil rights.  

It is also important to note that one potential reason to evict a client is to replace a client who requires a great deal of time in terms of care and services with an individual who requires less time and services and is therefore a more lucrative client; nursing homes may also be turning out Medicare and Medicaid clients, who bring in less money, in hopes of filling that space with someone who will be using private insurance and bringing in more money. This is discrimination based on a disorder or socioeconomic status and it is within the scope of DHHS to step in.  

How can we support the creation of this policy?

Data needs to be collected in order to determine exactly how frequent this occurrence is, according to NPR there are between 8,000 and 9,000 patients that make this complaint annually. It will then be important to look at the costs that were created as a direct result of the eviction through long-term hospitalizations compared to what would have been spent in skilled nursing.  It is also important to look at the quality of life of these individuals who are being displaced from their homes.

Implications for OT

Evicting individuals from a nursing home may be completely barring them from receiving appropriate OT services. In the NPR article the focus was on Bruce Anderson; using this example of an individual who suffered an anoxic brain injury four years prior, this patient will not be appropriate for receiving OT in a hospital setting where the goal is to have an individual medically stable and prepared to transfer into their homes. In a hospital setting the priority will be given to individuals who have a medical need for OT services, and Bruce will receive very little enrichment or stimulation. Little enrichment or opportunity for occupation means that Bruce will have very little opportunity to perform meaningful occupations, this can negatively affect his sense of self and his quality of life. The same would be true of other patients who is displaced and required to stay in the hospital unnecessarily. In addition to this, depending on the presentation of Bruce’s injury he could begin to lose the ability to perform movements or specific tasks because he spends so much time sedentary.

If Bruce does qualify for OT services in the hospital, the resources necessary for him to practice his activities of daily living may not be readily available or the setting may be so different that any of the skills learned will not carry over to his home outside of the hospital.  For the therapist, this would also mean working with a client who is medically stable and this could take time away from patients who are in need of more intensive therapies. For the OT this also means working with an individual who is very dissatisfied with their environment and living situation. If Bruce were in a nursing facility he would be able to receive enrichment and OT services that can help to increase his ability to be independent as well as offering some meaning and enjoyment to his daily life. Having these patients placed in more appropriate long-term care is also helpful for practitioners who can create a more appropriate treatment environment and will be better able to address the needs of their whole clientele.