NEW YORK – Nursing homes are increasingly evicting their most challenging residents, advocates for the aged and disabled say, testing protections for some of society’s most vulnerable.
Those targeted for eviction are frequently poor and suffering from dementia, according to residents’ allies. They often put up little fight, their families unsure what to do. Removing them makes room for less labor-intensive and more profitable patients, critics of the tactic say, noting it can be shattering.
“It’s not just losing their home. It’s losing their whole community, it’s losing their familiar caregivers, it’s losing their roommate, it’s losing the people they sit with and have meals with,” said Alison Hirschel, an attorney who directs the Michigan Elder Justice Initiative and has fought evictions. “It’s completely devastating.”
Complaints and lawsuits across the country point to a spike in evictions even as observers note available records give only a glimpse of the problem.
An Associated Press analysis of federal data from the Long-Term Care Ombudsman Program finds complaints about discharges and evictions are up about 57 percent since 2000. It was the top-reported grievance in 2014, with 11,331 such issues logged by ombudsmen, who work to resolve problems faced by residents of nursing homes, assisted-living facilities and other adult-care settings.
“When they get tired of caring for the resident, they kick the resident out,” said Richard Mollot of the Long Term Care Community Coalition, a New York advocacy group.
That is often because the resident came to be regarded as undesirable – requiring a greater level of care, exhibiting dementia-induced signs of aggression, or having a family that complained repeatedly about treatment, advocates say. Federal law spells out rules on acceptable transfers, but the advocates say offending facilities routinely stretch permitted justifications for discharge. Even when families fight a move and win an appeal, some homes have disregarded rulings.
“It’s an epidemic,” said Sam Brooks, who has litigated evictions for Community Legal Services of Philadelphia. “It’s a hard thing to catch and it’s a hard thing to enforce.”
He reviewed three years of nursing home violations in Philadelphia and found only one case in which an operator was actually cited for an involuntary discharge, as evictions are known in long-term care parlance. The citation carried no fine, he said.
“It’s a risk they’re willing to take,” he said, “because no one penalizes them.”
The American Health Care Association, which represents nursing homes, defends the discharge process as lawful and necessary to remove residents who can’t be kept safe or who endanger the safety of others, and says processes are in place to ensure evictions aren’t done improperly.
Dr. David Gifford, a senior vice president with the group, said a national policy discussion is necessary because there is a growing number of individuals with complex, difficult-to-manage cases who outpace the current model of what a nursing home offers.
“There are times these individuals can’t be managed or they require so much staff attention to manage them that the other residents are endangered,” he said.
The numbers of both nursing homes and residents in the U.S. have decreased in recent years; about 1.4 million people occupy about 15,600 homes now. The overall number of complaints across a spectrum of issues has fallen precipitously in the past decade, though complaints about evictions are down only slightly from their high-water mark in 2007, the federal figures show. The share of complaints that evictions and discharges represent has steadily grown, holding the top spot since 2010.
Whatever a facility’s reasons are, involuntary discharges leave families reeling.
When John Wilson, 61, was refused readmission to St. John’s Pleasant Valley, a nursing home in Camarillo, California, the facility cited his family’s repeated complaints about his care, his son Jeremy Wilson said.
The family sued to get Wilson back into the nursing home, but even when they prevailed, the facility refused. The younger Wilson said his father, who has Lou Gehrig’s disease and is unable to speak or walk, was needlessly kept hospitalized for more than seven months until management changed and the home finally relented.
“What they look for and what they want is basically the family to drop Grandpa off at the front door and not be involved,” he said. “They don’t want anybody monitoring them, they don’t want anybody complaining. They just want to take care of that person until they die and collect that check.”
Dignity Health, the facility’s parent company, said it could not discuss the specifics of the case but that patient care and safety are the top priority.
Advocates say hospitalizations are a common time when facilities seek to purge residents, even though the Nursing Home Reform Act of 1987 guarantees Medicaid recipients’ beds must be held in their nursing homes during hospital stays of up to a week.
“You’ve got facilities that sometimes would prefer that they be rid of certain residents,” said Eric Carlson, an attorney who has contested evictions for the advocacy group Justice in Aging. But when they don’t have legal cause to move someone out, he said, sometimes “they try and take the easy way out and refuse to let the person back in.”
