Background to the Pleasant View Nursing Home story

   
    Yesterday the death count from the Pleasant View Nursing Home reached 24.  I thought it might be useful to have some background on nursing home care in Maryland to see how we got to this point.
    Back in the 1970's the long term care system in our country was going through a change in how Medicaid was paying for care.   Nursing home care up to the 1970's was often provided by "mom and pop" operators.  We had a long term care system that was divided into three levels of reimbursement, skilled, intermediate and domiciliary care.  Each was reimbursed differently with skilled care the highest and domiciliary care the lowest.
     In the 1980's for-profit healthcare companies saw the potential of operating nursing homes as a growing business opportunity and nursing homes started to be run more like a profit-making business with healthcare decisions becoming secondary to business decisions in its operations.  When this change occurred the old mom and pop operators had to decide how to continue operating with this new competition.  Some started to operate as just domiciliary care facilities and others tried to upgrade their operations to meet the new standards for Medicaid reimbursement.  In many cases, this required them to increase staffing levels.  Because they were operating with lower profit levels they struggled to just maintain adequate staffing levels.
    Back in the 1990's one of my responsibilities was to be the Nursing Home Ombudsman for Howard County.  The State of Maryland was developing this program in response to stories of inadequate care in nursing homes.  In this role, I regularly met with families who had a relative being discharged from the hospital and had to quickly identify a nursing home.  I realized that my information was limited.  I decided to try and visit a number of nursing homes that eventually grew to number over 50 nursing homes in our area.  I also visited the Maryland Department of Health to review the licensing reports on the nursing homes that I visited.  I had to go to a storage facility in Timonium to review the reports.  The person at the facility told me that no one ever came to look at the reports filed there and wanted to know why I wanted to look at the reports.  A side note to this is that I can tell you the exact date that I went there.  October 17, 1983.  The day after the Orioles won the World Series.

    One of the homes I visited was Pleasant View the name coming from it being perched on the top of a hill overlooking Route 70 in Mount Airy.  Reviewing the licensing reports I learned that the home had been cited for inadequate staffing on a regular basis.  After having visited many of the newer "corporate-type" nursing homes, Pleasant View reminded me of the older "mom and pop" homes.  What distinguished the two types of homes?  It was that they accepted new residents who were on Medical Assistance.  The difference in revenue from private paying residents and what Medical Assistance paid was substantial---often twice as much.  The higher the percentage of residents on Medical Assistance the more likely a home skimped on staffing and the care you received in the home.  In the United States the care you received in nursing homes, like many other things, depends on your level of income.  It didn't surprise me to hear that the virus struck a nursing home like Pleasant View.  The poor generally suffer disproportionally with any tragedy.

P.S.
Gov.Hogan appoints a nursing home task force.