Pursuit of profit leads to increase in infections in nursing home residents
Wednesday, May 4, 2011
An understaffed nursing home can be hazardous to your health if you’re a resident there. The latest evidence comes from a study conducted by researchers at the University of Pittsburgh‘s Graduate School of Public Health, published in the May issue of the American Journal of Infection Control (AJIC).
The study found “a strong correlation between low staffing levels and the receipt of an infection control deficiency citation” at nursing homes, according to a news release from the Association of Professionals in Infection Control and Epidemiology, publisher of APIC. And infections are the leading cause of death in nursing homes, according to the release, responsible for nearly 400,000 deaths per year.
Inadequate staffing levels leave the people who are working with too much to do, and that seems to be what leads to the increase in infections. “With low staffing levels,” wrote the authors of the study, “these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene.”
The researchers found the percentage of nursing homes nationally that received deficiency citations for infection control from the Centers for Medicare & Medicaid Services (CMS) was 17.3% in 2007 — more than one in six. And that percentage was up sharply from 12.9% in 2000. The increase comes as no surprise when you know the study also found a strong correlation between infection citations and nursing homes’ for-profit status. Investment groups began gobbling up nursing homes over the past decade; CMS data shows the percentage of nursing home nationally that are operated as for-profits rose from 65.6% in 2004 to 67.4% in 2008.
As far back as 2001, a University of California, San Francisco study found “for-profit nursing homes are much more likely than their non-profit counterparts to be cited for deficient quality”; similar findings came from a federal study in 2008. (This 2007 New York Times story by Charles Duhigg describes how for-profit operators cut staffs after taking over non-profit nursing homes.)
Infection rates can be reduced all the way to zero, with proper procedures. But those procedures take time to execute. As Tina Rosenberg wrote on The New York Times‘ web site, hand washing “has to be done dozens or hundreds of times a day by busy health care workers who may be doing two or three things at once and have their hands full of supplies.” It’s harder to keep your hands clean when your workload is increased as the result of understaffing.
There are good reasons why California and other states have minimum staffing requirements for nursing homes — and why there are penalties for failure to meet those requirements. The risk of spreading lethal infections is one of those reasons.