My first exposure to the legal profession was working as a minion at a nursing home malpractice firm (under the technical job title of “intern”). Tort reform had not yet passed in Mississippi, and much of the state’s nursing home care was dismal. That meant it was booming business for nursing home malpractice suits, with our firm securing several multi-million-dollar settlements in light of the horrific care our clients received.
One afternoon, when filing behind mountains of discovery, I came across some pictures of one of our clients. The pictures showed someone neglected, covered in bedsores that developed into large open wounds on their back. The gory photos revealed that their skin had already begun to rot, and pests had nested within their body. I was horrified at how this person had been left to die, and that they died in a painful, humiliating, isolated way.
Later that summer, in a room with other interns and paralegals, we spent hours highlighting nursing home records. Every time nursing staff lied about having completed a round, we highlighted it. The little boxes of initials added up. It felt like we went through hundreds of papers. I found myself wrestling with the complexity of nursing home care — the very real pain of our clients, evidence that the staff were overwhelmed and underfunded, and the lack of long-term care options in my community.
Did the cascading, multi-million-dollar lawsuits help or hinder the problem? Within five years, the legislature passed tort reform, easing litigation pressures on facilities. That meant that families had fewer tools to seek justice. On the other hand, it prevented nursing facilities from going out of business, which in turn had further exacerbated pressures on the long-term care system in the state.
This January, Richard Mollot, the executive director of the Long Term Care Community Coalition (LTCCC), wrote an op-ed for The Post-Standard in Syracuse, New York. He praised the work of New York State Attorney General Letitia James in suing nursing facilities, seconding the idea that it’s “time to crack down on NY’s predatory nursing home operators.” Like many, he recognizes that nursing facilities are a necessary part of the long-term care ecosystem. But a lack of accountability and transparency have made it possible for facilities to “siphon resources” away from staffing shortages and patient care. He writes, “Substandard nursing home care is not inevitable.”
Repeatedly, research on what people want indicates that they’d prefer to age at home instead of a facility. Nursing facilities are widely considered a “necessary evil.” Yet when someone needs intensive medical care that a friend or family member cannot provide, or care that exceeds what is available through home-based medical services, what are the options? Could NAELA play a role in making nursing facilities a necessary neutral? Or even, a necessary good?
Our advocacy committees, working on federal, state, and local issues, have been active in their work to end institutional bias and improve quality of care. This past year, NAELA advocates submitted comments and attorney perspectives to the federal Consumer Financial Protection Bureau about debt collection and nursing home contracts. In our chapters and at national, we monitor trends in legislation that would impact the quality of care in facilities while encouraging our society to move away from institutional bias. We offer educational programming and content through our meetings and publications on navigating the complexities of facility-based care. There’s no easy answer, but at the end of the day, there’s got to be something better than the system we have now.