Ohio Nursing Homes Dump Patients at Homeless Shelters

By Crystal Lindell

A woman at a Columbus, Ohio nursing home who was suffering from a painful leg fracture, diabetes, and other health problems was dumped by the staff at a homeless shelter because she drank a beer in her room.

That’s according to a 2023 inspector’s report by the Centers for Medicare and Medicaid Services (CMS), which found other disturbing incidents of Ohio nursing homes discharging older and medically fragile residents to homeless shelters.  

The Columbus nursing home, Eastland Rehabilitation and Nursing Center, told CMS it tried to get the woman into a rehabilitation program for substance use but they couldn’t find a bed. 

At the time of her discharge, she was using a walker, incontinent, and carrying a large bag of medications, according to a news report from Ohio-based Signal. 

And the story only gets worse.

The nursing home staff didn’t even bother to call the homeless shelter ahead of time to let them know that they were dropping her off. So when they left her at the homeless shelter, staff there initially refused to take her in “leaving her outside in the late-summer heat." They said they had their own 100-person-long waiting list.

According to the CMS inspector, “The [homeless shelter] staff member revealed Resident #83 was unclear of what was going on, scared, and not sure who dropped her off there.”

Eventually the homeless shelter let her into the lobby, gave her a glass of cold water and allowed her to come inside, while they called the fire department and a social worker. 

But after that, her story just… ends. None of the people involved have since been able to track her down. Administrators at Eastland did not return phone calls about the incident, according to the Signal. 

It’s a truly disgusting tale. And anyone who deals with chronic pain or other health issues should sympathize with the woman.

Medicare gives Eastland just two out of five stars in its nursing home ratings system, which is considered below average. The facility, which gets only one star for “health inspections” and “staffing,” has been fined four times over the last few years for over $300,000. 

It’s not a one-off situation either. CMS has faulted Eastland and six other Ohio nursing homes in the last few years for discharging residents to homeless shelters.

“We are starting to deal with it more and more. The facilities are so closely monitored on discharges, but yet they still try and send them to hospitals and not take them back. Or drop them off at homeless shelters,” Chip Wilkins, who heads Dayton’s Long Term Care Ombudsman program, told the Signal. 

It’s inhumane and upsetting that the only consequences the nursing homes seem to face for such a cruel act was a fine. It’s not nearly enough to deter them from doing it again. 

It’s tempting to believe that people like Resident #83 are in some outlier group. As though such a situation could never happen to you or me or someone we love. 

But the scenario is indicative of how some nursing homes treat their patients. It can happen when a resident behaves aggressively, has a substance use problem, or even if they lose their Medicare or Medicaid coverage. If you can’t pay your bills or cause too much trouble, you’re out.

Personally, I’m lucky enough to have family who I can live with now, and I’m also lucky enough that my health issues have not yet required skilled nursing care. But I’m well aware of my deteriorating body and how easily I too could end up in such a situation.

We are supposed to be human beings. We are supposed to care for each other. It shouldn’t matter if Resident #83 was drinking three 24-packs of beer a day. She still deserved medical care. All of us do.

Unless we start truly regulating medical providers to force them to actually care for their patients, situations like this will only get more common. And one day, it could happen to us or someone we love.

I have thought about Resident #83 many times since first reading the Signal article last week. I hope that she found somewhere to go. That some distant relative took her in, or that she was able to get a bed in a hospital or a different nursing home. But I know that the most likely outcome is that she died, alone and scared. 

It’s horrifying and it should never be allowed to happen.

Opioid Prescribing Down Significantly for U.S. Nursing Home Residents

By Pat Anson

Opioid prescribing to U.S. nursing home residents declined significantly over the past decade, the latest sign that efforts to limit access to opioid medication are impacting patients who need them for pain relief.

Researchers at University of California San Francisco (UCSF) looked at health data for nearly 3 million Medicare beneficiaries and found that the likelihood of nursing home residents receiving a prescription opioid fell from 48% in 2011 to 33.5% in 2022. 

The chances of a resident receiving a high daily dose above 50 morphine milligram equivalents (MME) also declined, from 25.1% to 21.9%. 

Over half of nursing home residents have chronic pain from arthritis, osteoporosis, degenerative disc disease and other age-related conditions. The average age of residents in this study was 84.

“We weren’t expecting to see a decline, especially for people who are actually reporting high incidence of chronic pain,” first author Ulrike Muench, an associate professor at UCSF School of Nursing, told the San Francisco Chronicle. “It might be a good thing that opioids are used less, but at the same time it raises concerns about potentially untreated pain for individuals who are in need of pain medications.”

The study is believed to be the first to examine opioid prescribing to nursing home residents after the release of the CDC’s 2016 opioid guideline. Although that voluntary guideline was intended only for patients being treated for chronic pain by primary care providers, it essentially became the default guideline for all patients and doctors of every specialty.

Opioid prescriptions to nursing home residents were falling even before the CDC guideline was released, with the decline affecting every racial and ethnic group. 

Opioid Prescribing to U.S. Nursing Home Residents

JAMA INTERNAL MEDICINE

“These reductions parallel national patterns in primary care and may reflect implications of opioid-related policies, such as the 2016 Guideline, extending beyond their intended setting. Some residents may have benefitted from opioid reductions, but others may face barriers to adequate pain control,” researchers reported in JAMA Internal Medicine.    

“We also observed that minoritized residents were consistently less likely to receive opioids and higher daily MMEs, suggesting that prescribing decisions may not be based solely on clinical need.”

White nursing home residents were significantly more likely to be prescribed an opioid for pain than residents who are Black, Hispanic, Asian or Native American, even though minority residents are more likely to have severe pain.   

Previous studies have also documented declines in opioid prescribing to cancer patients, as well as seriously ill patients in palliative or hospice care  – groups that were supposed to be exempt from the CDC guideline.