ARI SHAPIRO, HOST:
COVID-19 has placed a spotlight on nursing homes, which have been hard-hit by the virus. But two new national studies show that even before the pandemic, the nursing home industry was in crisis. As Gabrielle Emanuel of member station GBH in Boston reports, the numbers paint a picture of places where it's unappealing to work and risky to live.
GABRIELLE EMANUEL, BYLINE: In high school, McDavid Rodriguez spent two years training to become a certified nursing assistant. So-called CNAs are on the front lines in nursing homes - feeding patients, bathing them, helping them use the bathroom.
MCDAVID RODRIGUEZ: And I always told them, hey, if you need help, don't be scared; you know, I'm here for you.
EMANUEL: Rodriguez liked being useful, but he says the work's hard and the pay's poor. He and his colleagues would sometimes ask for a raise.
RODRIGUEZ: And they refused. They refused to increase it. And if they did, it was by a few cents. It's never been, like, a dollar - not even $1, just a few cents.
EMANUEL: After four years as a CNA, Rodriguez is now an Amazon shopper at Whole Foods, and his pay's gone up by $3 an hour.
DAVID GRABOWSKI: It's no wonder that individuals leave this workforce.
EMANUEL: David Grabowski is a professor of health care policy at Harvard Medical School. He co-authored the first national study looking at staff turnover in nursing homes before the pandemic.
GRABOWSKI: The average nursing home in the U.S. has their entire nursing home staff change over over the course of the calendar year. This is a horrible way to provide good, quality nursing home care.
EMANUEL: A second national study also presents a bleak picture. Private equity firms have been a growing force in health care, and Atul Gupta at the University of Pennsylvania worked with colleagues to find out what the impact has been. They wanted to know when a private equity firm takes over a nursing home, is it good for patients? And the answer was decidedly no. Deaths went up 10%.
ATUL GUPTA: But you don't expect to find these type of mortality effects. And so, you know, we double-checked it, triple-checked it, quadruple-checked it.
EMANUEL: And it held up. A troubling trend emerged. These homes started spending more on things not related to patient care, like interest payments, lease payments, management fees. And at the same time, the number of front-line nurses decreased. Gupta also found more antipsychotic drugs were used. He speculates that's to keep patients docile with fewer CNAs around. But some say private equity is not at fault for all the problems at U.S. nursing homes.
JAY WAGNER: The private equity is not involved in the day-to-day decision-making around these things.
EMANUEL: That's Jay Wagner. He's at the real estate services firm Cushman & Wakefield, where he focuses on senior living and skilled nursing facilities. He says one way private equity firms make money is buying a nursing home and then selling off the building. The cash goes to the investors, while the nursing home operator starts paying rent for the facility they used to own. But Wagner says even to those in private equity, the nursing home industry is pretty unappealing.
WAGNER: It's a very challenging business, candidly.
EMANUEL: So what is happening? It's not good for the staff, the patients or even the owners, necessarily. All parties blame the payment system. Medicaid pays for most nursing home care, and reimbursement rates are notoriously low. The American Health Care Association and National Center for Assisted Living, a trade group, said in a statement that these new studies expose chronic underfunding. The group says it's so bad that most nursing homes barely break even, hence the low wages and drive to cut costs. But Gupta and Grabowski have some tips when looking for a place to send a family member. Don't just rely on the government's star-rating system and its nursing home compare website.
GUPTA: I would definitely do my research on the quality of the facility or its history. Has it changed hands recently? If so, who's the new buyer?
GRABOWSKI: Talk to the staff. How long have you worked here? How long have other staff been there?
EMANUEL: And don't be swayed by the glossy ads or glass chandeliers.
For NPR News, I'm Gabrielle Emanuel. Transcript provided by NPR, Copyright NPR.