This week, the Veterans Affairs Oversight Committee of the General Assembly took testimony about substandard care at the Tennessee State Veterans Home in Murfreesboro. It found that the Department of Health had cited the home with nine regulatory violations of life-threatening severity. In one case, the home had allowed a patient's bed sore to become so severe that it became infected with maggots.
Nursing home neglect and abuse is nothing new in Tennessee, and despite several press accounts of it in the past, conditions do not seem to have improved. The state would probably be the first to tell you that manpower and budgetary constraints have hindered oversight and enforcement of health regulations in the nursing home industry.
The irony of it all is that 70% of all nursing home care in Tennessee is paid for with tax dollars through TennCare. And a whopping amount it is: over a billion dollars annually.
Tennessee citizens, on the other hand, are solidly in favor of transferring care for the sick and elderly from nursing home settings to home and community based services wherever possible. Even in the best of circumstances, most people agree that the nursing home is not where they want to wind up.
It is permissible under federal Medicaid regulations for Tennessee to divert part of its TennCare dollars to home based care, and it would be cheaper to do so. But at present, despite decades-long pleas from patients rights advocates, Tennessee devotes only .6% of its budget to home care. The remaining 99.4% goes to nursing homes. This places Tennessee dead last among states which have home and community based care programs.
Why do you suppose that is? Why are we spending tax dollars from an already struggling TennCare program on warehouses for the sick and elderly?
The answer is the nursing home lobby which, dominated by a few large corporate chains of homes, exerts great power in state government. To its credit, Tennessee has begun a pilot home care program under Governor Bredesen, but it's not clear whether it will ever grow beyond its present abysmal size.