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USA TODAY Network-Florida

Regulators aren’t holding nursing homes and their employees accountable when their residents are abused or knowingly neglected. Floridians must demand change.

A series of realistic policy solutions will save lives and prevent suffering among residents of the worst nursing homes in the state. The governor and state legislators should take the lead.

In 2018, a USA TODAY Network-Florida investigative team — Melanie Payne and Ryan Mills — documented atrocities at these nursing homes in a series of stories that concluded that even when someone dies, regulators don’t often follow through.

The blame lies with the state's primary regulatory agency — Florida's Agency for Healthcare Administration, called AHCA. The agency’s goal is compliance, not punishment. But nursing homes aren’t complying.

In five years, inspectors found 7,200 violations in 54 of the worst homes in the state. Lawsuits were filed — and many settled — as a result of 191 deaths at many of those homes because of abuse and neglect. The deaths are significant, but other offenses are just as hard to stomach. Our articles describe one neglected patient who suffered from rotting genitals because he wasn't bathed; he eventually died. What good did a promise of compliance do for him and his family? Another patient died vomiting her own feces.

More: Neglected: Even when staffs cause patient deaths, Florida nursing homes face few penalties

Our investigative report showed there are enough cases documented to warrant closing down many of these 54 homes. Yet, only two out of the approximately 680 homes AHCA regulates have been shut down since 2013. In 2017, AHCA had no choice but to shut down Hollywood Hills nursing home after 12 people died following extreme heat exposure after Hurricane Irma knocked out the power to the air conditioning.

Based on the findings of the USA TODAY Network investigative report, here is what needs to change:

More: Neglected: Could review teams prevent deaths of elderly patients by Florida nursing homes?

Treat abuse and neglect seriously. Put a system in place where similar rules are used to investigate deaths at nursing homes that are used to investigate the death of a child where there is evidence of possible abuse or neglect.

Close down repeat offenders. If a home has multiple deaths due to neglect, it should either be closed immediately or the state should force an ownership change. There should be zero tolerance for a pattern of repeated abuse. The nursing home should be given ample time to relocate patients, and required to relocate them safely, but the days of excusing homes for repeated neglect must end.

More: Why our nursing homes are helping, not neglecting people

Increase fines levied by state agencies, especially for nursing homes that rack up multiple violations. Currently, the average state fine is about $5,000 for a severe violation, and many violations don't carry fines at all. Federal fines are much more substantial — averaging about $27,000 — but seldom levied. A $5,000 fine is nothing for nursing homes that rake in millions from Medicaid and Medicare reimbursement. The offending homes simply pay the small fine and move on. If patient neglect is proven, the fines should be based on the severity of the neglect and be significant.

Prosecute the worst offenders. We call on local law enforcement agencies to file charges and state attorney offices to prosecute those who intentionally abuse or wantonly neglect. Documented cases — such as a woman who died after she was dropped and suffered five broken bones, then was put back in bed by nursing home staff and not taken to a hospital for a day — should be actively pursued by law enforcement. Most of the 191 wrongful death cases were pushed into civil court and many of them settled from 2013-17.

Increase vigilance. Inspect low performers more often, not just once a year or when there is a complaint.

Overhaul regulations. The state needs to revamp its regulation system. There is a significant problem when there are so many repeat violators. Any change in regulations is going to require bipartisan support, especially from key members of the Senate appropriations subcommittee on Health and Human Services, including Sen. Aaron Bean, R-Jacksonville, chair of the committee, and Sen. Kathleen Passidomo, R-Naples, a member of the committee and Senate Majority Leader.

More: Most Florida nursing homes don't have generators, despite new requirement after Irma deaths

Increase transparency. It should be mandatory that all preventable or suspicious deaths at nursing homes are investigated and thorough reports filed with respective agencies. Those reports should also be available for public review. The reports should include how the patient died and eventually updated with any action taken to correct the problem. Information should be posted on state and federal government websites and be easily accessible to those seeking the details.

Invest in better care. Find federal and state money to increase Medicaid payments. They are often inadequate to cover the costs of care.

Expand the state's Long-Term Care Ombudsman Program. Specifically, it should provide more volunteers to monitor the care provided to nursing home residents, investigate patient complaints and advocate on their behalf. The volunteer ombudsmen identify and help resolve problems in nursing homes that adversely affect the health, safety, welfare or rights of nursing home residents. They are often the eyes and ears of residents who don’t have family to advocate on their behalf.

Give incentives to those who will work in nursing homes. Make it more attractive for those wanting a career in health care to work at nursing homes. Few want to empty bed pans for the going rate of $11 an hour. State colleges and universities, along with the government agencies, should be working together to offer academic and pay incentives to bring qualified individuals into nursing homes. Patient neglect can be tied to a lack of staffing for many homes, so it is in the best interests of the patients, the nursing homes and potential employees to offer attractive compensation packages.

Invest in home health. The state needs to divert some money from nursing homes to in-home care. According to the Center for Independent Living, providing an elderly person with daily living assistance — such as fixing meals, assisting with personal care and hygiene, medication reminders and housekeeping — costs three times as much in an institution as it does in a person's home. But Florida lawmakers continue to be influenced by for-profit nursing home operators who need the money to keep their homes profitable.

Florida needs nursing homes. They serve an important role as our families and neighbors age. If we’re too cavalier about shutting them down, there will be no place for people to go. But we must demand the highest standards of care for people who can’t care for themselves and ensure nursing home operators are held accountable to meeting those standards.

State and federal agencies must improve regulation and stop the cycle of death. Protect patients rather than try to coax compliance.

It is time to put an end to ghastly reports like that of Coleman Felts, a Vietnam veteran found dead, face down, floating in a pond next to his nursing home; Dolly Moore whose head swelled to the size of basketball after test results showing an infection were either forgotten or ignored; and York Spratling, whose hygiene was neglected for so long that his genitals rotted and had to be cut away.

Speak to your state legislators on behalf of those families and your own.

The News-Press Senior Engagement Editor Tom Hayden wrote this editorial on behalf of the six editorial boards across USA TODAY NETWORK-Florida.

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