12 Trial Lawyer • Winter 2023 Guarding Against Continued from p 11 informal and largely publicly unavailable “letters of understanding.” There has been a legislative response at least to the first issue, namely requiring DHS to investigate complaints brought to them. Going private The second troubling development is the entry of private equity firms into the nursing home industry. Facilities owned and operated by private equity firms have poorer safety records and higher rates of injuries and death. A working paper examining 18,000 nursing home facilities over a 17 year period found that private equity ownership increased mortality by 10%, increased prescription use of anti-psychotic drugs for residents (chemical restraints) by 50% and increased taxpayer spending per resident by 11%. Bills requiring transparency about how revenues are spent might provide for greater accountability. In New Jersey, a bill proposed this past summer (SB 2769) would require facilities to have a website where there is a link to their consolidated financial statements, ownership information, and organizational charts. https://legiscan.com/NJ/text/S2769/2022. Building access Legislation and agency practices that provide for greater access to information by the public is also helpful. In New Jersey, the Office of State Comptroller posts information on poorly rated nursing homes that are still receiving Medicaid funds. https://www.nj.gov/comptroller/ ltc/. In Oregon, there is complaint information available online. However, complaints that are not substantiated are not included on the website, and the website is often not up-to-date. Informal agreements, like letters of understanding, about deficiencies in care, are not included on the website either, which prevents the public from knowing about quality issues. Oregon requires facilities receiving Medicaid funds to provide cost reports. Perhaps Oregon should make these available online so the public can know what percentage of revenue is spent on direct care and what is spent on profit, including profit disguised as expense, like lease payments to a related corporate entity. Increasing staffing levels and providing transparency is important, but these changes, if they are adopted, will not solve every problem. Changing the culture is also important. Staff members need to be trained and supervised, and they need to be encouraged to report abuse and neglect. Administrators should be rewarded for quality care. Facilities should not hide problems but should instead pro-actively work to solve them. Bad facility culture can result in cases such as these: • The facility administration knew a medication aide was not giving resi-
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