How to Improve Nursing Home Care

Tammy Bowman and her husband. Ms. Bowman’s sister died in an Indiana nursing home that did not isolate residents suspected of having Covid-19.
Johnathon Kelso for The New York Times

To the Editor:

How Nursing Homes Hide Their Most Serious Lapses” (front page, Dec. 10) exposes conditions in nursing homes, issues with their regulation and the underlying problems with the care of our seniors. The examples cited are believable, but might it have been more balanced to include the good work done in these settings?

If it were easy to care for elderly people with significant health, memory and behavior problems, more of us would be keeping our frail parents at home with us. If it’s not possible for us to do it, it’s certainly not simple for nursing homes to care for many such people.

It’s even more of a problem that their overworked staff are paid so little. Other than spending more to increase staffing at these places, what else could we do? Might we pay staff members based on the quality of care they give? Could each of us volunteer to help at our local senior facilities four hours a week?

Might some seniors do well in smaller “group home” settings? Could society better support families that keep their elderly relatives in their homes? Could we admit more immigrants specifically to help care for our parents?

I don’t excuse egregious lapses in care, but do we expect perfection from nursing homes? Think it’ll be better when you’re 90?

Jesse Samuels
West Hartford, Conn.
The writer is a retired family physician.

To the Editor:

I strongly commend “How Nursing Homes Hide Their Most Serious Lapses.” This is not a new issue. I testified before the Senate Finance Committee in July 2019 and noted that according to the Department of Health and Human Services’ Office of the Inspector General, skilled nursing facilities failed to report an estimated 6,600 instances of potential abuse or neglect to state agencies in 2016 alone.

One contributing factor is staffing shortages. A strong reason for the Senate to pass the House version of the Build Back Better Act is the act’s provisions that would provide funding for increased wages, tuition assistance and other incentives to attract qualified staff.

One of the hardest decisions for any individual or family to make is to determine that a loved one requires nursing home care. The federal government must provide these consumers with reliable information on nursing home quality. Further, only facilities that are free from abuse and neglect should be permitted to participate in either Medicare or Medicaid.

Bob Blancato
Washington
The writer is national coordinator for the Elder Justice Coalition.

To the Editor:

My wife and I are 86 and currently live in a nonprofit continuing care residential community in Tallahassee, Fla. Your article comes across as a generalized indictment of nursing homes. We observe interactions of staff and residents regularly. The management and staff have an incredibly difficult agenda to manage these days.

Resident care and solvency are necessarily at the top of their agendas. Failure on one can lead to failure on the other. The most difficult problem they have is attracting, training and retaining high-quality staff. Constant interaction with often unruly residents continuously tests the limits of the staff’s physical and mental endurance. Adding to the woes is the seemingly unrelenting public and official scrutiny of the business.

Peter D. Hunter
Tallahassee, Fla.

To the Editor:

Your investigation revealing that more than 2,700 dangerous incidents in nursing homes identified by state inspectors were never publicly disclosed was timely and needed.

I had a friend who worked as an administrator in a nursing home and regularly reported to us how corrupt and dishonest the place was. To maximize profits, it operated with too few staff members at all levels, which impaired services and quality of care. His protests and that of the head nurse went unheeded by the owners/operators, leading to his resignation. The state had its usual level of inspection and monitoring, which allowed deficiencies of care to go on.

I have had aged relatives in a facility in another state. There, too, apparently, there are ongoing staff shortages and diminishing quality of food and other services — plus, during Covid, way too many violations of masking, vaccination and testing standards.

I hope and pray I never am subjected to this sorry end-of-life situation.

Lynn Means
Huntington, N.Y.

Claire Merchlinsky/The New York Times; photograph by Karjean Levine/Getty Images

To the Editor:

I first discovered the works of bell hooks as a middle schooler looking to fill my spare time with feminist literature. The book “Feminist Theory” (1984), criticizing white feminism, immediately stood out to me for its direct writing style. It didn’t take long for me to obtain dog-eared copies of her other books, all of which left me in awe, and established bell hooks as one of my favorite authors.

Reading Kovie Biakolo’s Opinion guest essay “It Was bell hooks Who Taught Me How to ‘Talk Back’” (Dec. 27) helped me realize the influence that bell hooks has had on me in light of her recent death. Ms. hooks has encouraged generations of young women to speak out against oppression. I am now a high school freshman, and I am confident that the strength of Ms. hooks is something that I will remember as a staple of my girlhood.

Sriya Tallapragada
New Providence, N.J.

Marco Bello/Reuters

To the Editor:

Why would Donald Trump run in 2024? He already controls the Republican Party from the shadows with less transparency than if he were president.

As a private citizen he is free to do what he likes with his money and to advance his agenda through congressional surrogates without taking an oath to defend the Constitution. It seems to me that he can do more damage from Mar-a-Lago than he could from the White House.

Lawrence Weisman
Westport, Conn.