State lets too many nursing homes lag on dementia care

In this day and age, a nursing home that cannot provide adequate care for its residents with dementia is the equivalent of a hospital that can’t provide a safe blood transfusion or maintain sterile surgical facilities. And yet, a recent Globe story by Kay Lazar reported on glaring deficiencies in many of the state’s more than 400 nursing homes in terms of care for these particularly vulnerable patients. State regulators need to step up their efforts to enforce compliance, and nursing home facilities must see their way to obeying the law.

Dementia is a broad category that encompasses a range of loss of mental capacity — from basic cognitive skills like short-term memory, speech, and language skills, to behavior and physical coordination. Dementia can sometimes be a temporary, treatable, even reversible condition — a symptom of systemic infection, thyroid disease, or even vitamin deficiencies. Other causes of dementia, like Alzheimer’s disease, are chronic, with no known cure. Based on statements from regulators, the Globe story reported that regulators believe that more than half of Massachusetts’ 41,000 nursing home residents have some form of dementia.

Massachusetts has lagged behind other states in mandating protections for these patients, which is one of the reasons that the current report is so disturbing. The health department adopted new rules for dementia care last February but did not issue a special-care checklist until December. The new regulations require, among other things, special staff training for dementia care. Besides providing new training requirements, the new rules were meant to prevent nursing homes from advertising dementia units without that specific training, specialized activities for residents, or safety measures. Regulators have claimed that they’re overburdened by routine monitoring (including annual visits) in order to conduct spot checks for compliance. Nursing home operators, meanwhile, have complained of the added expense (sometimes tens of thousands of dollars) to upgrade their training and facilities.

These arguments won’t do. Dementia care is a crucial aspect of nursing home care. What’s more, dementia patients are especially vulnerable to the afflictions common to elder care, like bed sores and highly contagious, dangerous common infections like Clostridium difficile (C. diff.). These illnesses have a cost, too — in medical care, and human suffering. “The point . . . is not to drive people out of the business, but to improve the quality of care,” James Wessler, of the Alzheimer’s Association of Massachusetts and New Hampshire, told the Globe. But one has to wonder: if you can’t meet the minimum requirements of your field, then why are you in the business in the first place?