A recent investigation by The Guardian uncovered a secret program by UnitedHealth Group that exposed elderly patients in nursing homes to grave harm. The program encouraged nursing homes to reduce hospital transfers of residents. For some elderly patients, this scheme led to significant harm, including permanent injuries.

Incentivizing Reduced Hospital Transfers

UnitedHealth is the largest healthcare conglomerate in the U.S. The organization implemented a program that stationed its medical staff in nearly 2,000 nursing facilities. These staff members were tasked with minimizing hospital admissions, a move aimed at cutting costs under Medicare Advantage plans.

Financial bonuses were offered to facilities that successfully reduced hospital transfers. The result? A system where cost-saving measures potentially took precedence over patient care.

Delayed Care Leading to Lasting Harm

The Guardian’s investigation highlighted several cases where delayed hospital transfers resulted in severe consequences for residents.

• Case in Renton, Washington (2019): A nursing home resident exhibited classic stroke symptoms, including slurred speech and arm weakness. Despite these signs, a remote UnitedHealth medical provider advised waiting four hours and conducting a blood test before considering hospitalization. This delay potentially exacerbated the resident’s condition.
• Case in Puyallup, Washington (2019): Another resident showing stroke symptoms faced similar delays due to UnitedHealth protocols. The nursing staff, uncertain about immediate hospitalization, waited for guidance from UnitedHealth’s remote provider. Eventually, an independent doctor was contacted, but the delay resulted in the resident suffering permanent facial droop and speech impairments.

Ethical Concerns and Whistleblower Allegations

Former and current staff members have raised alarms about the program’s ethical implications. Allegations include pressure to alter patients’ code statuses to “Do Not Resuscitate” (DNR) without proper consent and the misuse of patient data for sales purposes. Whistleblowers have filed complaints to Congress and initiated lawsuits, asserting that UnitedHealth’s practices compromised patient care in pursuit of profit.

UnitedHealth’s Response

UnitedHealth has denied any wrongdoing, stating that the program aims to improve patient outcomes and reduce unnecessary hospitalizations. The company emphasized that decisions regarding hospital transfers depend on various factors, including a patient’s goals of care and the input of their care team.

However, internal records and staff interviews suggest a systemic approach to cost-cutting that may have adversely affected patient health.

Implications for Elderly Care

According to attorney Rachael Gilmer of Levin Papantonio, the study published by The Guardian exposes how profit-driven models in elder care sometimes clash with patients’ well-being. “The lack of transparency and potential ethical violations in UnitedHealth’s program call for increased oversight and accountability in nursing home care practices,” Gilmer said.

She further reinforced that the aging population means more individuals rely on long-term care facilities. According to the U.S. Census Bureau, the U.S. population age 65 and over is the fastest growing age group since 1880. Given this reality, patient health in nursing homes demands serious attention.

“The story uncovered by The Guardian serves as a stark reminder of the potential consequences when financial considerations overshadow the fundamental duty of care owed to vulnerable populations,” Gilmer added.

Understanding the Scope of the Problem

Elder abuse in nursing homes is alarmingly prevalent. The World Health Organization reports that approximately 1 in 6 people aged 60 years and older have experienced some form of abuse in community settings during the past year. In institutional settings like nursing homes, the rates are even higher, with 2 in 3 staff members admitting to committing abuse in the past year.

Neglect, a form of abuse characterized by the failure to meet an individual’s basic needs, is particularly insidious. It can manifest as inadequate nutrition, poor hygiene, untreated medical conditions, and lack of social interaction. Such neglect can lead to severe physical and psychological consequences, including bedsores, malnutrition, depression, and even death.

Signs of Abuse and Neglect

Gilmer stresses that family members and caregivers should be vigilant for signs that may indicate elderly abuse or neglect:

• Physical Indicators: Unexplained bruises, fractures, burns, or bedsores.
• Emotional Changes: Withdrawal, anxiety, fearfulness, or sudden mood swings.
• Poor Hygiene: Unclean clothing, strong odors, or unsanitary living conditions.
• Weight Loss: Sudden or unexplained loss of weight, which may indicate malnutrition.
• Medical Issues: Untreated infections, frequent illnesses, or worsening chronic conditions.

Taking Action

Gilmer urges family members to take several important steps if they suspect a loved one is experiencing abuse or neglect in a nursing home:

1. Document Everything: Keep detailed records of any signs or incidents, including dates, times, and descriptions.
2. Report Immediately: Contact the facility’s administration, local adult protective services, or law enforcement.
3. Seek Legal Counsel: Consult with a nursing home and elderly abuse lawyer to understand your rights and potential courses of action.

Preventing Future Abuse

Finally, Gilmer stresses that preventing elder abuse requires a collective effort:

• Regular Visits: Frequent, unannounced visits can deter potential abusers and allow you to monitor your loved one’s well-being.
• Open Communication: Encourage your loved one to speak openly about their experiences and feelings.
• Educate Yourself: Learn about the rights of nursing home residents and the standards of care they should receive.
• Advocate for Change: Support policies and legislation aimed at improving oversight and accountability in long-term care facilities.

“The safety and dignity of our elders should never be compromised,” Gilmer said. “By staying informed, vigilant, and proactive, we can work together to ensure that nursing homes are places of care, respect, and compassion.”

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UnitedHealth secretly paid nursing homes to reduce hospital transfers.