When corporations run nursing homes the quality of care suffers

More evidence of the danger of allowing for- profit corporations to provide human and caring services to vulnerable people.

A major US study  to be published in the Journal Health Services Research has found that for-profit nursing homes deliver significantly lower quality of care than not-for- profit and government run nursing homes.

In the US the 10 largest for-profit corporate providers of hursing homes  operate about 2,000 nursing homes, controlling approximately 13 percent of the country’s nursing home beds.

The study found that the main reason that the quality of care is worse in corporate and for-profit run  nursing homes is that corporate and for- profit providers employ fewer staff  to keep costs down and profits up. In studying staffing and quality in the 10 largest corporate for profit providers of nursing homes the researchers found that the corporate providers  have a strategy of keeping labor costs low to increase profits, with the result that the quality of care suffers and there is a higher number of rated deficiencies.

The researchers found that low nurse staffing levels are the strongest predictor of poor nursing home quality.

The study found that between 2003 and 2008, both the percent of registered nurses and the numbers of all nursing staff were significantly less (30 percent) in the corporate for profit providers than the non-profit homes.  The lower staffing correlated with a considerably higher number of rated deficiencies - the private chains having 36 percent more deficiencies, and 41 percent more serious deficiencies than the non-profits.  Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

What is also troubling is that the study found that the quality of care worsened in nursing homes taken over by private equity companies. Nursing homes had more deficiencies after being acquired by a private equity company.This is directly relevant to Australia where private equity companies are increasingly involved in aged care and nursing home provision. The study is the first to make the connection between worse care following acquisition by private equity companies.

"In recent decades, nursing home chains have undergone a considerable expansion.A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses. 

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share. 

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

 The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

There is now a growing body of evidence that demonstrates conclusively that for-profit corporate run nursing homes deliver lower quality care than not-for profit nursing homes.

A study in the British Medical Journal  compared quality-of-care measurements in 82 individual studies that collected data from 1965 to 2003 involving tens of thousands of nursing homes, mostly in the United States. It found that

The authors' meta-analysis, i.e. their integration and statistical analysis of the data from the multiple studies, shows that nonprofit facilities delivered higher quality care than for-profit facilities for two of the four most frequently reported quality measures: (1) more or higher quality staffing and (2) less prevalence of pressure ulcers, sometimes called bedsores.

The results also suggest better performance of nonprofit homes in two other quality measures: less frequent use of physical restraints and fewer noted deficiencies (quality violations) in governmental regulatory assessments.

"The reason patients' quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes..... For-profit providers cut corners to ensure shareholders achieve their expected return on investment."

When the charitable sector takes money from the mining sector

Sometimes artists and charities who take money from mining companies in Western Australia give the game away.

This story Mining Company cash creates movie making boom  appeared on the ABC TV program Stateline WA on Friday November 4 and demonstrates that the primary reason for the "philanthropic" activity of the mining industry in WA is self interest.

The message is very clear- we will sponsor you but you must not speak certain truths about the industry. In other words the mining industry buys the silence and acquiesence of those it sponsors.

Listen to the journalists and artists in the ABC story who make it very clear that with the money comes conditions and the expectation is that you must show the mining industry in a favourable light.

Show the mining industry in a less than favourable light in their eyes or speak certain truths about the industry and you can say goodbye to the sponsorship.

One interviewer put it this way:

" We can't say we want you to sponsor us but the script says you are unscrupulous swines who rape and pillage the land..... they see the first draft of the script....... they don't want the industry shown in an unfavourable light..... you don't bite the hand that feeds you".

Of course this story reflects a much larger issue- the way that the mining industry and corporations in WA are using their money and power to shape the arts and cultural industry and the charitable sector to serve their corporate interests.

This article by Rosemary Neill provides an insight into the corporate takeover of the arts and cultural industry and charitable sector in WA:

In a harbinger of this, some of the country's most powerful businesspeople have teamed up with artists and launched a new, turbo-charged arts lobby, the Chamber of Arts and Culture, aimed at developing a coherent cultural vision for WA. Among the chamber's founding members are Rio Tinto iron ore chief executive Sam Walsh, prominent arts patron and businesswoman Janet Holmes a Court, former WA Chamber of Commerce and Industry boss John Langoulant, KPMG national executive director Helen Cook and former Australia Council chairwoman Margaret Seares.

An alliance of high-powered executives -- some drawn from the blokey resources and engineering sectors -- intent on proselytising for the arts is a first not just for the West but, arguably, for the nation. Walsh says this move signifies that "the state is growing; there is a need for a more creative and vibrant community and arts and culture will help us deliver that and help us attract people. I think the stars are aligned . . . we have a unique opportunity in Perth and WA's history, building on the mining boom, to work on these things." The unfailingly courteous Rio Tinto boss says the chamber has received "very strong support" from Day and federal Arts Minister Simon Crean. He stresses it is not merely an arts lobby; that it will engage with governments, the regions, schools and untapped audiences to spread the word about culture.

Corporate power, corporate criminality and secret lobbying: Goldman Sachs

It has not been a good couple of weeks for Goldman Sachs.

A report by a bipartisan US Senate Committee  into US investment banks has recommended criminal charges be bought against Goldman Sachs . Goldman Sachs and other Wall St firms were described by the Senate Report  as a "financial snake pit rife with greed, conflicts of interest, and wrongdoing." 

Goldman Sachs, the nation's fifth-largest bank by assets, systematically misled clients, sold them financial instruments it knew to be junk, bet against them and profited off of their losses, according to a Senate report released this week.

The report, the product of a two-year investigation, paints the firm as Exhibit A of Wall Street's evolution from a place that raises and deploys capital to worthy businesses into a vulturous creature that preys on unwitting investors.

Goldman's conduct in the two years leading up to the near-implosion of the financial system show a firm dedicated to "sticking it to their own clients," said Senator Carl Levin, a Michigan Democrat who chairs the panel that produced the report. "Goldman gained at the expense of their clients, and used abusive practices to do it."

In the UK a  report published  by SpinWatch UK  exposes  Goldman Sachs political and financial lobbying muscle in the UK and Brussels (The European Parliament).

The report, entitled, Doing God’s Work: How Goldman Sachs Rigs the Game details Goldman Sachs’ secret lobbying activities in the UK and Brussels and links to politicians. It exposes:

• The extensive links between Goldman Sachs and the Conservative Party;
•   Political donations totalling £8.5million to British politicians in the past decade from Goldman and ex-Goldman people;
•    Goldman Sachs’ immense lobbying machine in Brussels, including active membership of over a dozen financial sector lobby groups;
•    Extensive meetings between Goldman Sachs and Conservative MEPs including: 9 meetings in six months with a key MEP on the Parliament’s Economics and Monetary Committee; and a total of 36 meetings between just four Tory MEPs and Goldman Sachs, its lobby groups or PR companies acting on their behalf;
•   The bank’s lobbying campaign to undermine political reform on derivatives and alternative investment funds including: private dinners and unminuted "after office hours” meetings, high-level conferences and targeted campaigns to Commission officials, MEPs and their assistants;
•   How Goldman Sach’s lobbyists tried to undermine amendments in a key report on derivatives, seen as “financial weapons of mass destruction”; 
•   The bank’s lobbying enabled them to gamble on food futures and drive up prices.

Report author, journalist Andy Rowell said: “A year ago, David Cameron said that lobbying was the next big scandal waiting to happen. This report shows that banks like Goldman Sachs – who are intricately connected to the Tories – continue to lobby to get what they want."

Rowell continued: "The entire regulatory process - and the lobbying activity that surrounds it - has to become significantly more transparent and accountable. If it is allowed to be captured by bankers, the next financial crisis will only be a matter of time.”

This is what privatization delivers: systemic crises in immigration detention

photo courtesy of the ABC

So another privatized detention centre burns. Only weeks after the Christmas Island detention centres erupted in protests, riots and fires, the unrest has spread to Sydney's Villawood Detention Centre.

Former staff of Serco, the UK multinational corporation that runs the privatized detention centres, are already pointing the finger directly at the corporation, claiming that it contributed to the crises. Serco whistle blowers claim that at Villawood (like Christmas Island), Serco's incompetence and mismanagement were a primary cause of the riots.

The whitleblower claims that:

• Serco management threw raw and untrained recruits into the detention centre without proper training
• Training courses for new staff were dropped
• Serco staff lack basic training and are forced to learn "on the job" 
• Serco management constantly understaff the centre
• Serco has no effective emergency management procedures for such events.

These are precisely the claims made against Serco at Christmas Island; claims that are now the subject of multiple investigations into Serco's management of the Christmas Island Centres, and it looks likely that the investigations will be extended to include Serco's management of Villawood.

The ABC reports that:

The detention centre was set on fire, while asylum seekers overwhelmed staff from the detention centre service provider, Serco.

The former guard says there would have been 11 staff members rostered on the night the asylum seekers rioted. 

He says his former employer, Serco, does not train staff properly and would not have known what to do when trouble starts. 

"From what I've seen, new recruits are basically put on the floor with no training whatsoever," he said. 

"They were told that they would be trained as they worked and that also has never happened before. Basically what is supposed to happen is, they go through at least a six-week minimum course and then have a year of on-the-job training. 

"Serco basically got rid of the six-week course using staffing levels as an excuse and basically threw the staff onto the floor and expected experienced staff to train them as well as do their normal jobs."

He says Serco has never emphasised emergency response training for incidents like fire and riots experienced on Wednesday night. 

"I am led to believe they still don't have any real effective emergency operational procedures. So basically (Wednesday night) would have been every man for themselves," he said.

In a statement, Serco acknowledged an increased number of arrivals and longer periods of detention have placed significant pressures on their operations. 

The company said its staff training program meets it contractual requirements and that it has provided additional training beyond what is contracted and has invested $1.5 million in staff training.

This is the second Australian immigration detention to be set on fire this year. Riots at the Christmas Island detention centre in March led to tear gas and bean bag rounds being fired at asylum seekers.

The former Villawood guard says the Federal Government should review Serco's contract. 

"They've had pretty poor performance. Basically the spate of incidents, major incidents, under Serco's control have been ... there's just been too many. So I really think that the contract should be reassessed," he said.

Canadian corporation to transport uranium through WA cities and towns

In Western Australia mining and resource companies can pretty much do whatever they like. They talk a lot about world's best practice safety standards and social license to operate, but ultimately what they want they generally get. Here is a perfect example of how it works.

Australian Greens Senator for Western Australia Scott Ludlam has slammed provocative plans by Canadian uranium mining company Cameco to truck uranium through several WA cities and towns.

The Cameco planned course will see up to 3,600 tonnes of uranium oxide concentrate from the Kintyre project trucked past Port Headland and though Newman, Meekatharra, Mount Magnet, Leonora and a number of other towns en route to the proposed Parkeston travel hub outside Kalgoorlie each year. If the hub is not completed by 2013, the uranium will be transported though Kalgoorlie itself.

“There are a significant number of freight truck accidents in Western Australia each year, but that’s just part of the concern. This is a project that goes wrong at every turn, planned by a company with an appalling history,” said Senator Ludlam.

“The mine itself is proposed for a site right next to Rudall River, alongside the Karlamilyi National Park. The site of the uranium deposit was originally part of the park and was excised in 1994, so as you can imagine it is a pristine natural area and it has environmentally sensitive wetlands in the vicinity,” said Senator Ludlam.

“Especially given the sordid and sorry history of uranium mining in Australia contaminating ground water and wetlands, this is one of the worst possible sites for a uranium mine.”

It is estimated 2,500 to 3,600 tonnes of uranium oxide concentrate will be trucked through the state each year by Cameco. The company says it will send between 55 and 70 truck convoys a year along the estimated 2000km route.

“The residents along this uranium trail will no doubt be very concerned,” said Senator Ludlam. “They have the right to say no to Cameco’s plan to transport radioactive material through their neighbourhoods.”

Nuclear safety sacrificied for corporate profits

Rosa Moussaoui writes in Truth Out that the crises unfolding in Japan's nuclear reactors demonstrates the destructive power of corporate capitalism and the neoliberal logic. 

Moussaoui argues that nuclear security is far too important to be left in the hands of private corporations. She is right.

Since 2003, the big Japanese private group aimed at "reduction of costs of maintenance" in order to render profits "secure".

Profit at Any Price. This could be the motto of Tokyo Electric Power (Tepco), the multinational that exploits the nuclear power plants at Fukushima. The largest producer of electricity in the world illustrates the excesses of an industrial sector in which neo-liberalism has unfurled to the last extremities of its destructive logic.

Poof. At the beginning of 2010, Tepco announced net earnings of 157.7 billion yen (1.19 billion euros) for the period from April to December 2009, as compared with a loss of 137.7 billion yen (1.04 billion euros) a year earlier. Miraculous recovery, for a multinational company whose annual turnover decreased, at the same time, by 14%. In order to restore profits, the officers of the company affirm, Tepco had to restrict its "current expenses", which dropped by 22%. Officially, this was due to a drop in the price of petroleum needed for the functioning of its thermal power plants. The explanation is a bit thin, for an industrial outfit that insisted, in a financial document in August 2003, on the necessity of "a rationalization of the totality of operations, including a reduction of the costs of maintenance" in order to render its profits "secure".

Has performance of maintenance, and thus the security of equipment, become a variable for adjustment? Tepco has not hesitated to do this in the past. Between September 2002 and April 2003, the multinational was constrained to shut down its 17 nuclear reactors. This was a consequence of revelations concerning the falsifications of some thirty inspection reports on three nuclear power plants in the group. It involved, among other aspects, the electro-nuclear giant’s act of disguising three incidents that had occurred in the nuclear facilities in Fukushima and Kashiwazaki-Kariwa.

This scandal implicating Tepco is not an isolated one. In March 2007, to cite but one example, the company Hokoriku Electric Power admitted having knowingly hidden a nuclear incident that occurred at the plant in Shikamachi eight years earlier, the 18 June 1999.

But who cares about security, when the race for profits takes command? With 28 million clients in Tokyo and in the region, Tepco announced triumphantly last 30 July that it wished to multiply by 5 its projections of profit for 2010-2011. Between April and December 2010, the multinational banked a net profit of 139.8 billion yen (1.27 billion euros). Surfing on the green wave, the group, already in the lead with its parks of wind turbines, planned to invest heavily in renewable energies. Ever so ready to threaten whole countries, the stock and bond rating company Standard and Poors granted Tepco an AA- on its long term debt, which is its fourth highest rating.

At the Heart of the Catastrophe, Tepco Remained Obsessed by Financial Considerations

Even at the heart of the current catastrophe in Fukushima, TEPCO remained obsessed by financial considerations. "It seems the the company waited until the last possible moment to drown the heart of the reactor by pumping sea water. In fact, if you drown the heart of the reactor, it becomes no longer usable," observes the Energy branch of the CGT [1]. Clearly, public ownership is not an all-risk insurance policy in these matters. But to what horrifying excesses can we be lead by the shameful acts of profit-taking. In 2005, in his essay From Tchernobyl to Tchernobyls [2], the winner of the Nobel Prize for Physics, Georges Charpak put us on our guard: "The problem of security in the nuclear power plants is too crucial to be left only in the hands of financiers, those champions of stock market optimization". Cruelly premonitory.

Corporate ownership of UK blood supply

What is that saying about putting Dracula in charge of the blood bank?. 

Well it's becoming a reality. Soon the UK blood supply will be privatized. Market madness!

From the UK Independent;

The proposed privatisation of NHS Blood and Transplant service, or parts of it, will instinctively make people shudder and we are right to be concerned about how commercial motives will change the service.

From Unite

Staff representatives from the National Blood Service (NBS) have written to chief executive, Linda Hamlyn, and to NBS board members warning that the privatisation of the NBS could have serious effects on the fragile relationship between the service and its donors.
 

Around three million UK citizens give their blood every year.  Unite says it is the ultimate "big society" service but the essence of the service would be fundamentally altered if a profit-motive was introduced to any part of the service.

Unite is demanding a full written report from the NBS board setting out what discussions have taken place with potential bidders, what decisions have been made and what time scales there might be regarding possible privatisation.

The union also wants MPs currently scrutinising the Health and Social Care bill to look seriously at ways to preserve the NBS so that profit-making companies are not handed parts of the service to operate, arguing that the only motive for the service ought to be the collection and distribution of blood for the common good.

On 16 February, the Health Service Journal learned that the Department of Health's commercial directorate held talks with private providers about running parts of the NHS Blood and Transplant service. Capita and DHL are understood to be interested in taking over parts of the service (see notes to editors).

Unite, Britain's biggest union which represents staff working for the NBS, resolutely opposes any privatisation of the service arguing that it goes against the very ethos of giving blood.

Unite's regional officer, Owen Granfield said: "On behalf of the staff working for the blood service who are very proud and dedicated, we have written to the chief executive of the NBS demanding to know just how far discussions with the private sector have progressed. Unite is not prepared to allow the private sector to profit from a voluntary service which was in existence even before the NHS was founded.

"People who give blood for free because they believe it is in the common good will be shocked to learn the Department of Health is considering allowing the private sector to profit from their blood. This is blood money and it is totally wrong.

"The very essence of the blood service is about people giving their blood for free to help and save lives. The blood service is always short of donors and privatisation could have serious effects on the fragile relationship between the service and voluntary donations."

Privatization: when corporations and government profit from human suffereing

So this is how privatization and contracting out of public services works.

Serco the operator of Australia's immigration detention centres, is paid nearly $400 million by the Federal Government to run immigration detention. But Serco breaches its contract so much that it has been fined $4.5 million for contract breaches over a 2 month period (November and December). Information suggests that Serco were fined $2 million dollars in November and $2.5 million in December for breaches that include poor practice, incompetence, inappropriate treatment of detainees, incidents in centres, and escapes.

But the Government refuses to release any detail of the breaches, citing commercial confidentiality.

As Antony Lowenstein points out  rather than demand that Serco improve the treatment of detainees, or even rescind Serco's contract for constant breaches, the Federal Government simply pockets the money Serco pays in fines.

The immigration department has fined the company that runs its detention centres for contract breaches, including a series of breakouts.

The Department of Immigration and Citizenship contracts the UK-based Serco to run its detention centres. The latest contract – worth about $370 million – was signed in 2009.
“Under the contract between Serco and DIAC there are provisions for the imposition of fines and sanctions against Serco for lax practices or incompetence,” a DIAC spokesman said.
The fines reportedly exceeded $4 million, but the department has refused to reveal the figure.
“The details are commercial in confidence,” the spokesman said.

 Here is yet another example of Serco's incompetence. Just what is Serco's risk management strategy for managing a disturbance in detention centres? Call the Police.

This extract is from the Sydney Morning Herald:

Concerns whether NT Police would have the capacity to deal with a large-scale disturbance emerged on Friday, after it was announced late on Thursday that a new 1,500-bed detention facility would be developed at Wickham Point, on Darwin Harbour - opposite the CBD - to house single men.

The move, along with plans to almost double the bed capacity at the Darwin Airport Lodge Detention Centre, will take Darwin's immigration detention capacity to 2,900, eclipsing Christmas Island's 2,600 capacity.

 

NT Police Association president Vince Kelly told AAP he understood that Serco, the private security company that manages Australia's immigration detention centres, had no real plans to handle a major disturbance other than to telephone the police.

"It would seem that there has been no contemplation of the impacts this might have on the NT police, or about the capacity of NT Police to deal with a large-scale disturbance involving 1,500 people who are held in these facilities," he said.

"The safety of NT police officers is something that should be considered."

Corporate crime and no punshment

Great piece by Russell Mokhiber comparing the case of Leandro Andrades, a man imprisoned for life for stealing five videotapes worth $150, with the the failure of the US authorities to pursue criminal charges against any of the corporate executives responsible for two of the biggest crimes in US history- the BP oil spill in the Gulf of Mexico and the financial meltdown of 2008-2009.

Two recent reports of inquiry into the Gulf Oil Spill and the 2008-2009 Financial crises failed to make any mention about corporate crime or criminal liability, despite finding massive systemic breaches of the law.

As Mohkiber writes:

"We live in a country with two systems of justice. One for the Leandro Andrades of this world and one for the Wall St Banks and their executives and the oil companies and their executives.... We have two systems of justice. One for the corporate class.. and one for the rest of us"

Woodside personifies corporate power in Western Australia

When you are the most powerful corporation in Western Australia you can pretty much do what you like. Here are two examples:

• Don Voelte, the CEO of Woodside was paid just $2,694,276 in 2009 (gee that must have been tough!). In 2010 his pay increased by a miserly 210% to $8,343,339.
• The body of 55 year old man who died at Woodside's Pluto Project Gap Ridge Camp in Karratha was not discovered for two weeks. The body remained in his donga without being discovered for two weeks. Police are investigating the death and will provide a report to the Coroner. Worksafe cannot look at the death because " it was not work related".

I am currently writing a longer piece about the power that Woodside is able to exercise over this state. Very happy to receive suggestions and ideas.