The nursing home industry gave at least $1.8 million to Kentucky politicians over the last decade while lobbying against bills that would require them to hire more direct-care employees, face higher fines for violations and abide by stronger precautions against elder abuse, among others.
The Herald-Leader examined the industry's campaign donations following stories earlier this summer that revealed systemic gaps in the state's handling of abuse and neglect cases at nursing homes.
Also in response to those stories, Gov. Steve Beshear — who has taken at least $58,500 in industry donations, and whose brother, David Beshear, helps care for patients at a nursing home in Dawson Springs — announced a review of how his administration handles reports of abuse and neglect of residents.
"The governor is very concerned about the issues that have been raised concerning abuse and neglect of the elderly in nursing homes," Beshear spokeswoman Kerri Richardson said last week. "While he welcomes campaign contributions from those who support him, they never have and never will have any impact on the decisions he makes as governor."
Reform advocates are pessimistic.
"We're David up against Goliath. They obviously have the money, they give so much, and we are just so overwhelmed," said Bernie Vonderheide, founder of Kentuckians for Nursing Home Reform.
Every winter, Vonderheide's group lobbies the General Assembly for bills sponsored by the same two or three lawmakers. Chief among the proposals is one to establish minimum staffing requirements for nursing homes based on the number of residents and the level of care they need. Residents are neglected when profit-focused companies put too few employees on duty, Vonderheide said.
And every winter, the reform bills die without receiving a committee vote.
"I'll keep trying. One of these times, I might get through," said Rep. Carl Rollins, D-Midway, who sponsors the lion's share of the reform bills. "I'm talking about having adequate staffing. My Lord! You would have thought I wanted to put a stake through their hearts."
Rollins said he sponsors the bills because of his late mother-in-law's experience in a Kentucky nursing home with too few employees to respond to residents' needs.
"We had to hire someone, a personal aide, who went in on weekends when they were particularly understaffed to make sure she was fed and cleaned and cared for," Rollins said. "I worry about any nursing home resident who doesn't have someone looking out for them."
Vonderheide and Rollins said it's their understanding, from talking with lawmakers, that House Democratic leaders don't want the reform bills called for a vote.
Since 2005, the nursing home industry has given at least $74,850 to the Kentucky House Democratic Caucus, which distributes campaign money at leadership's discretion to House Democrats in contested races. Overall, the industry gave at least $203,421 to state legislative campaigns in the past decade.
In a prepared statement, House Speaker Greg Stumbo said he isn't blocking the reform legislation.
"In fact, I don't recall this particular issue being brought up to me by any member during the legislative session," said Stumbo, D-Prestonsburg. "Personally, I favor reasonable guidelines on nursing homes, just as I support law enforcement and inspectors cracking down hard on those who do not follow the law."
Nursing home reform bills usually are assigned to the House Health and Welfare Committee, where they perish.
Committee chairman Tom Burch, D-Louisville, is invested in a real estate trust that includes nursing homes. Burch's former House aide, Eric Clark, now is chief lobbyist for the Kentucky Association of Health Care Facilities, the group representing for-profit nursing homes, and runs its political action committee, which has given at least $90,750 in campaign donations since 2005.
Last week, Burch said House Democratic leaders don't seem receptive to the reform bills advancing to the House floor.
"As chairman, I never get told directly, but I do get the feeling that it's not a good idea to bring the bills forward," Burch said. "I don't know exactly what they're thinking. It's like any time your boss lets you know indirectly what his preference is."
However, Burch added, he has his own objections to the reform bills.
For example, Burch said, his research suggests that setting minimum staff-to-patient ratios at nursing homes could cost hundreds of millions of dollars in additional payroll. It also could set a precedent by which other institutions — such as schools or prisons — are pressured to have more employees on duty to handle those in their care, he said.
"We don't have that kind of money," Burch said.
"The problem with nursing homes is bad management," he said. "I spent my career with General Electric. If you had those sorts of management problems at G.E., you would go out on your ear."
Burch said it's not a conflict of interest for him to control nursing home bills while invested in a medical-properties real estate trust that includes nursing homes as well as doctors' offices and hospitals.
"It's not that much money," Burch said. "I've got, like, $100,000 in there that used to be G.E. stock. If I had $1 million in there, I'd say I might have a conflict."
The Kentucky Association of Health Care Facilities gives annual awards to nursing homes that raise the most money for its political action committee, with special emphasis on companies that use payroll deduction to collect the money from employees.
In 2008, for instance, Barren County Health Center in Glasgow won an award from KAHCF for "most contributions raised overall per bed" for its region. That same year, the same nursing home received a Type A citation — the most serious — from the state after a resident choked to death on a fried chicken dinner.
Overall, KAHCF honored four nursing homes and consultants Wells Health Systems that year for their political fund-raising, according to the group's 2009-10 Membership Directory and Buyer's Guide.
"A strong PAC allows our members to support legislative candidates who represent the interests of the long-term-care profession and our residents," KAHCF wrote in the awards section of its guide.
KAHCF President Ruby Jo Cummins Lubarsky, who earlier worked in the Cabinet for Health and Family Services Office of Inspector General, which inspects nursing homes, declined to talk about her group's activities.
In a written statement, Lubarsky said KAHCF obeys all laws applicable to lobbying and campaign donations. The group reported spending about $50,000 lobbying the 2010 General Assembly, more than twice what the Kentucky Coal Association spent.
There clearly is pressure on nursing homes to make political donations, said Vonderheide, who runs the reform group.
"It amazes me that they give an award for payroll deductions to help politicians," Vonderheide said. "Who are they deducting this money from? Nurse's aides making $6 an hour?"
An analysis of industry campaign donations indicates that most comes from the top — nursing home owners, corporate executives and administrators — although several dozen rank-and-file workers also are listed as donors, including nurses, cooks and housekeepers.
A half-dozen industry officials who donated some of the largest sums declined to be interviewed about their reasons for giving and what, if anything, they get in return.
For example, employees of Carespring Health Care Management, which owns a chain of nursing homes in Kentucky and Ohio, have given at least $68,175 to Democratic and Republican campaigns in Kentucky. Sometimes they handed over their checks together at political fund-raising events.
Carespring declined to make its employees available for interviews. In a prepared statement, a Carespring official said donations are not coordinated by the company.
"Carespring executives make their own personal decisions regarding political contributions," wrote Kim Majick, Carespring executive vice president. "It is our hope that as citizens, we will elect and support individuals who are good policy-makers and understand the role of government in today's modern society."
The majority of the industry's campaign money goes to Kentucky's congressional delegation. The industry's national group, the American Health Care Association, reports spending more than $1.1 million so far this year lobbying Congress on Medicaid payments and rules that would require public disclosure of the size of nursing homes' direct-care staffs and how much they are paid, among other items.
U.S. Senate Republican Leader Mitch McConnell gets more of the industry's money than any other Kentucky politician, at least $266,350 over the last decade. McConnell does not support nursing home reform, said Vonderheide, who said he has lobbied McConnell's office on various bills.
McConnell's office did not return a call seeking comment.
U.S. Senate race
The nursing home industry is spending heavily on this year's U.S. Senate race in Kentucky. Secretary of State Trey Grayson, beaten in the Republican primary by Rand Paul, took at least $85,950 from the industry, while Paul got only $6,850.
Attorney General Jack Conway has taken at least $39,800 from the industry for his Democratic U.S. Senate campaign. Most of it came from nursing home chain Kindred Healthcare, based in Louisville, where Conway's brother-in-law, Henry Gordinier, is senior director for strategic planning.
Last year, to the applause of the nursing home lobby and the dismay of reform advocates, Conway joined 30 other attorneys general to ask the federal government to suspend a rating system for nursing homes that the industry says is unfair.
Also, the Herald-Leader in July reported that Type A citations issued against nursing homes by the state sometimes sit in Conway's office or with local prosecutors for more than 18 months while officials decide whether to pursue criminal charges.
Conway spokeswoman Allison Martin said industry donations do not influence the attorney general. In the last two years, Martin said, Conway's office has helped prosecute nursing home employees for abuse or neglect in Harrodsburg, Frankfort, Hazard, Richmond, Middlesboro and Russellville.
"Conway has a strong record of protecting and helping Kentucky seniors," she said. "Conway has made elder abuse and neglect investigations a priority and initiated more elder-abuse and neglect prosecutions than previous attorneys general."