Articles Posted in Understaffing

Outrage continues to grow at the poor quality of care being delivered at a New York nursing home. According to an investigation by News10NBC, Sodus Rehabilitation and Nursing Center in Sodus, New York is still violating numerous state regulations about the treatment of its senior citizens. The local news agency began investigating Sodus Rehab several years ago and, unfortunately, it does not appear that the quality of care has improved over time. According to the New York Department of Health, the nursing home received 90 citations for health and safety violations in just the last four years. In New York, the average number of violations per nursing home is approximately 30.

After undercover investigations by News10NBC last year showed unsafe and unsanitary conditions, Sodus Rehab says they “cleaned house” and brought in new administrators. Unfortunately, the new staffers do not appear to have fixed any of the nursing home’s problems. In one particularly egregious example cited by the news, Bill Tanner, a nursing home resident with leukemia, dementia and “other health issues,” developed bedsores that one doctor described as “some of the worst” he had ever seen. Bedsores, also called pressure ulcers, could have been easily prevented in Tanner, according to the doctors. Perhaps even more horrifically, the bedsores were only noticed because a former neighbor visiting Tanner noticed a foul smell in the room. According to the neighbor, she asked for a registered nurse and a licensed practical nurse to attend to the elderly man. Sodus Rehab staff said that neither was on-duty at the time.

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The Trump Administrations deregulation effort has led to decreased oversight across the country’s nursing home industry. According to The Washington Post, President Trump’s deregulation agenda has indiscriminately removed “essential protections for vulnerable Americans.” Citing the Trump administration’s popular boast of removing 22 regulations for every single regulation added, the newspaper understandably questions the necessity of these regulations and the consequences of their removal.

Sadly, the nursing home industry has never been a priority for many Presidential administrations. Despite the highly regulated nature of the industry, nursing homes have often escaped the scrutiny lodged at hospitals and other healthcare providers. Late in his second term, President Barack Obama attempted to change that and directed the Centers for Medicare and Medicaid Services (CMS) to aggressively pursue nursing homes flouting the law. Beginning in 2014, nursing home violations would not result in a one-time fine. Instead, the nursing home would be fined every single day until the violation was rectified. By 2016, over two-thirds of nursing home violations resulted in a per-day fine. Unfortunately, the Trump administration reversed this change – which was viewed by elder care advocates as broadly effective and necessary.

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State prosecutors charged seven nursing home employees with involuntary manslaughter after a patient died from a bedsore in 2017. The nursing home employees, which includes one nurse, are collectively charged with 37 crimes for their gross mistreatment and neglect of two nursing home patients during their time working at Whetstone Gardens and Care Center in Ohio. Announcing the charges, Attorney General Dave Yost says, “Evidence shows these nurses forced the victims to endure awful mistreatment and then lied about it.”

Yost says first patient “literally rotted to death” after developing a preventable bedsore or “pressure injury” in 2017. The patient, who entered the facility on a short-term basis, developed several bedsores after nursing staff failed to move the patient every few hours. Once the bedsores developed, the staff continued to ignore the nursing home resident and failed to treat the sores, also called pressure injuries or ulcers. Within weeks of developing the bedsore, the patient’s bedsores became infected with gangrene. The nursing home resident passed away just weeks later after the staffers at the nursing home failed to take “any medically appropriate steps.”

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The Centers for Medicare and Medicaid (CMS) announced it will launch a ‘comprehensive review’ of nursing home regulations across the country. According to Health Leaders Media, CMS Administrator Seema Verma announced the new initiative last week in response to mounting criticism by states and federal legislators. Administrator Verma said the government agency will seek $45 million in additional funding from Congress for its review.

CMS says the review will focus on several primary areas. First, CMS will work with state agencies across the country to strengthen oversight of the country’s nursing homes. According to CMS, federal and state agencies will work together to ensure CMS health and safety requirements are being followed and ever nursing home is inspected at least once a year. Second, the federal agency plans to increase enforcement of nursing homes by, according to Administrator Verma, “developing new ways to root out bad actors and repeat offenders.” Administrator Verma says nursing homes with insufficient nursing staff will be targeted will begin receiving more “unannounced inspections” to encourage compliance. Finally, nursing homes will now be more severely penalized for poor patient outcomes and less severely penalized for failing to follow CMS protocols. In addition to improving outcomes for current nursing home patients, the focus on patient outcomes will also be more helpful to prospective nursing home residents by providing a more meaningful metric to judge nursing homes.

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New York’s Department of Health appears unable to adequately monitor the nursing homes across the state and hold poor performers accountable. Elder care advocates say the state agency must reform to protect senior citizens from poor care and nursing home abuse. Thankfully, legislators in Albany appear to finally be listening.

According to The Buffalo News, Assembly Majority Leader Crystal Peoples Stokes is co-sponsoring a bill regulating the number of nurses at each assisted care facility in the state. The appropriately named Safe Staffing for Quality Care Act would mandate that each nursing home have RNs (registered nurses) and that practical nurses and CNAs (certified nursing assistants) spend a minimum of 291 minutes with each resident. According to federal data, nursing staff levels are the largest indicator of whether a nursing home is providing quality care to its residents. Unfortunately, the same federal data shows that most nursing homes are grossly deficient when it comes to staffing. According to a study released in January 2019, only 7.5 percent of nursing homes across the state currently satisfy the requirements laid out in the Safe Staffing for Quality Care Act.

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Recent data published by Nursing Home 411 shows America’s nursing homes continue to struggle with low levels of nursing staff. Adequate staffing is one of the most important factors in providing quality care to nursing home residents. Unfortunately, the nursing home industry has a widespread problem in staffing their facilities with a sufficient number of nurses and medical personnel. The data analyzed by the nonprofit group included all nursing homes receiving Medicare in 2018. The highlights published by Nursing Home 411 include:

  • Nursing homes spend an average of just 3.5 staff hours with each resident, per day. According to the nursing home advocacy group, the federal government states a minimum of 4.1 hours is required for the average resident.

 

  • Nursing homes spend only 0.5 registered nurse staff hours with each resident, per day. A registered nurse is typically more capable and better educated compared to certified nursing assistants. Another federal study cited by Nursing Home 411 recommended increasing registered nurse hours by 10 to 50 percent each day to satisfactorily meet each nursing home resident’s healthcare needs.

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In response to the increase in for-profit nursing homes and recent data on nursing staff levels across the state, New York lawmakers plan to introduce a bill establishing minimum levels of nursing staff at long-term care facilities across the state. According to state legislators, under-staffing remains a serious problem at New York nursing homes and directly contributes to a lower quality of care for their elderly residents. Originally drafted two years ago, Republicans in the state legislature blocked the measure. However, with Democrats set to control all branches of government next year, the Safe Staffing for Quality Care Act will likely become law.

The proposed legislation will establish a minimum ratio of nursing staff to patients, which will vary by the level of care required for the patient. For patients undergoing active rehabilitation at a nursing home, there cannot be less than one nurse or nursing assistant for each patient. Further, the bill would require a nurse to spend an average of 291 minutes with each patient every day. According to The Buffalo News, this would be a significant change for most nursing homes. According to the newspaper’s analysis, only 8 percent of New York nursing homes currently satisfy these requirements.

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The federal government announced this month that it will begin performing more surprise inspections at nursing homes in an effort to crack down on nursing homes with inadequate staffing. According to the government, these surprise inspections will be done on Saturdays and Sundays at nursing homes with records of insufficient nursing staff on the weekends. According to the federal Centers for Medicare and Medicaid Services (CMS), nursing staff levels are directly correlated with the quality of care received by the nursing home residents.

Over a decade after the federal government mandated CMS collect payroll data and publicize each nursing home’s results, the federal agency finally overhauled its information technology system and began publicizing the information this year. While staffing levels at nursing homes were previously determined by “spot-checking” during yearly inspections, the new method for calculating uses payroll data from the entire year. Consequentially, the new method employed by CMS provides a more accurate and complete picture of staff levels.

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More senior citizens are dying from falls each year, a problem that is only expected to get worse as the country’s population continues to age. According to a report by the Centers for Disease Control and Prevention, almost 30,000 Americans over the age of 65 died as the result of a fall. To put that into perspective, falls killed 61 out of every 100,000 senior citizens in 2016, the year with the most recent data available. In 2007, only 47 out of every 100,000 deaths were caused by a fall. This means fall-related deaths have increased 37 percent in less than a decade.

About one in every four elderly Americans has a serious fall each year, according to experts. These falls typically result in broken bones or traumatic brain injuries. The risk of death caused by a serious fall increases with age. Americans between 65 and 74 only have 15 fatal falls for every 100,000. For those that are over the age of 75, that statistic increases to 248 per 100,000, according to the data released by the CDC. Women are at a higher risk than men of both falling and dying from a fall. If the fall-related mortality rate continues at the same pace then 59,000 senior citizens will die from a fall in 2030, according to The Los Angeles Times.

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A rarity only a few decades ago, nursing homes operating for profit have exploded across the country. According to NPQ, for-profit nursing homes account for over 70 percent of all facilities across the country. According to elder care advocates, the rapid takeover of the nursing home system has harmed America’s vulnerable senior citizens. Instead of focusing on providing the best quality care for a reasonable price, for-profit nursing homes choose to maximize their income while limiting their costs and the resulting legal liability from their cost-cutting measures.

In general, the rise of for-profit nursing homes has coincided with the consolidation of the nursing home industry which means a senior citizen is more likely to choose a corporate nursing home chain than the once-ubiquitous retirement communities that operated solely for the best interest of their residents. Considering the deep pockets of a corporate chain, it would be reasonable to assume the potential for large settlements in the cases of mistreatment or elder abuse would incentivize these corporations to treat their residents with the utmost respect.

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