Articles Posted in Understaffing

The Department of Veterans Affairs has announced the decommissioning of a Georgia long-term care center following an investigation that found the nursing home was infested with fire ants. The  facility, Eagles’ Nest Community Living Center, will be permanently closed following a determination that it can’t provide an adequate setting for long-term care.

According to a report in the Atlanta Journal-Constitution, the VA intends to rebuild the nursing home, and to add more long-term care beds at a different facility west of Atlanta, the Veterans Village. As for the 34 residents living at Eagles’ Nest, they were transferred to other facilities back in April “to limit their exposure to COVID-19,” according to the AJC. Continue reading

A new analysis by City and State asks whether New York’s nursing home facilities are prepared for another wave of the Covid-19 pandemic. Noting that while long-term care facilities have so far accounted for about 8% of Covid-19 cases, they have comprised about 40% of US fatalities from the disease. In New York especially, there have been 27,307 total Covid-19 deaths, of which 6,967 confirmed or presumed Covid-19 fatalities took place in nursing home facilities, a number that excludes residents who died outside of the facility. While nursing homes have improved their policies and procedures when it comes to Covid-19 since the virus initially struck, City and State argues, “there are still vulnerabilities that could leave nursing-home residents and staff at risk again.”

On the positive side, nursing homes are more likely to have more consistent access to tests and personal protective equipment, the analysis suggests. Nursing homes have already been conducting regular testing of all employees, and are required to have a 60-day supply of PPE. Additionally, a state rule has been reversed that in the spring led to nursing homes accepting Covid-19 patients from hospitals, spreading the virus throughout facilities.

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Harlem Center for Nursing and Rehabilitation suffered 3 confirmed and 29 presumed COVID-19 deaths as of December 4, 2020, according to state records. The nursing home has also received 33 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on December 4, 2020. In May 2020, it received a fine of $24,000 in connection to unspecified findings of “multiple” health code violations. The Harlem nursing home’s citations resulted from a total of six surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not adequately establish and implement infection-control measures. Under Section 483.80 of the Federal Code, nursing homes must develop a program to prevent and control infection in a manner that provides residents a comfortable and sanitary environment. A May 2020 citation found that Harlem Center for Nursing and Rehabilitation failed to do so. The citation states specifically that facility staff were observed “not doffing Personal Protective Equipment (PPE) appropriately as they left resident rooms”; that a resident admitted with a recommendation that they be placed on contact isolation with put in a room with a resident who was not on contact isolation; that residents were seen gathering in the facility’s common areas, where staff did not encourage them to socially distance; and that a resident who had been placed on contact isolation and droplet precautions was seen “eating lunch with other residents in the dayroom without maintaining social distance.” A plan of correction undertaken by the facility included the in-servicing of relevant staff.

2. The nursing home did not provide an environment adequately free of accident hazards. Under Section 483.25 of the Federal Code, nursing home facilities must ensure their residents’ right to an environment as free as possible from accident hazards, and in which every resident receives supervision and assistive devices adequate to prevent accidents. A February 2020 citation found that Harlem Center for Nursing and Rehabilitation failed to ensure such. The citation states specifically that “an oversized television was positioned on a slant, on top of a smaller dresser in a resident’s room,” and that after another resident sustained a fall, the incident was not assessed “to determine if updates were needed to the plan of care to prevent further falls.” A plan of correction taken by the facility included the mounting of the TV to the wall, and the review of the fall and updating of the resident’s plan of care.

A new report by the Associated Press illustrates the devastating toll of the Covid-19 pandemic on nursing home residents across the country. The tragedy is not limited to Covid-19 deaths themselves, but also to deaths from other causes that ballooned as staff dealt with Covid-19 patients. One expert cited in the report estimated that “for every two COVID-19 victims in long-term care, there is another who died prematurely of other causes.” Ultimately, they concluded, there may have been more than 40,000 more “excess deaths” in nursing homes since March, compared to the same period in previous years.

The expert, professor Stephen Kaye at the University of California, San Francisco, attributes the spike in excess deaths to staffing issues at nursing homes. By comparing death rates at nursing homes that experienced outbreaks to nursing homes that didn’t, he found that “the more the virus spread through a home, the greater the number of deaths recorded for other reasons,” which suggests that healthcare workers were “consumed” caring for Covid-19 patients—and/or contracted the illness themselves—and therefore unable to devote adequate care to residents without Covid-19. Kaye suggests this effect was compounded by longstanding staffing issues at nursing homes: “In 20 states where virus cases are now surging,” the report observes, “federal data shows nearly 1 in 4 nursing homes report staff shortages.” Continue reading

Evergreen Commons Rehabilitation and Nursing Center has received 64 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on August 5, 2020. The facility also received fines totaling $30,000 in connection to findings that it violated health code provisions regarding quality of care, accidents, and more. The East Greenbush nursing home’s citations resulted from a total of five surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not maintain an adequate infection prevention and control program. Under Section 483.80 of the Federal Code, nursing homes must endeavor to provide residents with a safe and sanitary environment, one that helps mitigate the development of communicable diseases and infections, by establishing and upholding an infection prevention and control program. An August 2019 citation found that Evergreen Commons Rehabilitation and Nursing Center failed to ensure such for two residents. The citation specifically describes in which a Licensed Practical Nurse, while changing a resident’s wound dressing, did not remove her gloves, wash her hands, or don new gloves after touching the outside of a spray bottle and a gauze package. In an interview, the nurse stated that “she should not have touched the outside of the dressing packages and touch the dressing contents without first removing her gloves, washing her hands and putting on another pair of gloves.” The citation also describes an instance in which a a nurse, while assisting with a dressing change by holding a resident’s leg up, put the resident’s heels down on a cushion in contravention of policy. The citation states that these deficiencies had the “potential to cause more than minimal harm.”

2. The nursing home contravened garbage disposal code. Section 483.60 of the Federal Code requires nursing homes to “dispose of garbage and refuse properly.” An August 2019 citation found that Evergreen Commons Rehabilitation and Nursing Center failed to ensure such. The citation states specifically that the resident’s trash compactor “was leaking liquid waste and the door of the compactor was left open.” In an interview, the facility’s Director of Food Service said he would have the compactor serviced, and that he would reeducate employees to close the door after use.

A new edition of the Long Term Care Community Coalition Elder Justice Newsletter asks a simple question: does providing a nursing home resident breakfast in their soiled bed constitute harm? How about failing to provide a stop date for a resident’s psychotropic medication?

“No Harm” deficiencies refer to citations of rule violations at nursing homes in which health inspectors determined that the violations caused “no harm” to residents. As the LTCCC notes, data provided by the Centers for Medicare & Medicaid Service, which mandate minimum standards of care for nursing homes participating in their programs, show that more than 95% of nursing home health citations describe “no harm” deficiencies. The LTCCC argues, however, that these no harm citations reflect systemic failures to recognize the suffering of nursing home residents, which in turn results in systemic failures to hold nursing homes accountable through financial penalties. “In the absence of a financial penalty,” the newsletter states, “nursing homes may have little incentive to correct the underlying causes of resident abuse, neglect, and other forms of harm.”

The newsletter proceeds to provide instances of health violations in which regulators determined that no harm was done to the resident in question. For example:

New York Senator Kirsten Gillibrand proposed a new federal law aimed at improving staff levels at nursing homes across the country. According to Sen. Gillibrand, the impetus for the new legislation on nursing homes comes from a bipartisan report released this summer, which detailed widespread problems at nursing homes across the state and country. Speaking to reporters, the New York Senator said, “Unfortunately, a report came out on nursing homes and long-term care facilities that have had problems, and 17 are located in New York State.” 

Sen. Gillibrand is referring to the 488 nursing home facilities across the country which the report found a “persistent record of poor care.” Currently, the federal government only applies extra scrutiny on 88 so-called “special focus facilities” across the country. This leaves 400 nursing homes with records of abuse and neglect without sufficient oversight.

According to Sen. Gillibrand, insufficient and incompetent staffing is one of the root causes of the poor performance and conditions at these nursing homes. The bill she proposed in the Senate last month aims to fix that problem. The bill, which has bipartisan backing and is sponsored by Colorado Republican Cory Gardner, would expand access to Medicare and Medicaid data to “nursing homes, home health agencies, and hospice programs,” reports The Buffalo News. The bill, called Promote Responsible Oversight and Targeted Employee Background Check Transparency for Seniors (PROTECTS) Act, would improve the standard of living at nursing homes by “bringing more transparency to workforce quality,” says Sen. Gillibrand. 

A new study in the Journal of the American Geriatrics Society concludes that nursing homes with low staffing levels, low quality scores, and high concentrations of disadvantaged residents also experience “higher rates of confirmed COVID-19 cases and deaths.”

The study’s lead author, Yue Li, a professor at the University of Rochester Medical Center Department of Public Health Sciences, said in a statement: “In nursing homes, quality and staffing are important factors, and there already exists system-wide disparities in which facilities with lower resources and higher concentrations of socio-economically disadvantaged residents have poorer health outcomes… These same institutional disparities are now playing out during the coronavirus pandemic.”

The study notes that long-term care facility residents are demonstrably vulnerable to respiratory diseases like influenza and coronaviruses, and that research suggests COVID-19 “disproportionately impacts older adults and individuals with chronic health conditions.” This makes nursing homes, which have high concentrations of elderly adults with chronic health conditions, especially vulnerable to COVID-19. Since the pandemic reached the United States, roughly 50,000 deaths related to the novel coronavirus “have been linked to nursing homes,” according to the study.

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A new report by the Washington Post suggests that “thousands of nursing homes” across the United States were ill prepared for the novel coronavirus pandemic. Federal guidance as well as advice from researchers and medical experts encouraged a policy of treating patients in place, the article notes, believing that hospitals “are not friendly environments for the frail and elderly.” But, the Post suggests, nursing homes “neglected” the fact that treating patients in place “requires having effective means of treatment, staff who know how to deploy that treatment and procedures to stop the spread of infection.” The result was that even though nursing homes “did not swamp hospitals” with coronavirus patients, they also did not prevent “the deaths of more than 30,000 of their residents, or, in many cases, even provide decent palliative care.”

The Post discusses one nursing home in upstate New York, Absolut Care Care of Aurora Park in East Aurora. Public records indicated that 153 residents at the nursing home were infected, with 61 deaths by May 31, 2020. This figure “includes deaths on site and among those taken to hospitals,” the Post says, and is disputed by the facility’s owners, though they “did not provide their own tally.” A nurse who quit working at the facility in early May told the Post that “Once it was there it just spread like wildfire… It was very hectic, chaotic.”

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Federal data suggests that most nursing facilities “failed to maintain sufficient staffing to meet every resident’s needs” in the months leading up to the coronavirus pandemic, according to a new release by the Long Term Community Care Coalition.

The LTCCC has packaged that federal data regarding staffing figures for every nursing home in the United States in a “user-friendly” form, allowing members of the public, journalists, and policymakers to “identify and assess” nursing homes that are and are not meeting their residents’ essential staffing needs. The files for Q4 2019 are available on its website. Users can use the data to learn about staffing levels for nursing staff as well as activities staff and administrators; they can also use it to evaluate how much a given nursing home facility relies on contract workers to care for its residents.

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