Articles Posted in Understaffing

Cobble Hill Health Center in Brooklyn, New York suffered one of the highest COVID-19 death tolls in New York, according to recent news reports. An April 20, 2020 article by the Associated Press states that the facility listed 55 deaths by that date, “among the most of any such facility in the country.” The AP report states further that of 8,003 nursing home deaths it counted across the United States, one-third took place in New York.

In an interview with the AP, Cobble Hill Health Center’s Chief Executive Officer, Danny Tuchman, said that “he believes many other homes have more deaths than Cobble Hill but his has been singled out for its honesty.” He noted that a state survey of nursing home deaths did not require nursing homes to comply, and that he included “possible” COVID-19 fatalities in his response, emphasizing that Cobble Hill Health Center did not have testing kits and as such could not test any of its residents for the coronavirus. Tuchman told the AP that he did not know how the coronavirus entered the facility, acknowledging that it may have been carried by a paramedic or other staffer who was not symptomatic.

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Corporate nursing homes may provide lower quality care to its residents and low salaries for its meager staff but they appear to be doing well when it comes to turning a profit. According to ABC News, some for-profit nursing homes are in violation of the Fair Labors Standards Act for the horrific and exploitative way they treat their staff. An undercover investigation found “rampant wage theft” with nursing home staff working for $2 to $3.50 an hour – less than half the federal minimum wage, which is set at an anemic $7.25 per hour. These nursing home chains tend to hire immigrants, knowing they will be afraid of dealing with law enforcement.

The undercover investigation found that these workers usually awake before dawn to “cook meals, shower residents and scrub toilets.” These for-profit nursing homes who are engaging in behavior that could constitute human trafficking typically only hire staffers who will live at the facility. This means the early mornings lead to nights “deprived of sufficient sleep” as they respond to nursing home residents, change diapers, dispense medication, and deal with unruly patients. The nursing home then charges the staff a fee of $25 each day for “lodging” which leaves workers feeling “desperate and trapped.” The national news publication says nursing home workers are rarely allowed a day off and must pay for their substitute when offered this basic human right.

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Hopkins Center for Rehabilitation and Healthcare received 23 citations for violations of public health code between 2016 and 2019, according to New York State Department of Health records accessed on January 21, 2020. The facility has also been the subject of a 2015 fine of $10,000 in connection to findings it violated health code provisions regarding residents’ right to formulate advance directives; and a 2012 fine of $4,000 in connection to findings it violated health code provisions regarding accidents and administration. The Brooklyn nursing home’s citations resulted from a total of three surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not implement adequate measures to prevent and control infection. Section 483.80 of the Federal Code states that nursing homes must “establish and maintain an infection prevention and control program” that provides residents a “safe, sanitary and comfortable environment.” An August 2019 citation found that the nursing home did not ensure the maintenance of infection control practices, specifically finding that residents’ oxygen tubing made contact with the floor “on multiple occasions”; that a Certified Nursing Assistant entered the room of a resident on contact precautions “without wearing a gown and gloves”; and a Registered Nurse touched a resident’s head and bedding while wearing gloves, then connected a feeding tube without conducting hand hygiene or putting on clean gloves. The citation described these deficiencies as having the “potential to cause more than minimal harm.”

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A recent report published by Harvard University shows much lower staff levels at nursing homes across the country than previously reported. The author of the study, Fangli Geng, says that a recent change in how nursing homes report their staffing levels shows that up to 70 percent of nursing homes had previously overreported the number of staff between April 2017 and March 2018. The faulty reporting was almost exclusively confined to weekends, especially when counting registered nurses or RNs.

The author of the study point to the more accurate form of reporting currently used by the government. Previously, the number of nurses on staff at a nursing home would be calculated by using the payroll data in the month immediately preceding a health inspection visit. Because nursing home inspections usually occurred around the same time each year, nursing homes apparently increased their staff levels around this time. As part of the Affordable Care Act, nursing homes were required to transmit all payroll data to the federal government – providing a more accurate and complete understanding of nursing staff levels. 

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Queens Boulevard Extended Care received 16 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 19, 2019. The Woodside nursing home’s citations resulted from a total of three inspections by state authorities. The deficiencies they describe include the following:

1. The nursing home did not provide adequate treatment and services to promote the prevention and healing of pressure ulcers and bedsores. Section 483.25(c) of the Federal Code stipulates that nursing home facilities must provide treatment and services to promote the healing of pressure injuries / ulcers, and to ensure that residents admitted without pressure ulcers do not develop them unless medically unavoidable. An August 2019 citation found that Queens Boulevard Extended Care did not provide a resident with a level of treatment and services consistent with professional standards to promote the healing of their ulcers. An inspector specifically found that the facility did not implement the use of pressure relieving devices for a resident who had bilateral heel wounds. The inspector observed a Registered Nurse performing wound care treatment to both of the resident’s feet, but without putting pressure relieving devices in place after completing the wound care. A review of care records did not find any “documented evidence for the application of the use of heel protectors while in bed,” although facility policy provided for the use of pressure relief assistive devices in instances when pressure relief was warranted.

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United Hebrew Geriatric Center received 24 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 26, 2019. The New Rochelle nursing home’s citations resulted from a total of five inspections by state surveyors. The deficiencies they describe include the following:

1. The nursing home did NOT ensure residents were protected from abuse. Section 483.12 of the Federal Code stipulates that nursing home facilities must protect their residents’ “right to be free from abuse, neglect, misappropriation of resident property, and exploitation.” According to an August 2017 citation, the nursing home did not properly supervise its staff to identify or prevent abuse, follow up on abuse prevention education to ensure its compliance, or ensure the reporting of abuse to the facility’s administrator. As such, according to the citation, the facility did not prevent “repeated” physical and emotional abuse of a resident with dementia and dysphagia. The citation describes video evidence that showed nursing staff forcefully feeding the resident, who had a swallowing disorder, and who “grimaced” and “expressed a fearful look” during the feeding. The citation also notes that a Registered Nurse entered the room during one incident and observed a Certified Nursing Assistant “feeding and handling the resident in a rough manner,” but “did not intervene to protect the resident.” The citation identified this deficiency as a pattern of conduct that posed immediate jeopardy to resident health or safety.”

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New York nursing homes breathed a sigh of relief last week when a New York Supreme Court judge stopped the state from cutting Medicaid reimbursement funds to facilities across the state. Speaking on behalf of the nursing home industry, Ami Schnauber of LeadingAge New York told McKnight’s Long-Term Care News that the ruling is a “big relief” for its members across the state. The ruling comes after the New York Department of Health revamped its formula for determining Medicaid reimbursement rates. According to state officials, the new rates create a “more fair and accurate picture of [the needs of] nursing home patients.” 

The nursing home industry disagrees and says the state is trying to plug an unrelated budget shortfall by cutting necessary funding to the 80,000 New Yorkers who rely on Medicaid to pay for their nursing homes. While the health department says it does “not expect this change to result in any disruption to nursing home residents and the care they receive,” the nursing home industry disagreed and sued the state. In their arguments before Supreme Court Justice Kimberly O’Connor, the nursing homes said the $246 million cuts would cause “irreparable harm” to nursing home patients and force short-staffed nursing homes to lay off even more workers

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Fieldston Lodge Care Center received 38 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 14, 2019. That figure is six greater than the statewide average of 32 citations. The Bronx nursing home’s citations resulted from a total of five inspections by state authorities. The violations they describe include the following:

1. The nursing home did not take adequate measures to prevent and control infection. Section 483.80 of the Federal Code stipulates that nursing home facilities “must establish and maintain an infection prevention and control program… to help prevent the development and transmission of communicable diseases and infections.” A July 2019 citation found that Fieldston Lodge Care Center failed to properly implement its disease prevention guidelines by neglecting to properly clean poles for hanging gastrostomy tube feeding, and by allowing oxygen tubing to run along the floor in spite of protocol requiring that it be maintained off the floor. A state inspector found that this lapse had the “potential to cause more than minimal harm.”

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Jeanne Jugan Residence received 19 citations for violations of public health laws between 2015 and 2019, according to records provided by the New York State Department of Health and accessed on November 14, 2019. The Bronx nursing home also received a Federal Civil Money Penalty of $8,518.25 for citations found on a March 9, 2018 survey, according to the Long Term Care Community Coalition. Federal Civil Money Penalties are one of several remedies state and federal authorities are empowered to assess when nursing home facilities are found to fall short of minimum health and safety standards. Jeanne Jugan Residence’s 19 citations result from three inspections by state inspectors. The violations they describe include the following:

1. The facility did not ensure an environment free of accident hazards. Under Section 483.25 of the Federal Code, nursing home facilities must provide an environment as free as possible from accident hazards, and with adequate supervision and assistive devices to ensure that residents do not sustain accidents. A March 9, 2018 inspection found that Jeanne Jugan Residence’s staff failed to adequately train and supervise a Certified Nursing Assistant to ensure that a resident’s care plan was implemented in such a manner that would prevent them from sustaining an injury. The resident specifically required the assistant of two persons “when applying a sling for stand up lift while sitting in bed, and floor mats were to be at bedside to prevent injury from falls.” The inspection found that the CNA tried to assist the resident without a second staffer’s assistance, and apparently without floor mats in place. As a consequence of this lapse, the resident fell from their bed and sustained harm to their clavicle.

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Manhattanville Health Care Center received 21 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 14, 2019. The Bronx nursing home also received Federal Civil Money Penalties of $19,505 and $12,678.25 for citations found on a May 9, 2018 survey and a May 14, 2018 survey, respectively, according to the Long Term Care Community Coalition. Federal Civil Money Penalties are one of several mechanisms state and federal authorities are empowered to enforce when nursing home facilities are found to fall short of minimum health and safety standards. Manhattanville Health Care Center’s 21 citations result from six inspections by state inspectors. The violations they describe include the following:

1. The nursing home failed to ensure it adequately administrated itself in a manner that provided for the highest possible resident well being. Section 483.70 of the Federal Code requires nursing home facilities to administer themselves in a fashion that enables the most effective and efficient use of their resources “to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” A May 14, 2018 inspection found that Manhattanville Care Center failed to operate itself in a manner that timely provided basic life support to a resident who needed emergency care. An inspector observed a resident “unresponsive and not breathing.” A redacted number of minutes passed before staff administered CPR, and “approximately 5 minutes [passed] before 911 was activated.” The inspection found that this lapse “resulted in actual harm and the potential for serious harm to the health and safety of all residents in the facility.”

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