Articles Posted in Understaffing

Between 2015 and 2019, Adira at Riverside Rehabilitation and Nursing received 37 citations for violations of public health laws, according to records accessed on November 2, 2019. The Department of Health is the public entity responsible for inspecting nursing homes every 9 to 15 months to ensure compliance with state and federal health and safety laws. Adira at Riverside’s 37 citations, which resulted from three inspections, were five more than the statewide average of 32. The Yonkers nursing home’s citations include the following:

1. The nursing home failed to provide proper provide treatment and services sufficient to prevent and heal pressure ulcers and bedsores. A citation issued on December 2017, found that Adira at Riverside failed to ensure that one of three residents inspected was provided with appropriate care of pressure ulcers. Section 483.25 of the Federal Code requires that nursing homes provide residents with care adequate to prevent pressure ulcers unless otherwise unavoidable given their condition, and further, that residents suffering from pressure ulcers receive necessary treatment and services to prevent infection or the development of new ulcers. The Department of Health states specifically that the facility did not properly inflate an air mattress to the manufacturer’s recommended amount so as to provide the patient with “optimum pressure relief” while they were in bed. A surveyor found that whereas the resident’s weight was recorded as 109.6 pounds, the control box regulating the air mattress was set at 200 pounds, and that facility staff were unaware who had set the air pressure at that level or who was responsible for ensuring proper mattress inflation.

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A federal judge ruled against SensotaCare, the largest nursing home provider in New York, saying the agency violated human trafficking laws with its meager wages and “threat of serious financial harm” designed to prevent anyone from quitting. According to Newsday, Judge Gershon of the federal Eastern District of New York also found that the owners of SensotaCare, Benjamin Landa and Bent Philipson, could be held personally liable for violating the anti-trafficking laws. 

The ruling continues a decade-long saga between the corrupt owners of the nursing home and the Filipino nurses who say they were required to pay $25,000 if they ever quit their job. At one point, Suffolk County District Attorney Thomas Spota charged thirty nurses who quit en masse with endangering the welfare of children for leaving  their position. The charges were overturned by a state court because they violated the rights of the nurses to be “free from slavery.”  

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New York State agreed to pay more than $6 million to victims of abuse at a state-run nursing home in The Bronx. The settlement comes after a protracted legal battle that began more than five years ago after a series of news reports detailing physical abuse and widespread neglect at the nursing home. According to The New York Times, staff members would spit on the nursing home patient’s faces, force them to take cold showers, and physically attack the helpless patients. One family member of a nursing home resident, which is known as Union Avenue I.R.A., told the newspaper that the front desk answered the phone with, “Good morning, Bronx Zoo.”

As part of the legal settlement with New York, the nursing home abuse victims forced the state to surrender control of the facility to a private nonprofit agency. “We lost all faith that the agency can run this house effectively,” the victims said in a statement to The New York Times. Indeed, the misconduct of the nursing home was not the only problem at Union Avenue I.R.A. The lawsuit describes a dysfunctional culture where anyone who reported misconduct faced retaliation. After a state investigation found 13 instances of nursing home abuse at the Bronx facility, New York State did not fire anyone. A state-mandated arbitration process protected the confidentiality of the employees and the state merely transferred the abusers to a new facility.

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Senators released a list of 400 nursing homes with a ‘persistent record of poor care,’ according to the federal legislators. These nursing homes are not included in the federal government’s “special focus facilities” a list of nursing homes released by the government each year indicating poor care and unsafe conditions. According to the Senators, the list of 400 facilities is “virtually indistinguishable” from special focus facilities and the elder care facilities are not all lumped together only because a 2014 law imposed a cap on the number of so-called special focus facilities. Consequently, this left 400 facilities subject to heightened government scrutiny without public knowledge.

According to the Centers for Disease Control and Prevention, approximately 1.3 million Americans are nursing home residents at 15,600 facilities across the country. The federal government identified 3 percent of these nursing homes as problematic in April. In New York, these nursing homes include New Roc Nursing and Rehabilitation Center in Rochester, The Knolls in Valhalla, and Cayuga Ridge Extended Care in Ithaca, according to LoHud.com. In addition to these nursing homes, fourteen other New York long-term care facilities were included in the list of 400 released by the Senate.

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New York nursing home regulators knew an upstate nursing home’s roof leaked for four years before finally forcing the owner to fix the safety hazard. According to Syracuse.com, the state Health Department inspection records show reports of “water-stained ceiling tiles” and “a hose running down from the ceiling of a resident’s room into a rusty bucket” dating back in 2015 and 2016. The Health Department is responsible for inspecting nursing homes in New York every 16 months.

After noticing the leaky roof in 2015, inspectors worked with Pontiac Nursing Home to fix the ceiling tiles and the leaky roof. Despite the clearly hazardous conditions, the upstate nursing home never implemented the plan. Consequently, the ceiling was still leaking when inspectors returned in 2016. With the water collecting in a “rusty bucket,” nursing home employees assured state regulators that the slip-and-fall danger was only temporary and the leak had been fixed three months earlier.

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The federal government fined a Buffalo nursing home $47,827 for erroneously administering insulin to a resident. According to The Buffalo News, the fine against Humboldt House represents the sixth largest in New York for 2018. The newspaper reports that a physician at the nursing home administered insulin to a diabetic resident in February 2018 despite a hospital discharge report warning the nursing home staff to “PLEASE AVOID GIVING THIS PATIENT INSULIN” – in all capital letters.

The nursing home resident, who was not named by the newspaper, was found unresponsive multiple times over the next few days. After reviving the elderly woman with medication and fruit juice, the nursing home finally realized its mistake. Federal officials determined this medication error caused “actual harm” to a patient, the most serious type of violation for a nursing home.

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Almost three-fourths of nursing homes in the United States “almost never” have the minimum number of nurses on staff, according to McKnight’s Long-Term Care News. The new study, which utilized a year of payroll data, found that 75 percent of facilities self-reported a number of nurses that are “almost never in compliance with” the federally required minimums. The study was produced by researchers at Harvard University and Vanderbilt University who then published their findings in Health Affairs.
The study comes on the heels of new federal guidelines on reporting nursing staff. Previously, nursing homes would provide a sample of their time-sheets to local regulators when their facility was inspected. Unfortunately, nursing homes commonly knew when inspections would occur and would respond by increasing the number of nurses on staff in the weeks before an inspection. Further, local regulators – who are typically from the state’s health department – did not always scrutinize or authenticate the time-sheets provided by the nursing home. For these reasons, the federal government created a computer system that requires nursing homes to upload payroll information on staffing levels. This new system benefits from live-updates and 24/7 monitoring of the nursing home.

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After addressing the shortage of nursing staff in hospitals, healthcare advocates have set their sights on implementing “Safe Staffing” policies in New York’s nursing homes. Safe Staffing policies would legislate minimum levels of nursing staff across the state’s nursing homes. Currently, New York State law only requires “sufficient staffing” which grants nursing homes wide discretion to determine whether its facility has sufficient levels of staffing. Elder care advocates lobbied state legislators to include safe staffing requirements in the budget this year. Lawmakers in Albany declined their request.

Instead, lawmakers opted to study the staffing levels at nursing homes. According to The Buffalo News, the budget passed earlier this year in Albany included a directive to the New York State Health Department to begin a study on May 1 analyzing “the range of potential fiscal impacts of staffing levels, other staffing enhancement strategies, and other potential quality improvement initiatives,” according to WHEC. The health department will then issue a final report to lawmakers at the end of the year. Given the timing of the report, it appears unlikely that any legislation will pass this year establishing mandatory staffing levels at nursing homes. Studies in Albany can frequently go in two directions. In some situations, studies are meant to endlessly shelve an unpopular idea. In other circumstances, studies can empower government agencies to develop their own policy proposals that will then be quickly passed into law.

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Elder abuse is a growing problem in America that often goes unreported. According to a recent article in NPR, healthcare workers and government regulators are failing to report cases of suspected elder abuse to local authorities. The article analyzes a recent report by the Office of Inspector General which found that despite evidence of abuse or neglect severe enough to warrant medical attention, healthcare providers rarely alerted authorities. Under both federal and state law, healthcare professionals are legally required to report cases of suspected abuse.

Elder care advocates are unsurprised by the federal agency’s report, saying that elder abuse is widespread and unreported in the United States. The report only further confirms the severity of the elder abuse and the indifference to tackle the problem. One study relied upon by the federal agency that authored the report analyzed nursing home residents who end up in an emergency room. The researchers looked for potential signs of neglect or elder abuse, such as head injuries, body bruises, bedsores, or any diagnosis that may indicate sexual or physical abuse.

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The Centers for Medicare and Medicaid Services (CMS) announced arbitration agreements would be allowed in nursing home agreements which receive federal funding. Under President Obama’s administration, CMS barred nursing homes from inserting mandatory arbitration clauses into their agreements. Mandatory arbitration agreements bar nursing home residents from bringing any legal grievance against their nursing home in a courtroom. Since nursing home residents are particularly vulnerable and nursing homes have a poor record of abuse and neglect, President Obama’s administration reasoned that mandatory arbitration clauses should be banned in all nursing home contracts.

Predictably, the nursing home chain did not support the federal government’s ban on arbitration clauses. The elder care industry said that arbitration provides a faster, more efficient resolution of claims for everyone involved. When President Trump came into office, his administration took a more industry-friendly approach to regulating nursing homes. In addition to sharp drops in fines on nursing homes, CMS also began deregulating the nursing home industry and appears to have reached a compromise on the mandatory arbitration agreement. Under the rule finalized this month, nursing homes will be allowed to include arbitration agreements in their default contracts with nursing home residents. However, nursing homes cannot deny admission to any resident because of their refusal to include a mandatory arbitration clause in their contract.

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