Nursing homes seek solutions for workforce crisis

Investigates

Industry experts are sounding the alarms and realize that some out-of-the box ideas are going to be needed sooner rather than later

(WIVB) — Nursing homes are in a workforce crisis and some industry experts believe the state’s new minimum staffing standards will be tough for many facilities to meet.

Long-term care providers or nursing homes are struggling to fill positions for nurses and aides.

Industry experts told News 4 Investigates that the pool of workers is aging and has shrunk. In addition, the most recent labor report showed that nursing and residential care facilities lost almost 10,000 jobs in the past month.

A survey by the American Health Care Association and National Center for Assisted Living found that 94% of nursing home providers agreed that they have had a shortage of workers in the past month and more than half lost critical staff that quit during the worst of the pandemic.

“New York’s long-term care workforce is at a crisis level right now,” said Stephen Hanse, the president of the New York State Health Facilities Association.

“And quite frankly, it’s been a crisis level for quite some time.”

Terry Fiedler, a local teacher, told News 4 Investigates that she witnessed how poor staffing in a nursing home impacted the quality of care for her mother.

Her mother, Joan Fonzi, entered a nursing home in July 2017 and died less than two years later.

Fiedler said when she visited her mother, the room was often in disarray, her mother was not clean, and getting the attention of the staff was difficult. Her mother lost more than a third of her body weight during her time in a nursing home and weighed less than 70 pounds at the time of her death.

“For two years I was going to sue and then realized that it really wasn’t going to accomplish what I wanted to accomplish, and that would be to help other seniors and caregivers like myself from going through this,” Fiedler said.

Instead of suing the nursing home, Fiedler said she has pitched an idea that would connect high school students with educational opportunities that provide a direct path to jobs in nursing homes as aides or licensed practical nurses.

But state law would have to be amended to make this work, experts said.

Meanwhile, nursing homes will be facing the need for even more staffing soon.

That’s because in May, state lawmakers passed legislation that created minimum staffing levels for nursing homes. In addition, nursing homes will be required by Jan. 1, 2022, to disclose their staffing levels in a simple, understandable platform for the public to understand, or they could face penalties.

Most nursing homes in the state would not meet the new minimum staffing levels, according to industry experts.

“I think the industry has largely gotten away with substandard staffing,” said Richard Mollot, executive director of the Long Term Care Community Coalition.

“We track these data, it’s not my opinion, it’s actually based on upon data, based upon federal studies of how much staff is needed. And we know that three-quarters of nursing homes operate without sufficient staff just to meet their residents’ clinical needs. So, somehow, we have to turn the industry around.”

‘What can we do to change?’

Fiedler, the local teacher whose mother died in a nursing home, remembered days in which one aide had responsibility for an entire wing of more than 50 residents.

When she raised concerns with the new administrator, she would get denials that there was a staffing problem.

“At one point I’m sitting with my mother and I helped her to eat supper, and after supper all of a sudden I hear, ‘bing, bing, bing, bing,’” Fiedler said.

“I’m thinking, I don’t see anybody in the hallway coming. All of a sudden, you hear people yelling, ‘help, help, help me!’ And I went into the hallway and I looked and almost every light in the hallway was on for a nurse or somebody to come but there was nobody coming.”

“It was just such a helpless, helpless feeling to know I couldn’t help anybody.”

Fiedler said every weekend she visited her mother, there was something new she had to photograph to prove that her mother was not being appropriately cared for.

Her mother’s room and bathroom would not be clean. The toilet seat would be soiled. She found ants in the room. Her mother always had bruises that no one could explain, and old food was caked on her mother’s skin. She photographed each issue but couldn’t get much resolution with the new administrator.

She said the food was terrible and her concerns grew that her mother was not eating enough.

The day before her mother died, she weighed 66.8 pounds. The death certificate notes the cause of death as heart failure.

“I was so upset at the time,” Fiedler said.

“And I know a lot of times they were short, and I just felt like I wanted to sue to make a point. And then after a couple of years, I realized that this is not going to get anywhere. I want to take her story and have it be a catalyst for change. What can we do to change?”

That’s when the idea popped in her head of providing high school students with a direct link to nursing homes by providing coursework that qualifies them for an entry-level job while getting real-life experience that can be used to achieve a higher degree.

In other words, seniors could graduate with enough skillset to be licensed practical nurses or aides and then work directly in nursing homes to climb the workforce ladder to better-paying positions, such as nurses.

“This way they can earn their [nursing degree] while they’re working at the nursing home and then when they graduate, the next groups keep coming in,” she said. “So, a perpetual flow, keeping the population up as far as workers.”

While Erie BOCES provides health-related coursework for high school students, rules do not allow for them to provide a direct path to a full-time job at a nursing home once they graduate. Instead, BOCES offers courses for adults that connect them with nursing homes.

For a direct pathway like Fiedler recommends, the state would have to make changes to the rules to become a certified nursing assistant, which includes:

  • Be at least 18 years old
  • Have a high school diploma or GED
  • Graduate from a certified nursing assistant school in New York
  • Pass a state exam

Mollot said the industry must address the poor pay and working conditions if it wants to find success in attracting people to nursing homes.

“It’s a self-perpetuating issue with the industry is that the working conditions generally are so poor, as well as a poor salary that people leave,” Mollot said.

“They’re able to get people in but people leave.”

New York nursing homes ranked below average in staffing

In January 2020, News 4 Investigates analyzed federal data that showed that nursing homes across the state ranked in the lower 20% nationwide for staffing hours per resident per day.

Specifically, the state ranked:

  • 41st in reported total nurse staffing hours per resident per day
  • 41st in reported nursing aide staffing hours per resident per day
  • 40th in reported registered nurse staffing hours per resident per day
  • 37th in reported licensed staffing hours per resident per day

Couple this with what Mollot says has been a “very poor job” by the state Department of Health of regulating and fining nursing homes, and it is a recipe for subpar care.

“I mean, the public knows,” he said.

“No one wants to go to a nursing home. I talk to people; they would rather die than go to a nursing home. The nursing home industry has a well-deserved poor reputation.”

Minimum staffing levels

The state legislature this year finally passed minimum staffing standards for nursing homes after years of debate and tabled legislation.

The law states that by 2023, nursing home staffing standards would have to include 3.5 hours of nursing care per resident per day. Of the 3.5 hours, at least 2.2 hours need to be provided by nursing assistants and at least 1.1 hour would need to be provided by licensed practical nurses (LPNs) or registered nurses (RNs).

As of now, 64% of nursing homes have a median percentage below the minimum standard for CNAs and 65% would fail to meet the total staffing criteria.

The law gives the state commissioner of health authority to consider mitigating circumstances, such as natural disasters, national emergencies, frequency and nature of non-compliance and the existence of “an acute labor supply shortage within a particularly region” when considering fines.

In other words, some nursing homes may not meet state staffing guidelines and not get much of a fine for the violation.

Hanse, the president of the New York State Health Facilities Association, represents almost 400 nursing homes and assisted-living facilities across the state.

“When you look at the demographic data, nursing homes are going to be essential over the next five to seven years,” Hanse said.

“As the baby boomer generation ages out, they need skilled nursing care and we need the workforce to care for them.”

Can industry tap high schools?

Hanse said a “uniform statewide strategy” with an educational curriculum for high school students could help, but laws would have to be amended.

“To present these types of initiatives, some of these programs have to be created in the State Department of Education,” Hanse said.

“You simply cannot mandate staffing ratios. You need to have the staff to fill them and in some of those instances it’s going to take legislation to encourage individuals and investment.”

Mollot said poor pay and tough working conditions have been an obstacle for nursing homes finding and keeping a healthy workforce.

“I think they’re counting on an increasing elderly population,” Mollot said.

“And as long as they have customers and don’t have accountability, it’s pretty easy money. I mean, the industry claims that they operate on razor-thin margins. That’s not true. We have nursing home moguls in the state.”

Indeed, one of the chief complaints of the industry is how they are shortchanged in Medicaid reimbursement by 20% to 30%.

“So, we need to address the educational programming and we also need to address the state reimbursement for Medicaid,” Hanse said.

“If the Covid-19 pandemic has showed us anything, it’s how critical nursing homes are in the healthcare continuum and how their needs need to be addressed.”

But Mollot doesn’t buy the Medicaid argument. He points to the increasing number of privately-owned nursing homes to raise the argument that there must be profits or why would businessmen be buying them?

“These aren’t charities that are buying up nursing homes,” Mollot said.

“These are increasingly for-profit entities. They’re operating because there is money there and there is a lot of money there.”

Terry Fiedler created a petition to garner support for providing nursing programs at the high school level to link students with careers at nursing homes. Scan this QR code to sign the petition:

Dan Telvock is an award-winning investigative producer and reporter who has been part of the News 4 team since 2018. See more of his work here.

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