Understaffed: nursing homes struggle to find workers

Investigates

Some experts believe that staffing is by far the most important factor when it comes to a nursing home’s safety and quality of care. Yet, New York is one of a handful of states that do not mandate numerical staffing standards for nursing homes. Will that change?

BUFFALO, N.Y. (WIVB) — Dot Moody said her sister would often call her from an East Aurora nursing home in tears.

“She would tell me that they were letting her sit in her feces for hours at a time,” said Moody, who was the health proxy for her sister while she was at Absolut Aurora Park, a one-star nursing home in East Aurora.

“… and she says it burns and it’s very painful.”

Elizabeth “Bettie” Whiting, whose health was deteriorating after a stroke, eventually developed a terrible bed sore that had eaten away at her skin near her buttocks, leaving a black, infected hole.

The wound ended up killing her.

Whiting died in October of last year from sepsis, according to her death certificate.

Family members of Elizabeth “Bettie” Whiting are unhappy about the care she received at a local nursing home.

Moody said her sister did not get good care at the nursing home.

“I’m angry,” Moody said. “And I just think it’s unacceptable.”

Kim Kwietniewski, the nursing home’s executive director, said she could not discuss Whiting’s short stay because of federal privacy laws.

Nonetheless, she told News 4 Investigates that Whiting “was provided the highest level of care during her short time with us; there have been absolutely no credible findings to suggest otherwise.”

Another family near Springville is equally upset over their loved one’s stay at a nursing home.

Cassandra Felt said her mother, Wendy Wick, had similar complaints about Fiddler’s Green, a three-star nursing home in Springville. Wick was unable to walk short distances, so she was sent to the nursing home for rehab.

“She was supposed to be doing PT and she never did,” Felt said. “Either the equipment didn’t work or she couldn’t get out of bed. They didn’t have enough people.”

Jessica Schultz, Wick’s aunt, said Wick complained about being left in her own urine for hours at a time and staff did not immediately respond when she hit the emergency call button.

“They were constantly ignoring her call button,” Schultz said. “They’d shut it off and be like, ‘oh, I thought we did, I didn’t remember we didn’t come to help you.’ I understand the way business works. But even if you’re overworked, you’re tired, you’re short staffed, that’s your job. That’s what you signed up to do so do it to the best of your ability.”

The family filed complaints with the state Department of Health, which concluded this past summer that the agency found no violations of state or federal regulations.

Fiddler’s Green declined to comment on this specific case. In a prepared statement to News 4 Investigates, Mary A. Swartz, the director of strategic planning and development for Avanate Care Management LLC, said the nursing home provides high-quality care to its residents. Fiddler’s Green is a past recipient of the state Department of Health’s “Best Improver” award.

“We anticipate the facility to rise to an overall 4-star rating,” she said.  “The facility has not had any staffing related citations during its inspections from the Dept of Health.” 

Family members of Wendy Wick filed complaints with the state regarding quality of care concerns.

Regardless, the quality of care in nursing homes has long been a matter of concern to consumers after the U.S. Senate in 1986 found that many of the nation’s nursing homes operated at a substandard level.

According to federal data analyzed by News 4 Investigates, nursing homes in New York have the most average number of residents per day in the United States. More than 117,000 people reside in nursing homes in New York.

But nursing homes in the state don’t stack up as well when it comes to staffing.

In fact, the state ranks in the lower 20 percent nationwide when it comes to measuring staffing hours per resident per day, according to the federal data.

For example, 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 reporting registered nurse staffing hours per resident per day
  • 37th in reported licensed staffing hours per resident per day

“Staffing is by far the most important factor when it comes to a nursing home’s quality and a nursing home’s safety,” said Richard Mollot, executive director of the nonprofit Long Term Care Community Coalition.

“We’ve known for many, many years that nursing homes – not all of them – but a majority I would say of them – are understaffed. And New York has consistently in the data that I’ve reviewed over the years has been in the bottom 20 percent of the country in terms of staffing levels.”

Some are beginning to lean on the state legislature to further target an industry that is already under constant scrutiny from its residents, families and advocates for health and safety issues.

Staffing standards

Some state lawmakers have tried to address the shortage of workers in nursing homes.

Several bills that would have mandated numerical staffing limits for nursing homes and hospitals have failed in the state legislature.

Instead, the state Department of Health is studying the pros and cons of such legislation, but its report is already more than a month late.

Less than 10 percent of the nursing homes in the state would have passed the staffing ratios proposed in the prior legislation, according to federal data reviewed by News 4 Investigates.

Sen. Patrick Gallivan, R-Elma, who serves on the senate’s health committee, said most of the complaints of which he is aware target hospitals, not nursing homes.

“The legislation deals with nurse staffing ratios in both hospitals and nursing homes,” Gallivan said.

“To my knowledge that’s the only legislation that we have seen in New York in the last five or 10 years. I don’t know that there’s any legislation that has separated the two of them.”

Gallivan described the staffing shortages as “eye opening,” though, and wondered if the legislation should address only staffing at nursing homes.

“And if it is appropriate to take further action then we should do it,” Gallivan said.

State health department too lax?

The state Department of Health is responsible for enforcing nursing home regulations.

The agency typically gets more than 10,000 complaints each year.

About 11 percent of the complaints this year were against nursing homes in Western New York, with 166 reported cases of physical abuse, mistreatment or neglect, according to state data. About two-thirds of the cases were “unsubstantiated.”

The state Department of Health said that since 2016 it has levied more than $3 million in fines against 209 nursing homes.

Each nursing home is required to have appropriate staff to ensure that each resident receives treatments, medications, diets and other health services based on their individual care plans. But numerical standards for all staffing do not exist.

In fact, New York is one of only a handful of states that do not have numerical ratios for nursing home staffing despite numerous studies which have recommended such measures to improve care.

A January 2006 report by former Attorney General Eliot Spitzer found that staffing levels in about 70% of nursing homes in New York did not meet the standards set in Florida; about 38% did not meet the standard in California; and about 26% did not meet the standards in Vermont.

There are more than 600 nursing homes in New York and the most common citations are for neglect, hazards that could injure residents, bed sores, lacking infection control programs and mistreatment.

But penalties with big fines are not the norm in New York.

State law caps the amounts of fines for nursing homes to $2,000 per citation, $5,000 if it is a repeat violation and up to $10,000 if the violation directly resulted in serious physical harm.

State data shows that in the past three years New York ranked 18th lowest in the nation for the average fine against nursing homes, which is $23,600. West Virginia ranked highest with the average fine being $199,000, according to data analysis by ProPublica, a nonprofit investigative journalism center.

In addition, President Donald Trump’s administration softened regulations by no longer allowing nursing homes to be fined for each day they were in violation, which resulted in the average fine dropping by more than $12,000, according to research by NPR.

Mollot said both state and federal regulators have dropped the ball on nursing home enforcement. The fines are too small and fail to act as a deterrent.

“We definitely need stronger enforcement,” said Mollot, of the nonprofit Long Term Care Community Coalition.

“We know nationwide there’s only 5%, for instance, of healthcare deficiencies that identify harm. But we see that there are nursing homes that have repeat deficiencies, every year, year in and year out.”

Indeed, an August 2019 report from the U.S. Department of Health and Human Services Office of Inspector General found that New York officials need to improve the oversight of select nursing homes.

The OIG found that all 20 of the nursing homes it visited had deficiencies in life safety and emergency preparedness rules, including 205 areas of noncompliance with life safety requirements and 219 areas of noncompliance with emergency preparedness requirements.

“As a result, nursing home residents at the 20 nursing homes were at increased risk of injury or death during a fire or other emergency,” the report concluded.

“The identified areas of noncompliance occurred because of several contributing factors: specifically, inadequate management oversight and staff turnover at the nursing homes.”

A state Department of Health spokesman said the agency constantly revises its policies and methods “to enhance quality of care and improve nursing home care based on industry trends and the latest healthcare innovations.”

“We will continue to hold all nursing home providers accountable for violations of federal and state regulations,” the spokesman said.

Despite the state’s tough talk, former nursing home employees described a hectic work environment that makes it nearly impossible to give each resident the time and level of care they deserve.

Workers quit industry

Gabrielle Simano worked at three different nursing homes in Western New York before she called it quits last year.

She loved the work but the “staffing crisis” as she described it got to be too much for her to handle.

“I feel like if I don’t say something, then it is not going to get fixed,” Simano said.

The certified nursing assistant said a lot of the problems she witnessed had a direct link to understaffing at each nursing home.

“There is a lot of low staffing and it is hard to take care of people when you don’t have enough staff that have your back,” she said.

“Ultimately, it is not safe for employees, it is not safe for the residents.”

She described a workplace where she only had about five minutes every two hours for each of her 22 residents on the dementia floor. Five minutes to get a resident out of a wheelchair, clean them and change their undergarments. She said she would literally sprint room to room to help residents, some of whom were unable to walk, talk or eat alone.

The hectic pace was perpetuated, she said, by a lack of staffing and a well-meaning state rule that requires an employee to check on residents at least every two hours and change them if they are incontinent.

“The staffing crisis is a big setback, not just for the businesses but for employees to,” Simano said.

“It is scary because a lot of us went into this job wanting to help others.”

She said when she would raise her concerns with administrators, they’d always respond with “we are trying.”

“They would say that they were trying but a lot of us felt like they weren’t,” she said.

A second former worker who spent a decade as a nursing home aide said she witnessed a lot of problems that can be linked to a lack of staffing. She asked that her name not be used in the story because she still works in the industry as a home care worker for The Never Alone Agency.

“It was a little bit different back when I first started,” she said.

“They actually had an interview process and actually called references. But nowadays, you literally walk into a nursing home and get hired as long as you’re certified.”

She described poor pay that barely competes with fast-food wages as being a reason for workers quitting.

But for her, someone who enjoyed helping others, she found the lack of staffing to be the most frustrating part of her job.

“It’s terrible,” she said.

“You’re supposed to have seven residents to get up and ready for the day and nine times out of 10 you’ll have like 13, 14, 15, and then in the evenings it was way worse because nobody wants to work evening shifts.”

She said there were times when she was responsible for 34 residents on a shift.

“And then if you don’t get your computer work done, because that’s how the facility gets paid, you’re getting in trouble,” she said.

“So, if you don’t do all your work you feel bad for the residents, but if you have to stop at a certain point, you’re going to get written up and lose your job.”

Industry responds

The nursing home industry is facing some big challenges, experts said. 

Nancy Leveille, executive director for the Foundation for Quality Care, and Stephen Hanse, president and CEO of the NYS Health Facilities Association, said the state has gone over a decade without any cost of living increase for nursing homes’ Medicaid reimbursements.

The money that nursing homes do get from Medicaid reimbursements is not enough, Hanse said.

“New York State leads the nation in the Medicaid shortfall,” Hanse said.

“By that I mean New York short changes on average across the state by $65 the cost for care, per patient, per day of what it costs to care for a resident.”

According to the Genworth Cost of Care Survey, the average cost per day for a nursing home ranges between $245 and $275 a day, depending on if the resident has a private room.

In Western New York, the average cost is about $352 per day per resident, according to state Department of Health data, although other surveys peg the number closer to $400 per day per resident

In addition, the nursing home industry is faced with what Leveille and Hanse described as a healthcare workforce crisis. Minimum wage increases have made it more challenging to retain and attract help, they said, as workers leave for fast-food jobs.

“It is very difficult for us to compete for healthcare workers,” Leveille said.

“It makes it very difficult for us to give them raises or other benefits that we’d like to be able to give them. The nursing homes, they do their best on it, but when you’re paid $65 less than it costs to take care of the residents, your money is going to be putting in to try to provide the best care that you can.”

A state Department of Health spokesman said the state legislature enacted a freeze of all trend increases in 2009, which includes COLA increases for nursing homes. 

“However, nursing homes receive acuity-based case mix increases twice a year, to address acuity changes,” the spokesman said. 

“Additionally, the capital component of the rates are adjusted annually to accommodate changes in capital costs.”

Nursing homes are heavily scrutinized, they said, which creates a very stressful work environment for the nursing staff. Every mistake is logged and supposed to be sent to the state Department of Health, which can often lead to investigations.

“People are people,” Leveille said.

“You’re going to make some mistakes. Things happen with residents, they do fall. They fall at home before they come in. We can’t avoid all those things from happening because we don’t provide one-on-one care, but you’re kind of held to a standard of almost one-on-one care.”

Not everyone is sympathetic to the nursing home industry’s struggles.

Expert: ‘Basic dignity’ lacking

Mollot cautioned consumers to steer away from nursing homes that are ranked below four stars in the federal Nursing Home Compare database.

“What’s most important is you have made this promise,” Mollot said.

“This is a contract, and that’s the other argument, when nursing homes say ‘oh we can’t hire more staff we don’t have enough money or we can’t find them, then stop taking residents. If you don’t have enough staff to provide appropriate care, care with basic dignity – I’m not saying put a crown on the person and give them foot massages all day – I’m just saying basic dignity. If you don’t have the staff to do it, then don’t do it.”

The two former nursing home workers who spoke to News 4 said a lot of work needs to be done to make the facilities safer for both employees and residents.

“The morale was so low,” said the former nurse’s aide who asked to remain anonymous.

“They did the best that they could, but everyone was just so defeated because of how short we were. If you genuinely cared about these residents that are living in your nursing home you would make sure that there was adequate staff.”

The interactive chart below is best viewed on a desktop browser.

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Fish Fry

Trending Stories

Don't Miss