Category Archives: Staffing

The Huffington Post reported on Medicaid cuts in Iowa.  “The aging population is fueling what some health experts call an “Alzheimer’s tsunami” for which Iowa, and the rest of the nation, is ill-prepared. Unless a cure is found, an estimated 7.1 million Americans age 65 and older could have Alzheimer’s by 2025, almost a 35 percent increase, according to the Alzheimer’s Association. Iowa’s 65-plus population is above the national average.   In South Carolina, the total number of cases of Alzheimers in 2015 was 86,000; 120,000 are expected by 2025, according to Alzheimer’s Association estimates.

But instead of preparing for the onslaught, Iowa and other states have begun tightening Medicaid, the only government program that pays for nursing home care, in ways that increase the burden on those with Alzheimer’s and their loved ones.

Medicaid, typically seen as the government health insurance program for people with low incomes and those with disabilities, spends about one-quarter of its $4.8 billion in annual funding in Iowa for nursing home care. The program pays for half the nursing home residents in the state, according to the Kaiser Family Foundation.

Already, Iowa’s move last year to a Medicaid system managed by three for-profit companies is affecting people diagnosed with Alzheimer’s and their caregivers.

Kathy Horan, vice president of AbbeHealth Aging Services, which operates adult day health centers in Marion, Cedar Rapids and Iowa City, said managed care organizations, or MCOs, that coordinate Medicaid recipients’ care have started to decrease the number of days covered at those centers.

Dove Press had clinical guidelines on prescribing psychotropic medication for nursing home residents with dementia on their website.

Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia.

Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.

Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126).

Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

The Santa Fe New Mexican reported that Casa Real nursing home in Santa Fe owned and operated by Preferred Care Partners Management Group has at least temporarily improved persistent quality-of-care problems enough to resume billing Medicare and Medicaid for newly admitted residents.  Casa Real is one of only two homes in Santa Fe that accept Medicare and Medicaid patients.

For more than two months, Casa Real had been barred from charging Medicare or Medicaid for new residents after the Centers for Medicare and Medicaid Services found the nursing home wasn’t in compliance with federal care standards.

Inspections this year turned up a long list of problems, including medication errors, expired food and drugs on shelves, unreported resident injuries and assault, poor care of bed sores, nursing understaffing and inadequate safeguards against the spread of dangerous infections.

The former director of nursing at Casa Real from May to August has accused management of forging patient records in an attempt to show the facility was in compliance with care standards dealing with monitoring of medication effects on residents.  Of course, she was soon fired.

The August inspection found residents weren’t receiving medications as directed by their physicians and that the nursing home wasn’t doing enough to ensure that residents didn’t receive unnecessary drugs, including psychotropic medications.

The federal agency in May designated Casa Real as a “special focus facility” because of its poor record of complying with care standards, and it said the nursing home would be subject to more frequent inspections. The designation is given to the nation’s poorest-performing nursing homes and is meant to address the “yo-yo” problem of facilities routinely falling in and out of compliance with care standards.

The state Attorney General’s Office is suing Preferred Care, alleging it has defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as its facilities in five other New Mexico communities. Preferred Care has denied the allegations.

NPR had an article about the effect of Medicaid cuts on nursing home residents.  The nation has 1.4 million nursing home residents — two-thirds of whom are covered by the state-federal health care program for people with low incomes or those with disabilities.  Medicaid pays less than other forms of insurance. As a result, nursing homes make more than 10 percent on Medicare residents, but lose about 2 percent on the rest of their residents because so many have care paid for by Medicaid.

“Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.”

The reason for the disparity in quality of care, researchers have found, is that nursing homes with the most Medicaid residents can’t afford as many nurses and aides so they operate short-staffed. ”

The average five-star home has enough nurses and aides to provide 5.4 hours of care a day for each resident, while the average one-star home provides 3.0 hours of daily care per resident. At the best-staffed homes (five stars), only 4 of 10 residents are on Medicaid, meaning the remainder of residents are more lucrative for those facilities. At the worst-staffed homes (one star), 7 of 10 residents are on Medicaid.”

At nursing homes with worst inspection records (one star), an average 65 percent of residents are on Medicaid. Places with the best inspection records (five stars) have an average 47 percent of residents on Medicaid.

St. Louis Today reported the tragic death of a nursing home resident who choked and died in July after the patient was fed through a tube in 30 minutes instead of the one hour that was prescribed, according to a federal report.  Then a nurse failed to check on the patient, perform CPR and call 911, as required by the patient’s medical record and the nursing home’s policies, investigators with the U.S. Centers for Medicare and Medicaid Services found during an August inspection. The home was cited for placing residents in immediate jeopardy and could be fined for the incident.

A doctor at the nursing home told investigators that the formula coming out of the patient’s nose and mouth at the time of death indicated that he or she choked on the food and suffocated.

Because of the patient’s risk for choking, the formula tube feeding was supposed to be infused over one hour with supervision. At a 4 a.m. feeding on July 23, the nurse infused the formula through the tube in 30 minutes and left the patient after checking vital signs. One hour later, a nursing aide checked on the patient and couldn’t find a pulse. The aide called the nurse, who tried and failed to take the patient’s blood pressure and also could not locate a pulse, according to investigators’ interviews with the staff.

 The nurse then looked at the medical records and realized that CPR should have been performed and 911 called. In the report, investigators wrote “during that shift, Nurse A was very overwhelmed with trying to learn the facility procedures and there were no other nurses on duty to answer his/her questions … Nurse A knew what was expected of him/her and there was no excuse for failing to follow proper procedure.”



WUSA reported that the police are investigating a nursing home for alleged sexual misconduct between an employee and one of the senior citizens.  A similar allegation against an employee was already being investigated.  Forestville Health and Rehabilitation Center is owned by an company called CommuniCare.




Many baby boomers hit an important milestone last year. Those earliest boomers born at the start of 1946 turned 70and are now turning that age at a rate of 10,000 people per day for the next 18 years.  The Census Bureau also indicates that for the first time ihistory the aging populations of 65 and older will double that of children (ages 5 and under) worldwide within the next 3 years.  This has broad implications on health care and nursing, both now and well into the future, especially as there is already a shortage of nurses. 

As the nursing industry deals with this worrisome shortage, nursing schools are trying to meet the demand by expanding their programs and offering accelerated coursework; however, it is still projected that there will be a massive scarcity of Registered Nurses (RNs). 

According to the American Association of Colleges of Nursing (AACN), the demand for RNs in the workforce is expected to increase 16 percent to 3.2 million jobs in 2024, one of the highest of any industry in the U.S. Unfortunately; 1 million RNs will be reaching retirement age in the next 10 to 15 years. So, who will replace these retirees and make up for the anticipated demand? That’s not clear yet.  

The AACN reports nursing schools across the country have only seen a 3.6 percent increase in enrollment, nowhere near enough to meet the projected demand of nurses in the coming years. Compounding the problem is the lack of qualified faculty. The AACN reports 64,067 qualified nursing school applicants were turned away in 2016 due to a lack of faculty 

More details on the nursing shortage crisis, along with a helpful graphic can be found at 

Close to 20% of nursing home assistants are living below the federal poverty line, a result of low wages and part-time positions, according to The Paraprofessional Healthcare Institute’s new report.

Nearly 40% rely on some form of public assistance.  Wages “barely kept up with inflation” over the past decade. The average hourly wage for a direct care worker was $12.34 in 2016, compared to $12.35 in 2006, the report found.  [It is much less in South Carolina].

Despite the profound support they offer to millions of older people and people with disabilities nationwide, direct care workers remain undervalued and poorly compensated,” PHI President Jodi M. Sturgeon said in a statement. “Our country needs to improve wages and hours, provide more training and career paths, and implement workforce innovations that transform this sector — improving care for all of us.”

The data predicts new nursing assistant jobs will make up 39% of total employment growth in the sector, adding to the more than 600,000 frontline positions currently held in the U.S.

Click here to read the full PHI report, which also includes data on workers’ insurance coverage, injury rates, education and demographics.

The Press Democrat reported the lawsuit against Oakmont Senior Living chain founded by Sonoma County developer Bill Gallaher, accusing his company of fraudulent practices that allegedly deprived residents of needed care and exposed them to risk of injury.  Oakmont Senior Living, a privately held company based in Windsor and founded by Gallaher in 1997, operates 23 senior living facilities in California.

Fees at the facilities — which ran as high as $10,000 a month per resident — were based on “budgets driven primarily by desired profit margins” rather than assessments of its residents’ individual needs, the suit claimed.

The lawsuit alleges residents were found on the ground, left to sit in their own waste and at least one suffered an unexplained injury at the company’s assisted living facilities.  The Oakmont Senior Living facilities were understaffed and residents age 65 and older “run the continuing risk of not having their care needs met and of suffering frustration, pain, discomfort, humiliation and/or injury from inadequate care and supervision.”The lawsuit alleged that Oakmont violated the Consumer Legal Remedies Act, committed elder financial abuse and engaged in “unlawful, unfair and fraudulent” business practices.  The 43-page complaint did not specify the amount of financial damages it was seeking. If a judge certifies it as a class action case, the number of plaintiffs could expand to thousands and the potential penalties against Oakmont could be in millions of dollars, said Kathryn Stebner, a San Francisco attorney who filed the lawsuit with nine other attorneys.

The company “actively conceals from residents, prospective residents, and their family members the true facts about its corporate policy and practice of prioritizing profit over resident care,” it said.



Democracy Now had an article blaming deregulation and lack of enforcement on the 9 deaths at Rehabilitation Center at Hollywood Hills in the aftermath of Hurricane Irma.  Florida Governor Rick Scott has now directed the Agency for Health Care Administration to terminate the nursing home as a Medicaid provider.   It is incredible that Rick Scott blames everyone except himself.  See article at Miami Herald stating that Governor Scott deleted the messages from the nursing home begging for his help.

Scott gave out his number to nursing homes and assisted living facilities ahead of the hurricane so administrators could report concerns, according to a timeline released by Scott’s office. In the days following Irma, the staff at the Rehabilitation Center at Hollywood Hills called four times. But the messages they left the governor were ignored and then deleted.

New details about the nursing home include the fact a number of safety violations had already been reported at the facility, including two violations about its backup power capabilities—this was before the storm. However, Scott’s administration did nothing.

Unapproved work was done without city permits to the air conditioning and back-up generator systems.  City building officials say they discovered a temporary generator had been placed outside the facility and wired into the building without the necessary city permits.  The city also says officials discovered the air conditioning cooling tower was replaced without a permit — also a violation of the city’s building code.

Florida Power & Light refused to speed up its response to senior living facilities because Scott never listed nursing homes as critical facilities in power outages.

The main owner of the nursing home, Dr. Jack Michel, also has a history of running afoul of healthcare regulators. In 2006, the Justice Department fined another hospital that Michel runs, the Larkin Community Hospital, $15.4 million over civil fraud allegations.

“And it raises questions and concerns, not just about what happened in this particular situation, but how all nursing homes in Florida are regulated, and whether we’re going to require accountability and transparency, and whether nursing home owners, like the owner of this particular facility, that have a history of abuse should even be allowed to operate healthcare facilities. Certainly, things like putting them higher up on the FPL list and requiring facilities to have standby generators that would run air conditioning systems would make a whole lot of sense in a place like Florida. But there are broader questions about what we’re willing to allow nursing homes to get away with and what kind of accountability we want to have for the billions of dollars in public money that supports this industry.”

“The problem is that nursing homes are funded by our tax dollars; 70, 80 percent of the revenue that supports this industry is our money through Medicaid and Medicare. And it is simply not appropriate to have an industry that’s on the public dole. I mean, I would say we should question whether it’s appropriate to have an industry that takes care of frail elderly people that is run by for-profit corporations. But if we’re going to do that, then we have to have appropriate regulation that makes sure that staffing levels are sufficient to provide quality care and that nursing home operators are accountable for the money they receive and for standards of care. And that’s a problem that, you know, is not—that’s a day-to-day, 365-day-a-year problem, not just in natural disasters like this.”

“Most of the hands-on care that’s done in nursing homes is done by certified nursing assistants. And they, tragically, subsidize this industry through poverty-level wages and poor healthcare and retirement benefits. It’s a labor of love, but it is a crime that we ask our nursing home residents and our nursing home caregivers to subsidize the activities of for-profit corporations.”