Cleveland’s The Plain Dealer reported that certified nursing assistant jobs have one of the highest reported rates of injury in Ohio and across the nation, according to researchers and government reports. Nursing assistants are injured three times more often than the average worker, data show.  The rate of injury among nursing assistants is similar to the rate among construction workers, police and firefighters, according to 2016 data from the U.S. Bureau of Labor Statistics.

For the more than 75,000 residents of Ohio’s 960 nursing homes, nursing assistants provide nearly all of the hands-on care. It is a job that requires dedication, passion and empathy.  State and federal officials have issued reports on injuries at nursing homes, dating back to 1999. The studies found that the lifting and moving of residents and the nonstop pace necessary to meet residents’ needs have caused thousands of Ohio nurses and nursing assistants to suffer injuries from overexertion and falls.

The pay in Ohio has trended downward for more than a decade, according to the Paraprofessional Healthcare Institute, a New York watchdog group that advocates for nursing assistants and home health-care workers. In 2006, their average wage was $12.80 an hour. In 2016, it was $11.96.  (It is about $10.50 in South Carolina).

“It’s appalling,” said Toby Edelman, the senior policy attorney for the Center for Medicare Advocacy in Washington, D.C. “That’s not a living wage for anyone.”

The low pay and the physical demands of the job result in an unusually high turnover rate. In Ohio, that rate was 54 percent for nursing assistants at nursing homes in 2015, the most recent data available, said John Bowblis of the Scripps Gerontology Center at Miami University in Oxford.

To offer quality care, staffs at nursing homes should provide an average of 4.1 hours of care for a resident each day, researchers said.

“A large proportion of people in nursing homes need two [assistants] to help them move, and many nursing homes just don’t have enough staff to offer that,” said Charlene Harrington, a professor emeritus of nursing at the University of California at San Francisco and an expert on nursing home staffing. “The better the staffing in nursing homes, the better the care and the less likely workers will get injured.”

This is a gargantuan problem in nursing homes,” said Brian Lee, who leads a Texas-based national advocacy group for nursing home residents called Families for Better Care. “[Nurses and nursing assistants] are overworked, short-staffed and underappreciated. The burnout, the frustration, the injuries. They can all be prevented if employers just hire more people.”


McKnight’s had an article about the new in-depth analysis published by the Henry J. Kaiser Family Foundation.  According to the data, occupancy rates at nursing homes fell between 2009 and 2016, however, the needs of nursing home residents have grown considerably — placing more demands on unprepared and under-staffed nursing employees.  Average total nursing hours increased to 4.1 per resident day for 2016, up from 3.9 in 2009.

In 2016, nearly half of nursing home residents had a dementia diagnosis, and just under one-third had other psychiatric conditions such as schizophrenia, mood disorders or other diagnoses. In addition, the report found nearly two-thirds of residents received psychoactive medications, including anti-depressants, anti-anxiety drugs, sedatives, hypnotics and antipsychotics.

Over the past 25 years, numerous research studies have documented a significant relationship between higher nurse staffing levels, particularly RN staffing, and the better outcomes of care,” wrote lead researcher and staffing expert Charlene Harrington, RN, Ph.D., FAAN, professor emeritus at the University of California-San Francisco School of Nursing. “Nursing assistants who provide most of the care to these individuals often have limited training in working with this [behavioral health] population. … Regulations could implement ACA requirements to improve the quality of care for residents with cognitive impairments and further restrict the use of psychotropic agents.”

The report is based on the federal Online Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER) system and also examines staffing levels, payment, and compliance.  The most common deficiencies in 2016 were given for failures in infection control, accident environment, food sanitation, quality of care, and pharmacy consultation.

“In 2016, more than one in five facilities received a deficiency for actual harm or jeopardy,” Harrington wrote. “As with other outcomes, there was wide variation across states in these outcomes; however, some states had high rates across all top ten deficiencies.”

Other key findings of the report include:

  • Between 2009 and 2013, the average number of deficiencies per facility declined from 9.33 to 7.28, though there was a slight increase between 2013 and 2016.
  • The proportion of for-profit facilities increased from 67% in 2009 to 69% in 2016.
  • Medicaid is the primary payer source for most certified nursing facility residents, with 62% of residents — about 832,000 people — having Medicaid as their primary payer in 2016. States in the East have higher Medicaid population shares.

WFAA reported on the investigation into over-medication at Duncanville Healthcare and Rehabilitation Center.  Parkland Hospital investigators are conducting a review for possible over-drugging of patients in an alleged practice known as taking patients “to China.”  The reviews follow the WFAA series, “Drugged and Dying,” that investigated the unnecessary use of alleged powerful antipsychotic drugs to sedate or control patients.

In an effort to cut costs on staffing, many nursing homes drug the elderly rather than hire needed staff, patient advocates warn. They have dubbed the practice “chemical restraints.”  WFAA found in its “Drugged and Dying” series that about 70 percent of a typical nursing home expense goes to staffing.

Several witnesses have come forward stating that residents at Duncanville Healthcare and Rehabilitation were being sedated unnecessarily and inappropriately.   “They said: ‘Take this lady to China,’” the former employee told WFAA.  “It just can be any medication that will put a person to sleep,” the worker said.  “They took that lady to China, and she went to the hospital,” the worker said. “The lady never did come back from the hospital.”

The former employee claims the patient was given the antipsychotic drugs Risperdal and Seroquel. However, the patient, who had been awake and talkative – after receiving the drugs – was placed in bed and became nonresponsive, and within six hours was picked up in an ambulance – and later died, the worker said.  Advocates say the medications – particularly antipsychotics – may become another form of abuse when inappropriately and unnecessarily given. In fact, antipsychotic drugs may be potentially fatal for elderly patients.

Other patients at the Duncanville facility also may have been unnecessarily medicated, according to several workers.




SavaSeniorCare, one of the nation’s largest nursing home providers, has been sued in the United States District for the Northern District of California for multiple wage violations.

SavaSeniorCare owns and operates seven residential care and rehabilitation facilities in locations throughout California and more than 200 facilities throughout the United States. The proposed national class action lawsuit is seeking compensation for unpaid overtime and minimum wages, as well as missed meal and rest periods. The plaintiffs, current and former employees of SavaSeniorCare, have brought this action on behalf of all current and former non-exempt employees nationwide.

According to the complaint, the plaintiffs and other similarly situated employees were denied uninterrupted meal periods and rest breaks, overtime compensation, and other wages in violation of the federal Fair Labor Standards Act (FLSA) and California law. Plaintiffs also allege that SavaSeniorCare deducts 30 minutes of pay for meal breaks that employees do not take. In addition, plaintiffs allege that SavaSeniorCare fails to provide proper, itemized wage statements as required under California labor law.

Attorney Bryan J. McCormack of San Francisco-based employment law firm McCormack & Erlich, and Edward J. Wynne of Wynne Law Firm, are representing the plaintiffs.

According to McCormack, “SavaSeniorCare’s conduct of deducting 30 minutes of pay for meal periods that are not taken and failing to pay its employees overtime compensation for all hours worked over 40 per week is not only unjust, but also illegal under California and federal law.” “What is especially concerning is that the company’s practices have affected its employees nationwide for years. Employers need to be held accountable for failing to pay their employees correctly for all the hours they have worked.”

For more information contact:

McCormack & Erlich
150 Post Street
Suite 742
San Francisco, CA 94108
Phone: (415) 296-8420

The State reported that a Lexington County jury has found Lexington Medical Center Extended Care guilty of gross negligence in the death of one of its residents.  Jurors compensated the family of Samuel B. Cunningham $450,000, including $200,000 for Cunningham’s pain and suffering, medical and funeral expenses, and $250,000 for the family’s mental shock and suffering, wounded feelings and loss of companionship.

Cunningham was admitted to the facility at 815 Old Cherokee Road in Lexington on April 29, 2013, at age 81. He was suffering from dementia and was legally blind.  The family alleged that Cunningham often was found by his family soaked in urine, unclean and lacking in oral care.  Nursing home records showed Cunningham suffered 26 falls. He was found on the floor 19 times without anyone seeing him fall. On one occasion, he was found on the ground outside the building with multiple ant bites.

“We were heartened by the jury’s verdict and hope that it will provide incentive for the facility to get its act together and start treating its residents with the dignity and care that they deserve.,” Ken Connor, the Cunningham family’s attorney, said in a news release.

The suit alleged improper care; on one occasion, Cunningham fell and required a hip replacement at Lexington Medical Center, which also operates the nursing home.

Cunningham also developed bed sores because of improper care, and was not properly fed. He also developed pneumonia, which was not addressed in a timely fashion by the nursing home.

On July 1, 2015, Cunningham was admitted to Lexington Medical Center suffering from multiple areas of skin breakdown, malnutrition, dehydration and infections, the suit claimed. He was unable to recover from his decline and died two weeks later at Agape Hospice House in Columbia.

McKnight’s had an interesting article about a pilot program that decreases turnover and increases retention. The National Fund for Workforce Solutions issued a case study of five nursing homes in conjunction with the Massachusetts Senior Care Association and SkillWorks.  Supervisory coaching is one way facilities can attract and retain entry-level employees, the report explained.

It is well known that quality of care suffers when turnover is high.  Efforts to improve frontline supervision can improve the quality of entry-level jobs in long-term care and lead to higher retention of certified nursing assistants and better patient care.  The yearlong pilot trained supervisors in interpersonal communication and conflict management methods, and researchers reported an improvement in workplace culture. Specifically, the study found comprehensive training can reduced disciplinary actions and improve workers’ ability to communicate with coworkers and patients to solve complex problems.  

Staff satisfaction and engagement rose, and one study site quickly expanded the training program to all of its supervisors.

When staff feel supported, quality of care increases,” said Tara Gregorio, the association’s president. “Partnering with the National Fund and SkillWorks for this pilot program, allowed us to provide some funding and expertise to create more positive workplace environments, which in turn, can help reduce turnover and increase job satisfaction.”

“The long-term care industry has been facing a staffing crisis for years and the demand will only increase as Americans continue to live longer,” said Kelly Aiken, Vice President for the National Fund of Workforce Solutions. “Focusing on job quality will help America be more competitive and adapt to changing economic and business realities.”

The Laurinberg Exchange reported the alleged rape of a resident with mental deficiencies at Willow Place Assisted Living.    The brother of the rape victim contacted police to report that his sister had been raped by another resident.  An employee of the facility called the brother to let him know about the incident, the family said.

Last year, the facility was cited for 16 violations and issued a provisional license. One of the charges was, failure to protect a resident from another violent, combative resident suffering from Alzheimer’s.

Following the spring 2017 inspections, Willow Place was cited for having violated serious state codes concerning patient care and staffing during. The short staffing caused issues with patients’ personal care and safety because patients with dementia were not being kept in a separate hall or being properly monitored.

DHHSR conducted a second inspection in August to deal with additional complaints from patients and their families. Following that investigation, Willow Place was written up for an additional 18 violations some of which the home had been cited for in the first inspection.

The assessment determined that the home failed to follow state regulations for staffing after investigators sampled records for 10 days between June and July and found that “the facility failed to assure staffing met minimal requirements according to the census, for 36 of 45 shifts sampled,” according to the report.

If the facility had adequate staff, they could fulfill their duty and responsibility to supervise the residents and protect them from rape and assault.


WFAA had an interesting article discussing the problem of short-staffing and chemical restraints at nursing homes.  This article was Part 4 of WFAA’s continuing investigation of nursing home abuse and neglect. (See Parts 12 and 3 ).  The ongoing WFAA investigation into Texas nursing homes has already revealed questionable practices in the hiring of criminal caregivers – and now WFAA has uncovered inappropriate and unnecessary drugging of residents.

In effort to cut costs, troubled nursing homes may drug the elderly rather than hire needed staff. The practice has been dubbed “chemical restraints.” It’s a practice of using powerful drugs to sedate or quell agitated, disruptive or violent patients.  When a facility is chronically short-staffed, often the staff will administer medications that sedate the residents so the residents are easier to take care of for the overworked and burnt-out caregivers.  In the latest report, called “Drugged and Dying,” News 8 investigative reporter Charlotte Huffman found that 96 percent of Texas nursing homes admit they’re giving drugs to residents who don’t need them.

According to the FDA, unnecessary use of antipsychotic medication kills 15,000 nursing home patients every year. Of all the drugs used as chemical restraints, antipsychotics are the most widespread and may be the most dangerous.

The federal government has previously caught drug manufacturers improperly promoting their antipsychotic drugs for use in nursing homes. (See here and here.)

Before nursing homes can give residents antipsychotics, new federal guidelines require doctors to diagnose them with at least one of three mental illnesses, the most common being schizophrenia.  A WFAA analysis of nursing home data shows that, after this new rule, the number of residents diagnosed with schizophrenia has skyrocketed 26 percent.  Schizophrenia develops in a patient’s early 20s, not later in life, experts say.

Various healthcare officials and advocates, when reached for comment, have found WFAA’s findings troubling:

“There’s no doubt that it raises a big red flag,” said Amanda Fredriksen, AARP Texas director of advocacy and outreach. “It’s pretty disturbing when people are that motivated to drive their numbers down to falsify medical records or to make up diagnoses. But to the extent that that’s happening, that’s a real serious issue.”

Dr. Daniel Pearson, head of psychiatry at Methodist Hospital, questions a first-time schizophrenia diagnosis of an elderly nursing home resident. He said such a diagnosis, especially to sedate, may be inappropriate, and possibly dangerous.  “Does that surprise me? No. Are those diagnoses legitimate? Probably not,” Dr. Daniel Pearson told WFAA.  “If you are using it just to keep people quiet, there are significant risks that are associated with that…increased risk of cardiac death, increased risk of falling, breaking a hip,” added Dr. Pearson, who spent a decade as a psychiatrist in nursing homes.

About 70 percent of a nursing home’s expenses are staffing,” said attorney Ernest Tosh, who handles nursing home lawsuits. “So, if they can cut back on staffing, they can directly increase their profitability.”

Last year, the state of Texas warned nursing home administrators about inappropriately drugging residents.

That same watchdog created this brochure to inform nursing home residents about the dangers of them being inappropriately drugged.

Here is a link to federal government regulations dealing with medication administration and monitoring – see p. 505.

Watch a 2011 U.S. Senate hearing on antipsychotic drug use in nursing homes.





WYMT reported that Kentucky Rep. Rick Nelson of Middlesboro filed a bill that would require minimum staffing standards in Kentucky nursing homes.  Nursing homes and other long-term care facilities would have to meet minimum staff-to-resident ratios for licensure or re-licensure after July 30 of this year under House Bill 573.

Ratios of one nurse aide to every nine residents and one nurse per 21 residents at all times during the day would be among the requirements.

Additionally, facilities with 75 or more beds would be required to have a registered nurse supervisor during day and evening shifts, in addition to the other required staff.

Larger facilities would carry more requirements, including the need for a full-time assistant nursing director and education director.

Facilities that do not comply with the minimum staffing requirements for two consecutive days would be prohibited from accepting new patients until they have complied for six consecutive days, according to the bill. Fines of up to $1,000 per day could also be assessed against the facility.


The Herald & Review reported the disturbing story of James Rellihan who is accused of removing opioid patches from the bodies of residents at two nursing homes, including one where he worked as a registered nurse.  Rellihan is charged with burglary and theft under $500.

In a statement read in court, Assistant State’s Attorney Jeff Horve detailed two visits Rellihan allegedly made, one on Feb. 24 to Bloomington Rehabilitation and Health Care Center, and another on Feb. 26 to Heritage Health in Normal.

At the Bloomington facility, Rellihan removed three fentanyl patches from a terminally ill man, telling the patient, “It will be OK,” said the prosecutor.   The 31-year-old nurse was seen by co-workers who questioned why he was at the facility on his day off.
On Feb. 26, Rellihan showed up at the Normal nursing home where he had worked. He went to a patient’s room where he removed a fentanyl patch from a man with dementia, according to the charges.
When questioned by police, Rellihan “denied taking, using or selling” the patches, Horve told Associate Judge Amy McFarland.