In Dallas, Texas a local television station has been running background checks on licensed nurses. They have found "thousands of nurses with arrest records." That much didn’t surprise me – but the arrests include murder, kidnapping and arson.

What? Murder?

My immediate thought was, don’t employers do background checks? My second thought was, are these nurses currently employed?

Turns out that the Texas Board of Nursing "wanted to run background checks of all nurses in 2005" but the state didn’t allow the funding at that time. When they finally got the money to do it, they didn’t have enough staff to do it – short staffed at the Board of Nursing.

At any rate, it seems to me that even if the state Board didn’t check, surely employers do – But I certainly wouldn’t assume that. There is a lot of talk out there about a shortage of nurses,but stories like this only confirm my suspicion that it’s more than that – its a shortage of qualified and trustworthy nurses. Imagine if your loved one was being taken care of by a murderer . . . Unacceptable.

To check out the article, click here.

Alabama NewsChannell 19 had a horrendous story of neglect on their website.  NewsChannel 19’s Carson Clark reported that a Marshall County Nursing Home is in trouble with state and federal officials after a patient died there. A doctor says the Golden Living Center in Boaz allowed a young woman to scream for help for more than six hours, before finding her dead.

The patient, 20-year-old Felicia Ann Engle of Boaz, suffered from kidney disease. She had to be placed in Golden Living because her father was no longer capable of taking care of her needs.

According to state records obtained by NewsChannel 19, Engle began to yell for help around 3:00 p.m. on April 3, 2008. The records quote nurses at the facility, with one saying Felicia was, "…begging us to call her doctor that something was really wrong this time. She was hurting so bad it was unbearable."

The nurse tells investigators she went to another nurse to tell her of Engle’s request. The nurse reportedly replied, "Yes, we know, we’ve heard all about it four times at least."

NewsChannel 19 contacted Dr. Tom Geary with the Alabama Department of Public Health in Montgomery. He says the way in which Engle was treated violates the law.

"If the patient requests to go to the hospital, [if] they say something is wrong, I need to go to the emergency room, they are supposed to take them to the emergency room. They are not supposed to make a judgment that the person is just trying to disrupt the normal services in the facility, close the door and leave them alone," he says.

The director of Golden Living, Kevin Cogan, refused an on-camera interview and asked NewsChannel 19 to leave the property when they visited.

Vermont Legislative Study Tackles Direct Care Workforce: Study Reveals that Wages, Health Coverage, Training are Keys to Retention
Published by hthier on April 7, 2008 in Press Releases .

Montpelier, VT, March 25, 2008 –An impending health care crisis has not gone unnoticed in the Green Mountain State. The number of Vermonters age 65 and older is expected to double between 2005 and 2030 while the direct-care workforce continues to decline. A new study funded by the Department of Disabilities, Aging & Independent Living, The Community of Vermont Elders, and PHI has made nine recommendations to help avert this crisis. The Legislative Study of the Direct Care Workforce in Vermont reveals that wages, benefits and training are critical to retaining workers in this field.

The study analyzed survey responses from 1,700 direct-care workers in Vermont regarding wages, benefits, training, and career development. Key findings include:

Only half of the respondents expect to receive a raise. The forces of inflation, without annual cost-of-living increases, actually decrease wages over time. The responses show that the higher the wage, the longer caregivers remain in the profession.
Only one-third of direct-care workers in Vermont receive health insurance coverage as an employment benefit. However, workers with employee-sponsored health coverage remain in their jobs an average of 2.5 years longer.
Only 42 percent of respondents received formal job training. Those caregivers who do receive professional training remain in their jobs significantly longer.
Direct-care workers currently see few opportunities for advancement because of a lack of standardized and portable curricula and credentials. However, national research shows that workers who receive training, recognition, and advancement opportunities tend to remain in their profession.
Other results from the study show that 64 percent of Vermont’s current direct-care workers are over the age of 40.
In anticipation of the report, workforce and consumer advocates (the Community of Vermont Elders, the Vermont Association of Professional Care Providers, the Vermont Center for Independent Living and PHI) joined forces at a recent town meeting that featured Vermont Senator Bernie Sanders, members of the community, and direct-care workers, who gathered to address the need to support caregivers.

Several direct-care workers spoke candidly about the profession, noting the low wages, poor benefits, and lack of training for what is a remarkably difficult job.

Deborah Lisi-Baker, the executive director of Vermont Center for Independent Living, spoke about the need to improve the lives of caretakers to address the current and expected future declines of the workforce.

Direct-care workers provide crucial hands-on assistance to persons who are unable to perform basic activities of daily living (ADL) that many take for granted. Examples of ADLs include getting out of bed, attending to personal hygiene, eating, and other such tasks. Some people need help communicating, remembering, or simply engaging in meaningful activities. These workers provide 80 to 90 percent of the hands-on care for Vermont’s elders, children and adults with disabilities, and persons with chronic conditions.

PHI, a nonprofit organization that supports quality long-term care by improving direct-care jobs and served on the study group’s advisory board, notes that the Vermont study echoes their findings that direct-care workers are truly invested in their work and want to make a positive difference in other people’s lives.

However, PHI also notes that the common industry practices—including low wages, few opportunities for advancement, lack of training, and inadequate benefits—make it difficult to attract new workers and retain current ones in this field. This problem will only grow in the future, unless the state focuses on improving the quality of direct-care jobs.

For more information on this study, visit

Alexandra Olins
PHI Northern New England Regional Director

Alan Krawitz
Youngworth Public Relations
800.615.1230, ext. 18

 Amanda Falcone has an article about Connecticut’s attempt to increase staff in nursing homes.  A  plan to raise the minimum staff-to-resident ratio in nursing homes was described as historic, necessary and long overdue at a press conference Wednesday.

The plan would provide $9.5 million in fiscal year 2008-09, which begins on July 1, to increase staff-to-resident ratios from 1.9 hours to 4.2 hours of care per day at nursing home throughout the state.   The increase for nursing homes will be sustainable, adding that after the coming fiscal year, it will probably take about $30 million in subsequent years to maintain the change.   Staffing levels at nursing homes have not been addressed in 25 years.

Nursing staffing levels are a problem across the country, and Connecticut is no exception, said Toby S. Edelman, a senior policy attorney for the Washington, D.C.-based Center for Medicare Advocacy.   Adequate nursing staff is critical to providing good care, she said.

The Moultrie Observer reported a story about another nursing home employee who sexually assaulted a resident.  How can this happen if a criminal background check was done and RNs are properly supervising the staff?

Charles David Cone, 47, of 321 12th Ave. N.W. in Cairo, was charged with sodomy and sexual battery.   An employee at the Woodlands at Cobblestone on Cobblestone Trace reported Feb. 27 that Cone allegedly touched a 92-year-old male patient inappropriately. The patient stated there were two separate incidents, one on Feb. 25 and the other the next day.

According to a warrant for Cone’s arrest, he is accused of putting the patient’s penis in his mouth on Feb. 26. Cone allegedly fondled the patient’s genitals on Feb, 25,

Executive Director Joann Sloan said Cone was terminated from his job at Woodlands immediately after the alleged incident was reported.  “Our standard of practice and our goal is to provide a safe environment for our patients,” Sloan said.

U.S News & World Report has an article on the proposed Nursing Home Reform Bill.  Below is a summary of the article.

The byzantine world of the corporate nursing home industry may soon become a whole lot clearer. Republican Sen. Chuck Grassley and Democrat Sen. Herb Kohl seek to force nursing homes to provide more information about ownership and accountability.

The Nursing Home Transparency and Improvement Act would force nursing homes to clearly state ownership—something that has become increasingly complicated to figure out, as private investment groups have bought up nursing homes and enveloped them in labyrinthine legal structures. The opaque ownership makes it difficult for regulators to identify parties responsible for poor care and unfairly shields owners from complaints of neglect and abuse.

The bill also seeks to standardize complaint forms, improve reporting on staffing information, and replace some self-reported information with that gathered by independent audits. The primary goal is to make it easier for the public to compare nursing homes, a growing concern as baby boomers age.

The American Association of Homes and Services for the Aging, an industry group that represents not-for-profit nursing homes, applauds the bill.  The nonprofit sector is already required to produce information about finances and ownership to the IRS to qualify for its tax status.

The fight over nursing home reform will continue as the bill works its way through Congress. Proponents like the bill’s chances, in part because it’s authored by the respected Grassley, who is the senior Republican on the Senate Finance Committee.  Even the AAHSA wants some provisions removed, such as the bill’s call for an increase in civil penalties of up to $100,000 for a deficiency resulting in death. Delays likely to come from those and other proposed changes mean, for those waiting for nursing home reform, it could be 21 years and counting. has a great summary of the bill introduced by Senators Kohl and Grassley aimed at improving the quality of care in nursing homes with more and better information for consumers on the Nursing Home Compare Website published by The Centers for Medicare & Medicaid Services.   Supporting the bipartisan bill are the Service Employees International Union (SEIU) and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR).

The bill:

? Enables the residents and the government to know who actually owns the nursing home

? Strengthens accountability requirements for individual facilities and nursing home chains, including annual independent audits for nursing home chains

? Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of participants in the Special Focus Facility program, a standardized complaint form and links to nursing home inspection reports

? Provides more transparency of a nursing home’s expenditures by requiring more detail in cost reporting

? Provides for improved reporting of nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

? Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines

? Strengthens available penalties by making them more meaningful. 

Instead of imposing civil money penalties (CMPs) up to $10,000, the Secretary would be able to impose a range of penalties of up to $100,000 for a deficiency resulting in death, $3,000-$25,000 for deficiencies at the level of actually harm or immediate jeopardy and not more than $3,000 for other deficiencies. 

The Secretary would be able to reduce CMPs for facilities that do not appeal CMPs and for self-reporting deficiencies below the immediate jeopardy level or the actual harm level if the harm is found to be a “pattern” or “widespread” or those resulting in death. 

Penalties must be collected within 90 days, following a hearing.

? Equips the Secretary with tools to address corporate-level problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains

? Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents

? Requires a study on the role that financial issues play in poor-performing homes

? Requires a study on best practices for the appointment of temporary management for nursing homes as well as barriers

? Requires a study on barriers to purchasing facilities with a record of poor care

? Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

? Improves staff training to include dementia management and abuse prevention training as part of pre-employment training

? Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Hopefully, this bill will pass Congress and get proper funding in the budget.

Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse.  Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry.  Below are some excerpts.

As though declining health, impending mortality and other challenges weren’t hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans’ average life expectancy was 47. By 2000, it was 77, and it’s still rising.  Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they’re frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.   Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home.  But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable.  But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation’s nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents.  Yet not a single federal employee works on elder abuse issues full-time.

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice’s Elder Justice and Nursing Home Initiative. has a good article about the difficulty the government has in evaluating funding levels for Medicaid.  The article insists that an expansive view of nursing homes industry is needed to determine funding needs.

The Bush Administration’s FY 2009 budget will include no Medicare funding update to help care for the growing number of seniors who need high acuity nursing home care.  The Alliance for Quality Nursing Home Care will work to demonstrate that Medicare funding decisions can be accurately determined only by taking a more expansive, complete view of the industry’s operating environment. 

This White House has often cited the work of the Medicare Payment Advisory Commission (MedPAC).   Alan G. Rosenbloom, President of the Alliance, stated, "On behalf of nursing home patients and the hundreds of thousands of caregivers who serve them, we are disappointed that again, MedPAC’s flawed funding policy guidance is being adopted, and superseding the economic realities experienced by providers in the long term care marketplace.  By failing to consider the substantial Medicaid payment shortfalls to nursing homes in formulating its recommendations, MedPAC provides the Administration, Congress and the public a flawed basis upon which to assess the funding landscape, and to ultimately determine the best policy." 

Medicare funding is important when states are cutting Mediciad to balance their budgets. 

SOURCE The Alliance for Quality Nursing Home Care

The Courier-Journal in Kentucky has a great article about the necessity to increase staffing at nursing homes, and how the nursing home industry lobbyists are fighting against it so their profits remain large despite the poor care that is guaranteed with low levels of staff.  Please read the entire article and the Comments from other interested people.  Below is a summary of the article.

Lois Pemble said she once found her mother alone, sprawled on the floor of her nursing home room, where she’d fallen.   On other occasions, Pemble found her mother with her clothes soaked in urine, waiting for help to get to the bathroom.   She has joined with Kentuckians for Nursing Home Reform in pushing a bill that would require Kentucky to join 37 other states in setting minimum standards for the number of caregivers in nursing homes.

House Bill 109 would require nursing homes to have one nurse’s aide for every nine residents during the day shift; one aide per 13 residents during the evening shift; and one aide for every 19 at night.   The bill also would increase the number of RNs required to be on duty — currently the law requires only that one RN be on duty for only eight hours a day and that one licensed practical nurse be on duty the rest of the time.

The bill would require one nurse for every 21 residents in the day; one for every 29 on the evening shift; and one for every 42 residents overnight.

Other than requiring that a nurse be on duty, Kentucky law now says only that a "sufficient" number of staff be on hand to care for residents, but it does not define "sufficient." 

The reasonable measure already has encountered opposition from the industry, which has contributed more than $110,000 to lawmakers’ campaigns, according to records from the Kentucky Registry for Election Finance.  The political action committee of the Kentucky Association for Health Care Facilities has donated $114,150 to lawmakers, and many of the recipients were on key committees or in leadership roles.