The Journal describes how dozens of nursing homes in Wisconsin have been cited for improper care after the deaths of 56 residents since 2005 – a period marked by a dramatic surge in serious violations around the state. Neglect was noted after hundreds of elderly or disabled nursing home residents were found with bruises, broken bones or pressure ulcers – some so deep they tunneled to the bone. In hundreds of cases, reports document how inadequate training, lack of supervision and understaffing contributed to a rising number of injuries.
The Journal Sentinel built a database from thousands of pages of nursing home regulatory records over the past 3 1/2 years. Among the findings:
• Health care violations that put patients in jeopardy or resulted in harm spiked 34% the past three years.
• Dozens of homes are cited repeatedly for serious violations. Many of the homes cited multiple times are owned by out-of-state corporations.
• Deaths and injuries are occurring at a time of significant worker turnover. In one case, a problem home reported nursing staff turnover rates as high as 257% last year while it led the state in serious citations.
• Families are often kept in the dark about citations issued after the deaths of their loved ones. Four families learned from the Journal Sentinel that serious citations had been issued months and even years after their loved ones were buried.
Uunprecedented growth and profits in the industry is expected to continue. Last year, the federal government spent about $75 billion on nursing home care through the Medicare and Medicaid program.
The ownership and operation of Wisconsin nursing homes has changed dramatically. Locally owned mom-and-pop operations have given way to out-of-state for profit corporations that own clusters of homes.
Health care experts cite other factors that have affected nursing home care. The increase in pressure iulcers are a major concern and a leading indicator of neglect. Pressure ulcers occur when nursing home residents are left in one position too long. The ulcers get worse when people are forced to lie in their own waste which is common in uunderstaffed facilities. Without immediate attention, the ulcers can be life threatening.
High turnover rate is an major problem. The aides do not get paid well and are typically asked to do the work of 2 or 3 aides. Most aides don’t stay at one facility for long. The Journal Sentinel found that turnover for full-time nursing assistants at Wisconsin nursing homes can be as high as 200%, with an average of 42% last year. Many nursing assistant jobs start at less than $9 an hour.
"It’s a hard job, but it’s better than working at McDonald’s," said Jim Wilson, administrator at Oak Park Nursing and Rehabilitation in Madison. The turnover of full-time professional nurses who monitor residents’ care is also high. Among the homes cited repeatedly for serious violations, the turnover rate for full-time registered nurses averaged 57% last year with some homes reporting turnover as high as 300%. The state’s average turnover for full-time registered nurses in all nursing homes was 32%.
Staff turnover can directly affect care, said Julie Eisenhardt, a spokeswoman for the union representing nursing assistants. Inspection records back that up.
Sava Senior Care, a Georgia-based corporation, operates 185 homes nationally. Two of its four homes in the state have been cited with serious violations at least three times since 2005.
Even when large fines or other enforcement actions are imposed against nursing homes after serious injuries or deaths, families might never know about them. Neither federal nor state law requires that families be notified.
A Journal Sentinel analysis found that nursing homes in Wisconsin were cited for poor care after the deaths of 56 residents since 2005. But Nursing Home Compare doesn’t offer any details about those deaths. The Web site also doesn’t mention anything about corporate ownership, meaning that consumers would be unable to determine if the nursing home was owned by an out of state corporation or even one with a history of violations and fines. "Figuring out who is accountable for poor care can be very difficult," said Alice Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. "Consumers often don’t know who owns and operates a facility. Unless a facility tells them, there is no public way to find that out." For consumers, knowing who owns a home is important if they want to determine whether the same problems are showing up in multiple homes owned by the parent corporation.
The number of nurses and aides on staff to help residents is a key factor in determining whether quality care is being provided, according to experts. "The higher the staffing, the better the quality," said Charlene Harrington, a professor of sociology and nursing at the University of California in San Francisco. Staffing numbers provided by Nursing Home Compare are merely a two-week snapshot from the most recent inspection – and in an industry that has widespread staff turnover, those numbers can’t always be trusted, Hedt said.