The Evansville Courier & Press had an article written by Hanns Pieper is professor of sociology and gerontology at the University of Evansville regarding staffing.  He refers to which contains nationwide nursing home comparison data.

"Staffing time measures are especially important because it’s the staff that actually delivers the care. The data are based on the nursing home’s staffing hours during the two weeks before the inspection and represent the average amount of time available per resident. All other things being equal, the more time per resident the better."

CNA data is the most important since they provide 90-95% of the direct care to residents.  CNAs have the most frequent contact with the residents, so the time they have available is key.  The time available measure is an indicator of staffing adequacy and there often is a significant difference among the different star ratings.

He looked at a list of Indiana nursing homes, and randomly selected a nursing home with a 4-star rating and one with a 1-star rating for staffing.  The 4-star nursing home provided almost an extra hour per day per resident.

There are other important indicators of staffing adequacy that are not presented in the charts such as staff turnover, and call bell response time.   Data that shows how many CNAs who were working on Jan. 1 and still were employed on Dec. 31 should be available.   A CNA’s leaving often has a significant emotional impact on residents. The quality of care is affected. A high turnover rate also may be an indicator of other inadequate conditions in the nursing home.

The time it takes for a staff member to respond to call lights/bells requesting assitance made by a resident is also not presented in the data.  When facilities don’t have an intercom to determine if the situation is an emergency or routine event, a long response time can lead to devastating results. Inrercom systems and electronic recording of alarms and call bells should be standard in most nursing homes.

Nate Taylor wrote an article for The Coloradoan about a recent verdict for a family against nursing home involving a resident who fell because the nursing home refused to respond to the resident’s call light.   The fall led to her untimely death.  This happens all the time in nursing homes and is a result of understaffing.  The nursing home does not want to pay for adequate and competent staff because it will hurt their profit margins.  The staff becomes overworked and fails to respond to call lights.

While the family says her 87-year-old mother Doris Wolfe’s November 2007 death was the hardest thing she’s had to live through, a close second was the lawsuit her family endured suing Spring Creek Healthcare Center.  "We’re just a little tiny family of four against this huge corporation of nursing homes," Johnson said, referring to Spring Creek Healthcare Center’s parent company, Sava Senior Care. "You would never, ever, ever go through (a lawsuit) for any reason other than somebody had been harmed and you felt like you had to fight that fight. It was brutal."

Sava Senior Care owns at least 185 nursing homes across the country, including Spring Creek and Fort Collins Health Care Center.  They are represented by Lori Proctor.  We had a case against them last November when a resident fell three times in a 24 hour period.  The jury awarded us $200,000 in actual damages and $600,000 in punitive damages. 

Johnson said her mother stayed at Spring Creek for 17 days to rehabilitate following back surgery at Poudre Valley Hospital. Wolfe broke her ankle the day she was supposed to be sent home.

According to an investigation by the Colorado Department of Public Health and Environment, Wolfe may have turned on her call light to request help to go to the bathroom. When Wolfe thought an "extended amount of time passed" and no one answered her request, she opted to try to walk toward her walker on her own and fell and broke her ankle.  Jay Reinan, a Denver lawyer who represented the Wolfe family, said Doris Wolfe did push the button.

"As a result of staffing deficiencies, Mrs. Wolfe was left to decide between soiling herself or attempting to go to the bathroom on her own, and that eventually led to her death," Reinan said. "With a lot of older folks, dignity is important, and that’s what happened to Mrs. Wolfe."

The health department investigation also indicated that Spring Creek X-rayed Wolfe’s ankle and found no fracture, but a family physician looked at the X-ray results and determined it was fractured in two places.

Johnson said she hopes the jury’s decision will lead to changes at the nursing home. "As scary and intimidating as it was, that’s why we did this – for change," Johnson said.