Anyone following the types of stories covered on this blog knows that short-staffing in nursing homes is a big issue right now. What you might not realize is how bad the situation might get in the coming years. The Baby Boomers are aging, and this means a big spike in demand for elder care is approaching. In another 15 years, there will be 73 million Americans over 65 (compare that to around 40 million in 2010).

The industry of long term care simply isn’t ready for all of those patients. Turnover for nurse aides is 75%, staggeringly high, but unsurprising considering the low pay, long hours, grueling work and the recently discussed fact that nurses aides have the most musculoskeletal injuries of any group of workers in America.

When facilities don’t treat their employees well enough to keep them, it makes it nearly impossible to ensure the staff is properly trained, experienced, and capable. As demand for nurse aides increases, the epidemic of short-staffing is set to grow by leaps and bounds, and the worse the working conditions are for the staff, the more burnout, mistakes, accidents, abuse, neglect and incompetence will occur.

A former home health aide at All Heart Home Care of Manasquan, NJ was charged with stealing approximately $19,000 from an elderly resident’s bank account. The accused is 46 year old Sheila McFadden of Ashbury Park, NJ. McFadden was arrested in Lakewood Township while attempting to cash one of the checks that she had stolen. She was charged with Forgery, and Receiving Stolen Property. A total of twelve checks were stolen and cashed. During this time the investigation remains open.

Many times, crimes such as theft from residents in elder care facilities can be prevented. Nursing homes need to take a proactive approach in screening employees and implementing quality control procedures. The majority of facilities choose to not pay their employees much above minimum wage. This leads to the workforce seeking to find any other way possible to supplement their income and not care about fulfilling their job requirements. Overall, this leads to staff providing negligent care and abusing residents.
See article at Ocean Signal.

Tina Abassi was arrested at her home in Lancaster, KY and accused of using her job to steal pain pills from the residents at Golden Living Center in Stanford, KY.  This is a common and serious problem in the nursing home industry.  Abassi worked as an LPN for a year at Golden Living Center.

Upon her arrest, she answered the door and stated that she was intoxicated. She handed the police marijuana and prescription pain killers. Her two year old daughter was alone in the living room. Abassi faces numerous drug charges and first-degree wanton endangerment and endangering the welfare of a minor.

With the charges she is facing, hopefully she will no longer be able to work in a place with access to medication.  The nursing home has no idea how many residents have suffered inhumane amounts of pain due to the lack of receiving the proper medication. There is also no knowledge as to how long Abassi was stealing from the facility.

No statement had been issued by Golden Living Center regarding compensation for the residents that have suffered undue harm.  See WKYT article.

I would like to invite you to read a new blog post by Rod Baird of LTC Management & Geriatric Practice Management.  “The Best Nursing Home Quality Measure CMS Does Not Publish – Turnover” where he discusses how Administrative Turnover may be a much more effective measure to use for determining the relative quality of a Nursing Home.

A recent Journal of the American Medical Directors Association (JAMDA) article prompted this question: Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover? (Published February 2014).  As always, I’d love to hear your thoughts on this subject and would encourage you to join the discussion.

 

A study on the high incidence of “preventable adverse events” in skilled nursing facilities was published by the Inspector General of DHHS. Among other things, the report concludes that approximately one of three residents in skilled nursing facilities suffer a medication error, infection or some other type of harm related to their treatment, and that nearly 60 percent of the errors and injuries are preventable. Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled. The report further concludes that more than half of those harmed have to be readmitted to a hospital, amounting to about 2% of Medicare’s total inpatient spending.

The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure. Here is a good article on the report from Pro Publica.

A study on the high incidence of “preventable adverse events” in skilled nursing facilities was published by the Inspector General of DHHS. Among other things, the report concludes that approximately one of three residents in skilled nursing facilities suffer a medication error, infection or some other type of harm related to their treatment, and that nearly 60 percent of the errors and injuries are preventable. Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled. The report further concludes that more than half of those harmed have to be readmitted to a hospital, amounting to about 2% of Medicare’s total inpatient spending.

The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure. Here is a good article on the report from Pro Publica.

Charleston’s Post and Courier reported new legislation that Paul Thurmond is attempting to pass that will protect vulnerable nursing home residents from abuse and neglect; save taxpayers’  money by preventing injuries and incidents; and decrease insurance payouts by preventing and deterring neglect and negligence in long term care facilities.  Sen. Paul Thurmond, R-Charleston, said he introduced the bill after learning of similar legislation in Oklahoma.

Thanks to the courage and leadership of Thurmond, a Senate subcommittee advanced the bill that would allow for residents to place a video camera in their rooms. The bill – Electronic Monitoring of a Resident’s Room in a Long-Term Care Facility – would require facilities to make accommodations to comply with a resident’s request and penalties for staffers who tamper with the camera or equipment. The new legislation would allow electronic monitors to be placed in private rooms to record the care and treatment being provided and paid for by taxpayers. The bill has been changed since its introduction to address privacy concerns. For example, it would require a resident or the family to post a notice informing those about to enter the room that it is being monitored.

If Thurmond’s bill becomes law, a patient alleging abuse – or a family member with power of attorney who suspects as much – would have the ability to place a camera in a room. And the facility cannot stop them from doing so.

“It really puts a lot of power in their hands to be able to have oversight of their care in a way that family can be involved without being there,” Thurmond said. “The patient can interact where it’s positioned and what it’s going to capture.”

Coretta Bedsole, associate state director for advocacy for the AARP, said the organization is supportive of consumer-driven measures and of the modifications that were made to the bill that addressed privacy concerns. “It would give loved ones the opportunity to monitor what’s going on in the lives of their loved ones,” Bedsole said. “I think really it’s about consumer protection. Anything that we do in any setting really needs to be on what’s best for the resident of the facility.”

 

The L.A. Times reported that L.A. City Atty. Mike Feuer has filed a lawsuit against two assisted-care facilities for allegedly abusing their disabled patients in “deplorable, overcrowded and substandard living conditions.”   “These residents are among the most vulnerable in our society and they were forced to live a daily nightmare,” Feuer said. “We are bringing that nightmare to a close.”

The two facilities, Agape Mission House and Agape Home Church are unlicensed. A judge appointed a receiver to immediately begin relocating those being cared for at the two facilities with the assistance of state and county officials.

According to court documents, residents at the facilities would be punished for failure to attend religious services twice a day, despite their individual beliefs. The punishments allegedly included being made to stand by a tree for up to four hours, being required to translate Bible verses for an entire day and sleeping outside at night.

From January 2011 to October 2013, Los Angeles police reported receiving more than 180 calls related to the properties, including a dozen attempted suicides, numerous assaults and batteries, assault with a deadly weapon, narcotics activity, indecent exposure and burglary from a motor vehicle.

Boston.com reported that caregivers in Massachusetts are complaining about the poverty wages and labor conditions including chronic understaffing in the nation’s largest nursing home chain operated by private equity-owned Genesis HealthCare. Health Care REIT, Inc. (NYSE: HCN) and Sabra Health Care REIT, Inc. (NASDAQ: SBRA) are the publicly traded landowning companies for most Genesis facilities.  Genesis operates more than 400 nursing homes, assisted living facilities and behavioral health centers across 30 states. Despite this broad portfolio of revenue generating businesses, Genesis pays many of its workers at or near minimum wage.

Genesis is becoming one of the healthcare industry’s chief purveyors of poverty wages for caregiving staff. Genesis employees in Massachusetts are predominantly women and people of color and many are living at or below the poverty line who need and receive government assistance.  Why should we taxpayers subsidize a private for profit business instead of requiring them to provide a living wage?

“Caregivers employed by Genesis are responsible for the lives and health of literally thousands of Massachusetts seniors. It matters to seniors that those caregivers have fair wages and affordable healthcare. When Genesis pays poverty wages, they are devaluing not only the lives of the caregivers, but also the lives of the seniors they care for,” said Barbara Mann, President of the Massachusetts Senior Action Council.

“It is a moral outrage for a major healthcare employer like Genesis, with several billion dollars in annual revenues, to deny affordable health coverage to the workers caring for our nation’s seniors. This is not a mom and pop nursing home. There is never an excuse for this level of greed and exploitation in the healthcare industry,” said Veronica Turner, Executive Vice President of 1199SEIU United Healthcare Workers East, the state’s largest healthcare union.

 

Brookdale Senior Living and Emeritus Senior Living will merge in a $2.8 billion deal, creating the largest chain in the long-term care sector. The expanded Brookdale will consist of more than 1,100 communities in 46 states.  The Nashville-based company says the merger will make it the nation’s first “single-branded provider” offering “fully integrated ancillary services across the continuum of care.” The two providers share a similar profit driven culture.