Consumer Voice Action Alert

Help Increase RN staffing in Nursing Homes:
Ask your Congressperson to Co-sponsor 24-hr RN Bill

Congresswoman Jan Schakowsky has introduced a bill  – H.R. 5373 – calling for nursing homes to have a registered nurse (RN) on duty 24 hours a day/7 days a week! Currently, federal law only requires nursing homes receiving Medicaid and/or Medicare funding to have a RN on duty 8 hours a day/7 days a week. Now we need you to ask your U.S. Representative to sponsor the bill by September 8 when Congress returns from recess.

Getting as many cosponsors as possible will help the legislation get off to a strong start. The more sponsors there are – particularly when they are both Republicans and Democrats – the more likely other House members will be to support the bill as it moves forward.

To ask your Congressperson, just click here. It’s quick and easy.

Why round-the-clock RN coverage is critical:

  • Only a RN can assess a resident’s condition. The absence of RN staffing for up to 16 hours each day means that there is no one present capable of assessing and responding when residents’ medical conditions suddenly change or deteriorate.
  • Residents are entering nursing homes from hospitals “quicker and sicker.” Their care requires a high level of skill and knowledge. Registered nurses are the only nursing personnel with the education, training, and licensure to provide timely clinical assessment, appropriate medical intervention, and evaluation of nursing home residents. Other nursing home personnel such as LPN’s and geriatric nurse assistants are not trained to provide such assessments or interventions.
  • Research shows that higher RN levels improve resident care. Higher levels result in lower antipsychotic use, fewer pressure ulcers, less restraint use and cognitive decline, fewer urinary tract infections and catheterizations, less weight loss, less decrease in function and fewer unnecessary hospitalizations of nursing home residents.

Help us jumpstart this important bill that would improve the health and safety of nursing home residents nationwide.


Thanks again for your advocacy!

A recent NPR article by Ina Jaffe reported on the failing state of the nation’s long term care facility. In the article, Jaffe noted that many of theseshortcomings and harm to patients come from poor training and short staffing; these problems are nothing new to this industry.

 Jaffe’s report follows the story of the death of Charles Caldwell who drowned on the fluids in his system as a result of improper medication administration. Caldwell’s family could do but sit helplessly and watch this tragic event happen. A report released by the Office of the Inspector General of the U.S. Department of Health and Human Services indicates that Caldwell’s is not too dissimilar to the many reported to their offices. The report continues:

In a large sampling of Medicare patients discharged from hospital to skilled nursing facilities in one year, roughly a third of the patients were harmed by their treatment in the nursing homes, the study found. Most of that harm could have been prevented.

Officials believe the ignorance and misjudgment found in their many reports matches the failing of care in Mr. Caldwell’s case.

The DHHS report indicates that numerous problems in the facilities are found in the failures of routine day-to-day care. Jaffe notes that: “Lack of monitoring and paying attention was definitely a factor, along with ‘what clinicians would call substandard medical care’”.  The facilities charged with protecting and caring for our loved ones continue to fall short of numerous standards.

Beyond the failure of care in the facilities, results of this poor care are putting undue financial burden on the system. Jaffe reports:

About 60 percent of nursing home patients wound up back in the hospital as a result; such injuries cost Medicare about $2.8 billion a year, officials say. That’s just the hospitalization cost. It doesn’t account for extra doctor visits and longer nursing home stays that also result from patients’ injuries.

These statistics reflect the poor standards of our nursing facilities and further the lack of action to change this status quo. Many of the changes needed to improve the standard of care are simple: better monitor residents, increase staffing, promote continued education and better training in the facilities.

Everyone who works or studies the nursing home industry knows that nonprofits and mom and pop operators provide better care than the national for profit chains.  Numerous studies support this conclusion.

According to the NJ Spotlight, the performance gap between nonprofit nursing homes and for-profit nursing homes is quite distinctive. The analysis is based on ratings from the site “Nursing Home Compare,” which uses a five-star rating system to evaluate facilities’ health inspection scores over a three year span, staffing, and nine different quality measurements. Most of the highly rated facilities in the state, according to the investigation, are non-traditional and are operated by nonprofit organizations. Of the state’s 364 nursing homes, only eight received the site’s perfect scores, and four of the eight were nonprofit nursing homes.

Newsday reported that a nurse faces up to 4 years in prison for administering morphine to a resident instead of muscle relaxant and attempting to cover it up.  Vicki Price, a 46-year-old licensed practical nurse, pleaded not guilty to the charges of “second-degree endangering the welfare of a vulnerable elderly person, one count of endangering the welfare of an incompetent or physically disabled person, willful violation of the public health laws and first-degree falsifying business records,” on Sept. 3 according to News Day.

The charges relate to events that took place in Feb. 2012, when Price administered morphine to a 46-year-old wheelchair-bound resident with spina bifida who lost consciousness and was admitted to Long Beach Medical Center. Price then tried to cover up her mistake by falsifying records, officials said.

The defense for Price maintains that she mistakenly administered the morphine. “There’s an accident that happened. Doctors and nurses make errors on occasion and I would say she’s not guilty of any intentional act,” her attorney Edward Galison said. Her next court date is Oct. 16.

Though it’s the third most regulated business in the country, nursing homes still fall short in reporting incidents and abuse.  Intentional policy of cover up or poor training?

According to a report done by The Anniston Star, which surveyed state nursing home inspections for Calhoun County in Alabama, nursing homes are confused over what they are supposed to report. The nursing home records, some of which date back as far as 10 years, examined by the report also showed that nursing home staff often fail to properly investigate and report signs that their residents were being abused.

In many cases, nursing homes only address residents’ abuse when it has already been brought to the attention of state investigators. In August 2010, Beckwood Nursing Home in Alabama fired a nurse for verbal abuse after she allegedly called a resident a “crippled bastard.” Reports of sexual harassment between residents also go unreported such as in 2010, Golden Living Center of Oxford, Ala. a staff member failed to report seeing one resident touching another resident’s breast against her will. The incident was investigated the following April, when the resident’s family was finally notified.

The Star reported that though the Alabama Department of Public Health administers unannounced inspections to each of the state’s 230 nursing homes at least once every 15 months, in addition to inspections held when residents file complaints, there is a problem that no frequency of inspections can fix; which is the intentional abuse of residents and the failure to promptly report indicators of abuse to state officials.

Though the law requires that every report of abuse made to the nursing home be investigated, many facilities don’t report them because they are unsure of how to approach the reports made. To help the nursing homes with recognizing and reporting abuse, the Alabama Department of Senior Services employs staff members who travel to the area nursing homes and act as advocates for the residents.

The workers, called ombudsmen, talk with residents and their families after receiving complaints or seeing signs of abuse and mediate the issues with the nursing home staffs. They work with the councils for the residents to ensure that they and their families know their rights in reporting abuse. The ombudsmen also assist in training nursing home staff to prevent, recognize, and report abuse.

The American Journal of Nursing’s Magazine “Off The Charts” had a recent article on the need for more nurses in nursing homes.  See below for full article.

Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services [CMS]. To register for membership and gain access to more detailed information, click here.)

A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.

Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.

Could part of the problem be there aren’t enough nurses in nursing homes? An article in the New York Times states that, in evaluating Nursing Home Compare, the American Association of Nurse Assessment Coordination estimates that at least 11.4% of nursing homes don’t have RNs available around the clock (since data is self-reported, this could be higher). Yet studies show that care is improved when there are more RNs in nursing homes. (We published a 2005 original research study that found that increasing the amount of time that RNs spend with long-stay nursing home residents reduces pressure ulcers, hospitalization, and urinary tract infections.)

Anecdotally, I can say that I am sometimes dismayed by what I’ve seen in the nursing homes my grandmother has been in. There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever. I’ve spoken with nurses and nurses’ assistants working in these homes, and staff-to-resident ratio is always a common complaint of those working there. In my grandmother’s current home, residents are piling in by the dozen, while the number of staff seems to remain the same.

In addition, several cousins of mine who work as nurses in nursing homes have told me that one of the biggest problems they face is staffing—they see residents sitting around all day losing mobility because there aren’t enough people to watch them and encourage them to get up out of their chairs.

According to the same Times article, Representative Jan Schakowsky (D-IL) has introduced the Put a Registered Nurse in the Nursing Home Act, which would require a direct-care nurse on site 24 hours a day, seven days a week, in any nursing home that receives Medicare or Medicaid reimbursement. If passed, this might help address some of the deficiencies at these homes, but I also think more staff in general, such as CNAs, are needed if nursing home residents are to get the care they need. The decision to move a loved one into one of these homes is, after all, made in order to keep them safe.

Staten Island Live has a video and a story about an abused vulnerable adult.  Peter Mazza, a beloved husband, father and grandfather, wanted to spend his final years living with dignity in the comfort of his Oakwood home. Instead, Mazza’s last months before his death in June at age 99 were traumatic and terrifying.  Home-health aides they depended on to provide necessary round-the-clock care abused and neglected him, they allege.

Shocking videos obtained through cameras installed in Mazza’s home show one aide refusing to pick him up after he fell, and on another occasion, another aide pushing him into a bed and wrapping him up with a blanket. In another incident, a third aide is seen lying on a couch and watching Mazza struggle to reach his walker before he fell, sustaining fractures and head injuries.

In an Oct. 19, 2013, incident, Mazza falls and asks a female aide to pick him up, according to the civil complaint and video. She refuses, saying her back “is sick” and telling Mazza, “You are going to have to be tied to the chair or something,” the video shows.  A few months later, cameras caught a male aide masturbating as Mazza lay in bed nearby. That aide also dragged Mazza along the ground after he fell.

In another episode on April 1 of this year, a female aide watched Mazza “in excess of one minute” as he struggled to reach his walker before he fell.  The aide didn’t call 911 for help and then lied about the incident to try to conceal it from Mazza’s family.

The Des Moines Register reported that Life Care Services and a California nursing-home company called ParkVista that manages nursing homes across the country has agreed to help pay a $3.8 million settlement for alleged over-billing of Medicare, federal officials announced.  Life Care Services and ParkVista were involved in an “arrangement” (read as criminal enterprise) under which a therapy company provided “unreasonable and unnecessary” rehabilitation therapy services to nursing-home residents in California and Massachusetts.  Officials said the arrangement led to inflated reimbursements from Medicare.

Patients in skilled nursing facilities and the patients’ families should be able to have confidence that the facilities are not allowing therapy companies to manipulate the amount of therapy being provided based on financial motives,” U.S. Attorney Carmen Ortiz of Massachusetts said in the press release. “Settlements like this one show that, when a facility contracts with an outside rehabilitation therapy provider, the facility has a continuing responsibility to ensure that the provider is not engaged in conduct that causes the submission of false claims to Medicare.”


Andira Lawson was ‘charged with one count of abuse of a vulnerable adult and one count of neglect of a vulnerable adult’, The Post and Courier reports. Lawson worked at the Sumter Valley Health and Rehabilitation Center in Sumter, SC. Lawson allegedly committed these crimes against two residents in their 70’s. One woman said Lawson ‘struck’ her and one man said Lawson left him in a wheelchair, ‘nude from the waist down’. Lawson no longer works at the nursing home.

You know the licensing agreements that you probably never read? Pretty much every time you download software, get a credit card or cell phone, you’re signing an arbitration agreement. What this means is that if you should ever have a case against one of those companies, you would immediately bypass a jury trial in favor of arbitration. Arbitration is similar to a trial, but instead of a jury of your peers, you give your case to a panel of arbiters. Arbiters are legal experts. Some may be judges or other lawyers. That doesn’t sound too bad, right?

The problem is when the company pays for the arbiters and choose who they are. That doesn’t exactly seem unbiased and objective. In fact, the company is heavily favored in arbitration. There’s also no appeal in arbitration. Arbitration is yet another way for big companies to gain an advantage over the Average Joe. In a hypothetical case, the company is already at a significant advantage without adding arbitration to the mix. Company’s who use arbitration clauses tend to be larger, which means they have more resources, more experience, and more to lose. Arbitration is becoming a part of every person’s life, and the Supreme Court recently ruled that being ignorant of the clause doesn’t make you exempt. Know what you’re signing, and read those licensing agreements. Because you may find that in the event of a case against one of those companies, the odds will be heavily stacked against you.