Nursing homes were designed for high-needs residents and are heavily regulated by the federal government. Assisted living and other state-regulated homes were designed for healthier residents and are lightly regulated.  Vermont Public Radio and Seven Days investigated the lack of regulations for state-licensed facilities providing a home for vulnerable adults who may not need skilled care. In Vermont and elsewhere, investigations into these homes have revealed lax oversight, injuries and deaths.

A review of nearly six years of inspection reports revealed troubling patterns of inadequate care. At least five residents have died in accidents related to deficient care, and the majority of homes have been cited for severe infractions. One home’s owner told regulators that it was easier to accept a citation than to give staff the dozen hours of required annual training.

Homes that provide poor care are rarely fined by state regulators, who are acutely aware of their state’s need for long-term care beds. Vermont has one of the oldest populations in the nation, and people with dementia, such as Marilyn Kelly, can wait months for placement at a facility.

Vermont is not the only place where journalists have uncovered inadequate care and oversight at state-licensed long-term care facilities. The Atlanta Journal-ConstitutionThe Oregonian and PBS and ProPublica have published similar findings, with databases designed to help consumers.

“It could have been any state,” said Lori Smetanka after learning about VPR and Seven Day‘s findings in Vermont. Smetanka is executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.

Be on the lookout for unfriendly staff interactions, unpleasant smells and sounds of distress. Confirm the staffing numbers. And do research. Ask your state’s long-term care ombudsman about what kinds of complaints have come in about the facility; read the contract carefully; and get a hold of the facility’s state inspection reports.

The Trump Administration will no longer allow federal investigators to oversee and supervise nursing homes. Federal regulators plan to halt inspections of nursing homes to focus on coronavirus cases in facilities across the nation. Unsafe practices, poor training, and inadequate staffing led to serious infractions at the hardest-hit location. Many nursing homes have long struggled with infection control, according to federal inspection records and researchers. They need oversight and inspections to maintain compliance with safe practices.

Under the changes, regular inspections of nursing homes, home health and hospice companies, will be paused for April. The number of abused and neglected residents will skyrocket in the next 30 days.  Especially since family and other visitors are prohibited from checking in with their loved ones.  The lack of oversight and inspection was made under the Trump administration’s declaration of a national emergency.

The move follows a recent inspection of the Life Care Center of Kirkland, a nursing home near Seattle, which is tied so far to 35 coronavirus deaths. CMS said the inspection found three major violations at the facility that put residents in imminent danger, including not quickly identifying and managing sick residents. Life Care said it had faced an unprecedented crisis and has fixed the issues.

 “Right now, the biggest threat to our nursing home residents is the coronavirus,” CMS Administrator Seema Verma said in an interview. “We cannot have a repeat situation like we had in Kirkland.”  However, she agency isn’t blocking one practice that the CDC said may have made several nursing homes in the Seattle area more vulnerable to the spreading outbreak: staff members who work at more than one nursing home.
Nursing homes house the population most vulnerable to the respiratory sickness: older, often frail residents with underlying medical conditions.  At least 146 nursing homes in 27 states have at least one infected resident, CMS said, citing data from the Centers for Disease Control and Prevention.

 

 

 

We see it all the time where a nursing home’s doctor has a bias against one of our clients because of race, gender, or sexual orientation. It clearly affects their ability to testify honestly and consistently with accepted medical practice.  A recent article from the New York Times explored bias in missed medical diagnosis.  Bias, which takes many forms, affects how doctors think and the treatment decisions they make.

Racial biases in treatment decisions by physicians are well documented. One study found that black patients were significantly less likely than white patients to receive pain medication in the emergency department, despite reporting similar levels of pain. Other research suggests that racial biases among providers contributed to racial differences in patient trust in the health system.

A growing body of scientific research on physician decision-making shows that doctors exhibit other biases as well — cognitive ones — that influence the way they think and treat patients. These biases lead doctors to make the same mistakes as the rest of us, but usually at a greater cost.  Cognitive biases refer to a range of systematic errors in human decision-making stemming from the tendency to use mental shortcuts.

Prominent examples include confirmation bias, the tendency to interpret new information in a way favorable to one’s preconceptions; and anchoring, the tendency to overly weight an initial piece of information, even when order does not matter.  In health care, such biases can  affect whether similar patients live or die.  A recent study analyzed gender bias in surgeon referrals and found that when the patient of a female surgeon dies, the physician who made the referral to that surgeon sends fewer patients to all female surgeons in the future. The study found no such decline in referrals for male surgeons after a patient death.

In a new study of physician treatment decisions published in The New England Journal of Medicine, signs of left-digit bias are investigated. Left-digit bias could affect many clinical decisions. For example, patients with hemoglobin levels of 9.9 grams per deciliter may be perceived as being substantially more anemic than patients with hemoglobin levels of 10.0 grams per deciliter (the difference in the two values has no clinical significance).The study confirms previous work that found doctors are overly responsive to patient age when diagnosing illness, and that showed how seemingly irrelevant factors‚ such as the difference of a few weeks of age, could govern physicians’ decisions about treatment, with potentially life-altering consequences for patients.

Based on the latest figures from the World Health Organization, the nursing home industry will see an increase in positive cases of Covid-19.  There are now more than 54,100 cases in the country, along with 644 deaths, according to the Centers for Disease Control and Prevention. The CDC also reported 160 nursing homes across the country have at least one resident with COVID-19.

The organization is seeing a “very large acceleration” in cases in the United States. Over a 24-hour time period earlier this week, WHO reported that 85% of new cases have been in the United States and Europe — with 40% of those being from the U.S. alone.

WHO spokeswoman Margaret Harris said the latest figures show that the U.S. “does have that potential” to become the new epicenter of the disease.

“We cannot say that is the case yet but it does have that potential,” Harris told reporters Tuesday. “They [the United States] have a very large outbreak and an outbreak that is increasing in intensity.”

It took 67 days from the first reported case to reach the first 100,000 cases, 11 days for the second 100,000, and just four days for the third 100,000,” WHO Director-General Tedros Adhanom Ghebreyesus said Monday.

Dr. Glenn Mollette is the author of Nursing Home Nightmares — America’s Disgrace. He wrote the column below and it was published in The Logan Daily News.

About 1.5 million American seniors now live in nursing homes. Seventy percent (70 percent) of them rely on Medicaid to pay the bill, which means they are low-income or have otherwise spent down their assets.

My mother spent the last few months of her life in a nursing home. My first wife died in a nursing home. My wife’s mother spent a lot of time in nursing homes. Today, I have elderly friends in nursing homes who I try to occasionally go and see. It’s the same old story. I continue to see a multitude of lonely, forgotten people who have been warehoused in facilities until they breathe their last breath.

Placing my wife in a nursing home was one of the hardest things I’ve ever done. She was in the final stages of multiple sclerosis and needed 24 hour care which I couldn’t physically give. However, looking back emotionally and even physically I don’t think I would have been as drained if I had just kept her at home and tried to have cared for her.

One worker told me once she was in charge of taking care of sixty (60) persons every night. She said that oftentimes there would be people she never saw on her shift.

Nursing home care cost is astronomical. Just a bed, three meals a day and an occasional bath will cost you around $7,500 a month. My mother-in-law needed rehabilitation. Three years ago her cost was over $15,000 a month for four months. My father-in-law shelled out $60,000 of their life savings for rehab. They had worked hard to save that money, but you can’t take it with you. However, most people don’t intend to work all of their lives so that they can turn their savings over to a nursing home.

Nursing homes are not a relief emotionally or physically and financially they will break you. Most Americans end up paying for their nursing home care via Medicaid. Going on Medicaid is no picnic as it means, in reality, you no longer have any means to pay for your care.

Twenty years ago I was the pastor of a church with a small salary and financially we didn’t have anything except a house payment. Going to the local county office for health and family services and applying for Medicaid for nursing home care for the care of my invalid dying wife was tough. It was our last resort. We were glad it was available but it was emotionally tough. It’s the same office where you go and apply for food stamps.

There are some good nursing homes out there and many, many hardworking, caring nurses. There are some really bad ones out there too and they are all extremely expensive.

All the time we hear about Americans being medically insured. What about long term care insurance for aging Americans? Our nation is getting older. The baby boomers are a large chunk of our population — 75 million! Baby boomers are going to face bankruptcies and mega financial challenges as is this nation with the long term care of our generation.

Our politicians must come up with a long term care plan that does not require the financial ruin of millions of Americans. I know long term care insurance is available if you are not sick and can afford it. However, somehow we have to add long term care insurance to Medicare. Yes, it will cost us every month to pay for it just like we are paying for part B now.

However, it would be for real medical care in the nursing home with real rehabilitation if it is needed; and not just for a bed and three meals a day and an occasional bath. Plus it would spare the elders in this nation from having to file bankruptcy and go into poverty to have a shelter over their heads the last few months or even years of their lives.

Please add this issue to the national discussion.

Nursing homes – including the Kirkland, Washington facility that’s been linked to 35 deaths – are vulnerable to the spread of the Covid-19 virus because staff members work while displaying symptoms, according to a report released by the U.S. Centers for Disease Control and Prevention.  Inadequate equipment and poor infection control play a role as well, as did failing to recognize an infection and change of condition, according to the agency’s “morbidity and mortality” report. The findings may shed light on how long-term care facilities should respond to infections that pose a threat to their residents.

In addition to symptomatic workers, the agency cited four other factors that “likely contributed to the vulnerability of these facilities”:

* staff members who worked in more than one facility;
* inadequate training and adherence to standard, droplet, and contact precautions and eye protection recommendations;
* challenges to implementing infection-control practices including inadequate supplies of personal protective equipment and items such as alcohol-based hand sanitizer;
* delayed recognition of cases because of low index of suspicion, limited testing availability, and difficulty identifying persons with Covid-19 based on signs and symptoms alone.

Long-term care advocates and infectious disease experts state that federal regulators and state inspectors have failed to hold nursing homes to safe standards of infection control – and often failed to exact meaningful penalties for violations.

Experts agree that staffing is by far the most important factor when it comes to a nursing home’s safety and quality of care. Each nursing home is required to have appropriate staff to ensure that each resident receives treatments, medications, diets and other health services based on their individual care plans. Yet, many states do not mandate numerical safe staffing standards for nursing homes.  Studies and expert analysis have concluded that 4.1 hours per patient per day is the minimum safe staffing to provide quality of care to residents in nursing homes.  New York is thinking about mandating safe staffing.

According to federal data analyzed by News 4 Investigates, nursing homes in New York have the most average number of residents per day in the United States. More than 117,000 people reside in nursing homes in New York.

But nursing homes in the state don’t stack up as well when it comes to staffing.

In fact, the state ranks in the lower 20 percent nationwide when it comes to measuring staffing hours per resident per day, according to the federal data.

For example, the state ranked:

  • 41st in reported total nurse staffing hours per resident per day
  • 41st in reported nursing aide staffing hours per resident per day
  • 40th in reporting registered nurse staffing hours per resident per day
  • 37th in reported licensed staffing hours per resident per day

A January 2006 report by former Attorney General Eliot Spitzer found that staffing levels in about 70% of nursing homes in New York did not meet the standards set in Florida; about 38% did not meet the standard in California; and about 26% did not meet the standards in Vermont.

Gabrielle Simano worked at three different nursing homes in Western New York before she called it quits last year.

She loved the work but the “staffing crisis” as she described it got to be too much for her to handle.

“I feel like if I don’t say something, then it is not going to get fixed,” Simano said.

The certified nursing assistant said a lot of the problems she witnessed had a direct link to understaffing at each nursing home.

“There is a lot of low staffing and it is hard to take care of people when you don’t have enough staff that have your back,” she said.

“Ultimately, it is not safe for employees, it is not safe for the residents.”

She described a workplace where she only had about five minutes every two hours for each of her 22 residents on the dementia floor. Five minutes to get a resident out of a wheelchair, clean them and change their undergarments. She said she would literally sprint room to room to help residents, some of whom were unable to walk, talk or eat alone. The hectic pace was perpetuated, she said, by a lack of staffing and a safety rule that requires an employee to check on residents at least every two hours and change them if they are incontinent.

The Salem News had a great article about the chronic problems of infections and short-staffing at nursing homes. Deadly coronavirus outbreaks at nursing homes in Washington, South Carolina, Illinois, Florida, New York, New Jersey and elsewhere are laying bare the industry’s long-running problems:  short-staffing and poor infection control.  Federal investigators have concluded that infections spread in nursing homes because minimum wage workers come to work while sick, and even spread it to other nearby facilities where they work.

Sherry Perry, a certified nursing assistant at a nursing home Lebanon, Tennessee, has been working through the coronavirus crisis. But she knows the effect worker shortages have on her life – she’s often responsible for the care, washing and feeding of 13 patients on a given shift.

It’s challenging. We don’t get to spend as much as time as we’d like with the patients,” said Perry who after 34 years on the job makes $17 an hour. Those just starting out make $10 or $11. The work is hard, they’re underpaid and they’re underappreciated.”

75 percent of the nation’s nursing homes don’t meet federal suggested minimum levels for staffing and many workers are inexperienced. Four out of five nursing home employees are hourly workers, and given the low wages often leave for retail and restaurant jobs just as they become familiar with proper care procedures. And staffing problems at the nation’s 15,000 long-term care facilities could only be exacerbated by the coronavirus crisis, experts said, because lockdowns and school closures have left many such workers with no choice but to stay home and take care of their children.

Nursing homes would always have been ground zero, but given we already have huge staffing shortages, this will be magnified,” said David Grabowski, a Harvard Medical School professor who has studied staffing problems at homes. It could be worse for today’s nursing homes than ever.”

We have the most vulnerable people in a situation where … nursing homes don’t do what they have to do because they are understaffed, not sufficiently trained and there is high turnover,” said Steven Levin, a Chicago lawyer who has sued nursing homes over their practices. I am extremely frightened.”

Nursing homes have unsafe infection prevention and control procedures.  Nearly 10,000 homes in the U.S. – almost two thirds of the total – fell short on at least one infection control measure over the past four years, according to an analysis of inspection reports by Kaiser Health News such as staff not washing hands before helping residents put on a diaper or leaving open sores on a foot exposed to dirty floor.

Just months before the outbreak, the Trump administration eased up in preventing infections. The administration planned to change the rule requiring homes to have an infection control specialist on staff “at least part-time” to having one working a “sufficient” amount of time.

The Citizen’s Voice reported the assault suffered by Ruth Ann Albrecht at Allied Services Meade Street Skilled Nursing facility.  Berlanne Smith was charged criminally in December with the assault and harassment of Ruth Ann. Ruth Ann had to file a claim to request compensation for the alleged abuse and neglect. The lawsuit blames a co-worker who witnessed the abuse and their employer, Allied Services Personal Care, Inc.  Smith assaulted Albrecht while she was in the shower, the complaint alleges.

The defendant, Berlanne Smith, while working in the aforesaid facility, engaged in the most depraved conduct that a human being can perpetuate,” the Complaint states. “That is, she took advantage of one of the most vulnerable members of society’s population: a weak, frail, demented, elderly woman.”

According to the police account of the assault, certified nursing aide Lawrence VanBuren-Morgan reported hearing a female resident “screaming at the top of her lungs” and found Smith “grabbing and twisting” at Albrecht’s breast.

Smith left the room, but a short time later VanBuren-Morgan saw her return and close the door, police said. When Albrecht began screaming again, VanBuren-Morgan found her with a bloody nose, saying Smith had hit her in the face, according to police.

The civil complaint targets VanBuren-Morgan as well as Smith, alleging he “did not properly intervene” nor timely report the assault.