The shortage of nursing home workers is caused by low pay, the working conditions at many nursing homes, and the lack of benefits especially health insurance. Nursing home work is harder than most; it involves lifting, bathing, cleaning up after our elders who can’t manage on their own so well anymore. Another reason is that workers have plenty of other options to work for minimum wage. Nationally, just 3.5% of the workforce is unemployed, the lowest in roughly 50 years.
Nursing homes are desperate for staff at all levels, from registered nurse to certified nursing assistant, a job that doesn’t necessarily even require a high school diploma. For nurses, it’s scary to have so few of them on each shift, and many flee to work at places that aren’t so understaffed.
The economy will decline and shift in favor of nursing home employers, but demographics will exacerbate this particular staff shortage for at least a decade or two. Soon, the huge generation of Americans born in the baby boom after World War II will start entering nursing homes. The later generations that make up the work force are smaller, and therefore the ratio of people of nursing home worker age (18 to 64) to senior citizens (65 and older) has shrunk rapidly.
Meanwhile, lobbyists are pushing a bill that would require “safe staffing” levels at all nursing homes. Most experts and consumer advocates contend that a minimum of 4.1 is needed for safe staffing.
A recent survey of nurses shows that more and more nurses are facing increasingly difficult working conditions and are burning out. There are nearly 3 million registered nurses in America and the profession is still one of the fastest-growing in the country. According to a recent survey from AMN Healthcare, 22% of nurses hold more than one job as a nurse. And 37% of these nurses say that doing so “negatively affects their quality of life.” The survey also found that 27% of nurses have witnessed workplace violence, 41% have been victims of bullying, incivility, or any other forms of workplace violence, and 63% of nurses say their organization didn’t address the situation well at all. In the AMN survey, 66% of nurses said that they worry their job is affecting their health. In the AMN survey, 44% of nurses said they don’t usually have the time they need to spend with their patients.
The burnout leads to post traumatic stress disorder and an increase in substance abuse, addiction, and suicide rates. A study featured in the Archives of Psychiatric Nursing found that there are higher rates of suicide among those working in nursing compared to non-nurses. It also showed that nurses are “statistically significantly more likely to have reported mental health problems,” although it’s unclear whether or not their work environment plays a direct role in those figures.
“This is moral injury,” Mahon said. “They spent all these years in school, and they’re getting into an environment where basically they’re providing factory-level care. It feels like it’s so dehumanized.” Amid these industry changes, nurses feel like they can’t provide the same level of quality care as they used to.
Cole Edmonson, a doctorally-prepared nurse and chief clinical officer at AMN Healthcare, pointed to the distribution of nurses across the industry.
“If you look at the number of licensed nurses, there is not a shortage,” he said. “But you have to look at where those nurses are practicing, why they choose to practice in those area or leave those areas of practice.”
Another sad story of an overworked nurse stealing medications from a resident. Talisa Milam Haygood was arrested Dec. 20 on a felony charge for allegedly stealing medication from residents in October and falsifying records indicating she had given the drugs. Haygood is charged with obtaining a controlled substance by fraud, punishable by up to 10 years in prison.
She was employed at Lakewood Therapy and Living Center when the alleged theft and fraud occurred. According to the probable cause affidavit, the administrator at Lakewood filed a report with police on Oct. 10 after reviewing video surveillance footage at the center following a complaint by a resident about some missing Nexium pills.
In viewing the footage, he reportedly saw a nurse, identified as Haygood, removing a hydrocodone pill from the medication cart shortly before 1:30 p.m. on Oct. 9 and placing it in her mouth. The administrator counted the pills in the cart and compared it to the entries made by Haygood in the prescription log book.
He then spoke to the residents Haygood had indicated received their pain medication and found two residents who had not received any medication. One patient told him Haygood had refused to give her any hydrocodone at the prescribed time but instead gave her a Tylenol pill.
One patient was reportedly not capable of advising if he received any medication, but a review of the security footage showed Haygood never entered the man’s room at the time indicated and only went into his room once during her eight-hour shift for about three seconds.
The administrator noted that in the entry for that patient Haygood had indicated she had crushed the pill up in a solution and injected it into the patient, but the video showed Haygood never retrieved a syringe from the storage closet.
Police Detective Jjesus Anaya spoke to the administrator and one patient who confirmed the same information. The administrator noted he has video evidence of 17 “pill diversions” by Haygood and is still reviewing the footage to compile more evidence.
Karen Paredes-Luquin is a nursing assistant at Auburn Oaks Care Center nursing home facing multiple charges of felony fraud involving elders she cared for, according to the Placer County Sheriff’s Office. Paredes-Luquin was caught on surveillance video Nov. 22 using stolen credit cards belonging to two residents.
Authorities received reports of the fraud from the nursing home and found video at the locations the credit cards were used. One of the videos shows Paredes-Luquin wearing nursing scrubs and a surgical mask while making the purchases, which made the cashier serving her suspicious, according to officials. The cashier followed Paredes-Luquin and wrote down her vehicle information. The cashier was able to provide that information to investigators, who then used it to identify Paredes-Luquin.
Detectives arrested Paredes-Luquin when she arrived at work and charged her with multiple counts of felony fraud. She has since posted $100,000 bail and was released from custody.
The skilled nursing industry lost 1,300 jobs in October and 1,700 jobs in November after the new Patient Driven Payment Model was started on October 1, 2019. Despite the overall healthcare sector seeing significant growth according to the latest employment figures released by the Bureau of Labor Statistics, somehow nursing homes cut staffing.
The lack of hiring at nursing homes is being impacted by the new Patient Driven Payment Model. There have been numerous reports of full-time therapist ranks being thinned out, for example. However, long-term care operators are currently complaining about workforce shortage. Last week, industry lobbyist LeadingAge formally announced an initiative that aims to increase the number of foreign-born aging service workers to help ease caregiver shortages.
When managers and owners of Symphony Residences nursing home discovered employees had stolen more than $700,000 from a 98-year-old resident who has Alzheimer’s disease, they didn’t fire them or go to authorities — they sought to cover it up, according to a lawsuit. The Cook County public guardian’s office filed a 335-page complaint seeking monetary damages for four entities that own Symphony Residences, several managers and the five employees accused of stealing Grace Watanabe’s life savings. The lawsuit alleges Cruz and other nursing home executives discovered the theft and failed to report it to law enforcement.
Bank regulators noticed irregularities and brought the case to the attention of authorities.
The lawsuit accuses nursing home executives of locking Watanabe in an office to keep county social workers from moving her to another nursing home. Word of the standoff got back to authorities who dispatched Dawn Lawkowski-Keller, an attorney who works in the financial recovery unit. After a shouting match, Lawkowski-Keller boiled it down for Symphony Executive Director Erika Cruz: “You have 5 minutes or we’re calling the cops.” Cruz finally freed Watanabe.
An investigation later concluded that five nursing home employees used Watanabe as their personal piggy bank — draining her life savings through a series of ATM withdrawals, forged checks and other payments. Two of the five employees accused in the civil suit of stealing from Watanabe have been charged criminally with financial exploitation of an elderly person.
A separate civil suit filed seeking information from Symphony is stalled while company executives appeal a September court order compelling them to testify. They are being fined $400 for every day they defy the order and remain silent.
Watanabe was born in Santa Cruz, California, in 1921 and was held in the Poston internment camp from 1942 to 1946. After her release, she earned a bachelor’s degree in English from the University of Illinois at Chicago.
Substance abuse among health care professionals (especially nurses in skilled care facilities) has increased significantly over the last decade. The opioid crisis has dramatically affected nurses and other caregivers. Recently another registered nurse was arrested for stealing pain mediacation and watering down morphine intended for a patient, according to court documents. Joshua D. Williams worked at Greenbrier Regional Medical Center. He was charged with tampering with a consumer product.
The indictment says Williams was working as a supervisory registered nurse at Greenbrier Regional in August 2018 when he tampered with a bottle of liquid morphine sulfate prescribed to a patient. The indictment says he removed a quantity of the drug and replaced it with a saline solution, diluting its concentration to about 14% of what it was labeled.
Court documents don’t say why Williams allegedly diluted the morphine, but according to media reports and prosecutors in other cases, medical staff oftentimes steal the opiate for personal use.
“The morphine discrepancy … was detected during a routine audit,” R. Bruce McCorkle, Greenbrier Regional’s administrator said in a statement, indicating staff reported the situation to “the appropriate state and federal authorities.”
The department said he is authorized to work in several other states, including Maryland, West Virginia and North Carolina.
The National Association of Health Care Assistants has come forward to support a bill that would require minimum staffing requirements for nursing homes. The organization disclosed its support of the bill named the Quality Care for Nursing Home Residents Act.
The bill requires facilities to disclose their nurse staffing levels, and implement administrative staffing requirements and whistleblower and resident protections. Facilities could be subject to up to $10,000 in fines per day for noncompliance under the proposal.
“No longer shall we accept being understaffed as a standard practice, all while claiming quality care is being provided. The needs of the residents are not being met and one reason is because sufficient staffing is not a requirement,” Dane Henning, NAHCA’s director of public policy, said in a statement. “We are in the business of taking care of humans with humans; how can this not be the most important aspect, the paramount characteristic in providing quality care,” he added.
“There are many aspects to recruiting and retaining staff, in which NAHCA have become experts; however, there really is no incentive for providers to do so. Unlike those that oppose, NAHCA supports this staffing bill, with or without funding. This is necessary in providing quality care and is a given in this line of work. This bill does not arrive a second too soon,” Henning added.
As a nursing home abuse and neglect lawyer, we see first hand how short-staffing affects the resident’s quality of care. I hope that the bill can get passed and signed into law.