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.

There was a time when the “company town” was common–workers were required to rent their houses and buy their goods from their employers.  The Non-Profit Quarterly had an interesting article about the re-emergence of “company towns” as a way to help staff nursing homes.  Nursing homes and assisted living facilities are always hindered by high turnover and vacancy rates because of the low pay, burn-out, and difficult work of caring for vulnerable adults make these jobs less attractive.  The staffing problem is compounded by the lack of affordable housing.  There might be a solution.

Bill Bogdanovich runs Broad Reach Healthcare, a health system that includes both a skilled nursing facility and assisted living. Bogdanovich has invested in a new strategy: buying residential housing and renting it at below-market rates to his certified nursing assistants and other frontline workers.

Bogdanovich is offering below-market rents to attract employees to work in the wealthy community of Chatham, where housing is out-of-reach for his low-wage staff. One of the major barriers has been housing: unable to afford local housing, workers had to drive long distances to work, increasing their costs and reducing their own quality of life. In other words, unlike the company town of old, here housing is an employee benefit, not a profit center.

About a dozen of the certified nursing assistants and housekeepers employed by Broad Reach now live in housing units purchased by Bogdanovich. The units include a six-bedroom shared home in Brewster, as well as two apartment buildings in the Chatham area. More units will become available for Broad Reach employees as existing tenants move out.

Broad Reach has reduced its vacancy rate to eight percent, while the average vacancy rate at Cape Cod nursing homes is nearly 20 percent.

“Having this housing available nearby makes working here that much more doable for many of our people,” Bogdanovich told Boston Globe reporter Robert Weisman.

The Broad Reach solution may not be scalable, but for an independent senior care company, it’s working. By keeping rents low—he’s not looking to profit, just to pay off his mortgages—Bogdanovich has been able to offer his staff a life-changing opportunity: cheaper housing, lower commuting costs, and more time to enjoy Cape Cod, instead of sitting in their cars trying to get to and from work.

New legislation seeks to protect individuals in nursing homes by implementing better staffing protocols — including increased clinical hours and training — among other safety measures for residents. The Quality Care for Nursing Home Residents Act has the support of at least 27 representatives and two senators. Nursing homes have a resident population of 1.5 million Americans every year — including older Americans, people with disabilities, patients with physical and mental health concerns.

The bill calls for more sufficient staffing levels, increased nurse training, and stronger protection for nursing home residents’ legal rights.

More specifically, the bill calls for:
  • Increased baseline staffing levels under Medicare and Medicaid;
  • Heightened training and supervision obligations for nursing staff;
  • Safeguards for whistleblowers for both personnel and residents;
  • Bans coercive arbitration arrangements between nursing homes and residents;
  • Implements a regulated protocol for collecting consent, both written and informed, from residents treated with psychotropic drugs

Staffing has come under scrutiny from lawmakers and the Centers for Medicare & Medicaid Services, with CMS recently amending the five-star rating system. The issue has also been in the press for years including a July 2018 New York Times piece revealing that nursing homes had been significantly over-reporting their nurse and caretaker staffing levels for years; CMS eventually re-calibrated and 1,400 buildings had the lowest one-star rating for staffing.

Under the proposal, nursing homes would have to meet the following standards for staffing, or face a freeze on payments and fines of $10,000 per day — as well as potentially having the government temporarily take over the property or terminate its ability to participate in Medicare and Medicaid.

Source: Rep. Jan Schakowsky

 

McKnight’s had an article on lawmakers attempts at figuring out the role of private equity firms in nursing home and long-term care, and how and why their involvement affects the quality of care provided.  Hint:  It is short-staffing to increase profits.

Letters asking for information were sent to Carlyle Group, Formation Capital, Fillmore Capital Partners and Warburg Pincus.  The letters questioned the firms’ impact on the “declining quality of care in nursing homes”  and their management of the facilities.  The legislators cited significant and credible research that “has shown that for-profit chain-affiliated companies often provide a lower quality of care and experience more serious health and safety deficiencies that non-profit facilities.”

“We have concerns about the rapid spread and effect of private equity investment in many sectors of the economy, especially industries that affect vulnerable populations and rely primarily on taxpayer-funded programs such as Medicare and Medicaid, like the nursing home industry,” the lawmakers wrote.

“We are particularly concerned about your firm’s investment in large for-profit nursing home chains, which research has shown often provide worse care than not-for-profit facilities,” they added.

Richard Mollot, executive director of the Long-Term Care Community Coalition, criticized real estate investment trusts’ role in the nursing home industry during a federal hearing last week.

The investment by (REITs) and other entities that have nothing to do with healthcare into the nursing home world has essentially savaged the industry and I think care across the country. We’re seeing that more and more with entities buy up nursing homes, they have no experience in the business, they sell out the underlying property,” Mollot added.

We’re seeing it over and over again that monies are being siphoned away from nursing homes and from care. They’re just being devalued and then sometimes even closing.”

The death of an elderly man who fought with his Brooklyn nursing home roommate over a pair of pants has been declared a homicide.  First responders were called to the Crown Heights Center for Nursing and Rehabilitation about 3:15 p.m. on Aug. 10 after the staff failed to supervise and prevent Eitel Vargas from brawling with his roommate.

Nursing home staffers called 911 but the injuries were too severe. Vargas died three days later at Kings County Hospital, police said. The city Medical Examiner declared his death a homicide. The assault exacerbated the heart condition, which led to his death, officials said.

Vargas’ death remains under police investigation, said an NYPD spokesman who added that the department was never told of the fight.

The state Department of Health is also investigating.

“The New York State Department of Health takes these disturbing allegations with the utmost seriousness,” DOH spokesman Jeffrey Hammond said. “Upon learning of this incident, we immediately opened an investigation. As this is an ongoing investigation we cannot comment further.”

Nursing homes are required to report any incidents of assault and sexual abuse at their facilities to the state, and are required to identify residents whose personal histories put them at risk for abusing other residents, according to federal rules.

Vargas’ roommate still lives at the nursing home and has not been criminally charged, staffers said.
Relatives of nursing home residents were stunned by the news and said they were never told of the fatal fight.

“I wish I’d have known,” said one woman who was visiting her husband. “I’m not saying I would move (my husband), but I might have been more vigilant (about) his roommates and who’s up and down the hallway.”

WTKR reported on the issue of sexual assaults in nursing homes.  The problem has been there since the beginning of institutional care but it has significantly increased in the last couple of years.  Many experts and consumer advocates question whether nursing homes that have demented and vulnerable adults attract sexual predators or if the failure to supervise and monitor employees allow for such assaults to occur regularly.  There were several cases in 2018 of medical staff accused of patient abuse in nursing homes and hospitals, and a 2017 CNN report found the federal government had cited more than 1,000 nursing homes for failing to prevent sex abuse at their facilities or mishandling the reports.

The article on WTKR has many tragic examples which illustrate a troubling concern for patients and families involved with medical facilities: Staff who may take advantage sexually of the weak and most vulnerable, regardless of age.

“I’ve wondered if nursing home care draws that particular type of predator,” said Dominique Penson, a partner at the law firm Barasch McGarry Salzman & Penson.  Penson believes many of these abuses happen on overnight shifts and early morning hours.

“I think it’s pervasive,” Penson said of alleged abuse in nursing homes and other medical facilities.

“I don’t think there’s any question it’s pervasive.”

“Unfortunately, it could be a physician, it could be some sort of health care professional, it could be maintenance,” forensic psychologist Dr. NG Berrill said of the staff who have access to patients.

Psychologist Dr. Patrick Suraci said this kind of sexual activity is like a fetish that stops just short of necrophilia, sex with dead people.

“In this case, what these men are doing, it’s a minor form (of necrophilia) because they will have sex with a living body, but also one that cannot respond. So, they have complete control over this body.”

“And this is exciting to them,” Berrill said.

“It’s sort of an issue of power and it probably fulfills some sort of morbid fantasy.”

In New York City, Dr. David Newman, once an emergency room doctor at Mount Sinai Hospital, pleaded guilty to sexually abusing four female patients.

One of the women said he immobilized her with the anesthetic Propofol and ejaculated on her chest. She was able to preserve DNA evidence.

Newman pleaded guilty and was sentenced to two years in state prison.

 

 

A forum to discuss the need for safe staffing was recently held in Rhode Island.  The coalition is made up of consumer advocates, staffing experts, SEIU (Service Employees International Union) 1199 Rhode Island, Sista Fire, Fuerza Laboral, Interfaith Coalition to Reduce Poverty, the Women’s Fund of Rhode Island and the Rhode Island Organizing Project. Several caregivers talked about the need for adequate staffing in nursing homes.  A report prepared by Raise the Bar and made available to those in attendance found that numerous studies conclude that nursing homes have serious quality of care deficiencies that can be traced to a decrease in staffing.

“Rhode Island’s lack of staffing standards force caregivers to rush through the very basics of care tasks like feeding, bathing and dressing residents. Nursing staff do not have adequate time for answering questions or providing the type of social interaction with residents that is essential for maintaining quality of life.”

The coalition defines the issue as “the nursing home staffing crisis.”  It sets forth three easy steps to solving the crisis: A minimum staffing standard of 4.1 hours of direct care per resident per day; a raise in wages for caregivers and to recruit more staff; and to provide training opportunities for caregivers to match the increased complexity of resident care. 

The coalition urges people to spread the word of falls, lack of hygiene and insufficient staffing to family members and to contact legislators.

Stefania Silvestri of Warwick, a nurse, told of how she had found her aunt in tears due of the pain of being left alone on a toilet in a nursing home. She noted the home had only two to three staff to serve at least 31 residents and questioned how personnel could be expected to perform a variety of tasks – from combing hair and assisting with brushing teeth to washing and dressing patients, no less feeding them.

Amanda Sawyer described “extremely stressful” conditions where she worked third shift and was in charge of 24 beds. She said the home management disconnected bed alarms that alert staff when a resident has left a bed that made for quieter conditions yet required her to be constantly on the lookout.

“A fall can end somebody’s life,” she said. Additionally, she said she was forced to choose what policy to break in order to have enough time to serve each of her patients. In place of showers, she said she only had the time to “focus on hands, faces and butts,” and when another caretaker is absent “it means someone is not walking to dinner.”

“I had to quit my job, I couldn’t take it anymore,” she said.

Nursing homes should be required to have a set number of direct care nursing staff to cover the needs and care of patients. New York State is trying to determine how to quantify that number base don the acuity of the residents. However, lobbyists and nursing home apologists are pushing back against any mandatory minimum staffing requirements.

Safe-staffing requirements have been talked about for years. The current version of legislation that addresses it would require nursing homes in New York have a set ratio of at least one nurse for every five patients. Governor Andrew Cuomo this year directed the NYS Department of Health to study the viability of the proposal and see whether it would offer increased safety to patients.

Over the last few years, News10NBC has told dozens of stories about the care and conditions inside some of our local nursing homes. Something we’ve heard consistently from patients and their families is complaints about a lack of proper staffing to provide the kind of care that’s needed.

“We are here today to be a voice for those in nursing homes and hospitals who suffer, and yes die, in silence because of low staffing levels,” said Mary Ann Spring, a registered nurse and member of the Elder Justice Committee.

Marj Donhauser’s mother has been a patient at a local nursing home for the past five years.

“I cry all the way back (home) because I don’t want to leave my mother in that situation because there’s no one to look after her,” she told News10NBC.

The turnover and burnout rate in nursing homes is high. Then there’s the pay. Certified Nursing Assistants and LPN’s are, in some cases, making close to minimum wage.

“You can go to McDonald’s, give somebody a hamburger and say, have a nice day, and get $15 for doing that,” said Donhauser.

 

A patient at West Vue Nursing and Rehabilitation Center in West Plains reported the sexual contact to police. The victim is a 68-year-old resident who told police that Stroman had had sex with her twice since August. The first encounter was consensual, she said, but the second one was not, according to documents. Another nurse explained to officers the victim “was getting scared” after Stroman had sex with her a second time on Sept. 7. Stroman allegedly gave the patient a pain pill before each encounter.

Police collected an item of clothing from the patient as possible evidence, the West Plains Daily Quill reported.

Stroman agreed to talk to police and initially denied any wrongdoing, the documents said. When police told Stroman that they had clothes from the patient with possible DNA evidence on them, Stroman allegedly said that the patient had inappropriately touched him.

He eventually admitted that there had been sexual contact as the woman described, according to the documents. Stroman had been employed as the weekend nurse supervisor at the facility for one year.

 

 

 

I thought I had seen it all.  I have been a nursing home abuse and neglect lawyer for over 20 years and this latest story surprised even me.

Apparently, three caregivers at a facility owned and operated by the Affinity Living Group have been charged with creating a makeshift fight club at Danby House in North Carolina. Their “fighters” were victims of dementia under their care at Danby House, a facility in Winston-Salem, police say.  The Winston-Salem Police Department received a tip in June about elder abuse at the assisted living and memory-care facility, according to Fox 8.

Marilyn Latish McKey, Tonacia Yvonne Tyson, and Taneshia Deshawn Jordan were arrested and charged with assault on an individual with a disability in early October, according to authorities. McKey, Tyson and Deshawn filmed two residents in Danby House’s “special care unit” for dementia patients and encouraged them to fight.

Resident 8 and Resident 9, as the women are referred to in the documents, fought in Resident 8′s room as the trio of health-care workers encouraged them and and recorded the assault.  The three caregivers can be heard in the video saying, “Stop screaming, [expletive].” Someone also prompts one of the residents to “punch her in the face.” Another is concerned that the phone is actually recording the video, so that it could be sent to her later.  Video shows the patients falling onto a bed in Resident 8′s room as Resident 9 continued her assault, according to court documents reviewed by Journal. The anguished pleas for help were ignored.

Staff members took video of the fight, which led to “one resident being strangled with her face turning red,” and shared it on social media.  The employees let the fight happen because one of the residents “always caused problems.”

They were only charged with Class A misdemeanors, which only come with a maximum penalty of 150 days of incarceration and a discretionary fine. Their next court date is Nov. 14.  Incredible.

Affinity Living Group is the fourth-largest provider of Alzheimer’s care and memory care in the country, according to its website.

McKey faces an additional charge after shoving one of the residents during a separate incident when staff took video while McKey pushed the woman “into a room, turned off the light and yelled to the resident to go to sleep, and then closed the door leaving the resident in the dark room,” according to the report.