Virginia has once again and for the the 16th time ignored the wishes and needs of its citizens for the comfort of campaign contributions from the nursing home industry. A simple proposal to set minimum safe staffing levels for Virginia nursing homes, which are ranked among the nation’s worst for the number of patients per caregiver, has been rejected.  The proposal required just one caregiver for every six residents.  Have you ever tried to take care of six people at once who all needed assistance with activities of daily living?  Good luck.

Residents who need help eating, showering, moving around and going to the bathroom get an average of two hours of direct care staff time a day.  Erin Hines, a certified nurse assistant from the Peninsula, said she often is assigned 20, 30 or 40 patients a shift.

“Call lights are going unanswered because there is no one to answer,” she said.People will keep getting neglected and abused in Virginia until they provide sufficient and safe staffing to meet the needs of the residents.

Great things are happening in New York regarding enforcing safe staffing levels at troubled nursing homes.  Last month, a persistently low-rated Buffalo nursing home, Safire Rehabilitation of Southtowns, has been fined $7,000 by the state after it was cited for failing to have sufficient staff on duty and other violations.  It is extremely rare that investigators cite a facility for short-staffing.  Very rare. The New York Health Department has come under pressure for allowing nursing homes to operate without enough nurses.

Last year state lawmakers considered legislation backed by unions representing nursing home workers that would have set for the first time minimum safe staffing levels for each of the state’s more than 600 nursing homes. At present, nursing homes are required only to have “sufficient” staffing levels, with no specified ratios. The nursing home industry balked and sent campaign contributions to the politicians.

The state Health Department in November fined Safire Rehabilitation, a facility with about 110 residents, the maximum allowed because understaffing has been a recurring problem, said a spokesman for the agency.  Meanwhile, Safire of Southtowns’ staffing logs showed the nursing home did not meet its own internal guidelines for safe staffing on 21 out of 51 shifts during a period in the summer of 2019 that the Health Department reviewed, according to a report written following an Aug. 22 inspection.

“Based on multiple sufficient staffing deficiencies cited by the department during three unannounced inspections, Safire Rehabilitation of Southtowns has been fined the maximum of $7,000,” said spokesman Jeffrey Hammond.

He said the Health Department only cited 26 nursing homes statewide for insufficient staffing in 2019, including two in the Buffalo Niagara region.

“Doing a safe staffing report was the Health Department’s idea, to put off doing a real law. Now it’s lagging on releasing the report,” said Assemblyman Richard Gottfried, D-Manhattan, the chairman of the Assembly health committee. “It undoubtedly shows the need for action on safe staffing, which the department doesn’t want to confront.”

Understaffing at nursing homes cause serious consequences, residents and nurses told the state.

A person identified only as Resident #53 told inspectors she had not been out of bed all day because there was not enough staff to help her. “The staff don’t get me out of bed because I need two people to get out of bed, there is not enough staff and it happens often,” the woman told inspectors.

Resident #95 complained, “Yesterday I didn’t get my morning meds (medications) until after 2:00 p.m. Some of the meds off schedule are my pain meds.”

A licensed practical nurse admitted he sometimes has to cover a unit with more than 30 residents alone, without any certified nurses aides helping, and as a result he’s unable to complete all of the required checks on residents every two hours.

“I worry about if we had a fire or an emergency, we won’t be able to do everything and get the things done that we need to for safety,” LPN#3 told the inspectors, according to the state report.

The nursing home’s staffing coordinator told inspectors the staffing shortages occur because too many workers call in sick or just don’t bother to show up.

Understaffing isn’t a new problem at Safire of Southtowns, which has been operated since 2014 by a company with five downstate partners: Solomon Abramczyk, Judy Landa, Richard Platschek, Robert Schuck and Moshe Steinberg.

The Health Department has cited the nursing home’s owners five times in the past two years for having insufficient staffing.

The staffing crisis was particularly bad on Christmas Eve 2017, when all four of the licensed practical nurses scheduled to take care of about 100 residents called in sick for the day shift and a registered nurse scheduled to work didn’t show up, according to the state reports. The home’s administrator scrambled to find replacements.

The $7,000 fine on Safire of Southtowns increased its total state and federal penalties for the past five years to $98,925, one of the highest totals for nursing homes in Erie and Niagara counties.

The facility’s biggest penalty came in 2016 when the federal government fined it $85,925. That fine was imposed after Health Department inspectors in May 2016 found that a licensed practical nurse failed to disinfect a shared blood glucose meter when testing up to 20 residents, including two who had known communicable bloodborne diseases.

Statewide, the Health Department has imposed more than $3.2 million in fines against 209 nursing homes since 2016, for a variety of violations, said Hammond, the agency’s spokesman.

Assemblywoman Aileen M. Gunther, D-Forestburgh, the sponsor of the safe staffing bill in the Assembly, said vulnerable residents in nursing homes deserve better care and the nursing staffs caring for them should not be overworked.

Inadequate staffing has the potential to contribute to negative situations, such as bed sores, which end up increasing the costs of treatment, she said. had a great article explaining why short-staffing at nursing homes are not only a danger to the residents but short-staffing is a danger to the staff as well.  Short-staffing causes injury, burn-out, and depression in the caregivers. Tasked with lifting, cleaning and caring for often helpless patients, certified nursing assistants work in one of the most dangerous jobs in the country. The article explains how many nurses get hurt when there is not enough staff to provide care such as transferring residents for personal hygiene or custodial care.

The job has a higher injury and illness rate than freight movers, construction laborers or carpenters, according to recent data from the U.S. Bureau of Labor Statistics.  Out of more than 900 occupations sorted by injury and illness rate, nursing assistants nationwide ranked 34. The risk is especially acute in nursing homes because of the short-staffing. Many places are chronically short staffed, which puts workers in an even riskier situation.

Throughout the country, nursing and residential care facilities reported higher rates of injuries and illnesses than the vast majority of other workplaces in 2018, the most recent year available. In interviews with more than a dozen nursing home employees throughout the state, many repeatedly said the workers can be just as much a victim of staffing shortages as the residents.

Ashley Conway, a nurse and assistant professor at the Rutgers School of Management and Labor Relations, said short-staffing does contribute to injuries. An immobile patient who needs to go to the bathroom, for example, puts nursing assistants especially in a tough spot if they do not have help.

“Do I do let them lay in their in beds and cry for help, or risk a back injury?” she said. “It’s a lose-lose situation.”

Conway, who has also advised the state’s labor department, estimated that many injuries are never even reported, and she doubted whether many employees received workers’ compensation. Over the past eight years, more than 14,000 injuries and illnesses caused employees to miss at least one day of work at privately owned nursing and residential care facilities in New Jersey, a higher rate than the nation overall.

Many missed more. The state’s nursing assistants missed a median of six days of work in 2018, and New Jersey has reported some of the highest numbers of days missed when compared to other states throughout the decade.

Missing work can increase the strain on staff, creating a snowball effect. More than one employee recalled trying to call in sick because of exhaustion, and being pressured to show up anyway because of how few people were working.

The need for certified nursing assistants especially is only expected to increase as the 65-and-older population soars nationwide, from 47.8 million a few years ago to 88 million by 2050, according to the nonprofit research and advocacy organization LeadingAge.


Steve Piskor placed a camera in his mother’s room at Summit County Nursing Homes in 2011.  The video recorded eight aides abusing his then-78-year-old mother, Esther, who had Alzheimer’s disease and died in 2018. Eventually, two of the aides went to prison, three were fired and three were disciplined, Piskor said.

The family’s experience with elder abuse inspired Senate Bill 255 and House Bill 461, or “Esther’s Law,” companion measures introduced in the Ohio legislature in December. It would allow residents of facilities like nursing homes and assisted living facilities to set up a video recording device in their room.

“I’m not trying to say all aides are bad and all nursing homes are bad. … What we’re trying to do is just stop the abuse,” said Piskor, 65, of Cleveland.

Piskor shared his experience during the second meeting of the Summit County Nursing Homes and Facilities Task Force on Tuesday morning in the Greater Akron Chamber office.

One of the primary focuses of the task force is staffing issues. Kim Hone McMahan, a retired Beacon Journal reporter and columnist whose 103-year-old mother was injured in a nursing home in May, said staff at nursing homes and other facilities are often underpaid, under-trained and difficult to retain, saying she’s found some facilities with a turnover rate of 100%.

“Many if not most incidents in nursing homes are [due to] a lack of staffing, proper staffing,” said McMahan, saying the lack of proper staffing “has reached a crisis.”

“Without staff, we’re not going to have the quality of care that we’re looking for,” attendees said.

Preliminary ideas from the task force include a workforce development initiative with Stark State College and a Peace Corps-style training program within the county for young people interested in health care or caregiving. The program would allow them to get experience in nursing homes and other facilities and potentially be hired permanently in the future.

“We’ve been hearing this ever since we mentioned we were looking into this, not only from the providers of the service but from families who have loved ones in the facilities,” Summit County Council President Jeff Wilhite said of staffing issues.



The U.S. Attorney’s Office in Northern District of Iowa released the following:
Falsely Stated He Was Spending More Time with Patients in Nursing Homes Than He Was Actually Spending With Them

Dr. Joseph X. Latella, a primary care doctor in Webster City, Iowa, was sentenced today to two months in prison and to pay a fine after previously pleading guilty to making false statements related to health care matters.  Dr. Latella has also agreed to pay $316,438.96 to resolve False Claims Act allegations relating to claims he submitted for routine visits for nursing facility residents between January 1, 2014, and November 30, 2018.  The United States alleged that Dr. Latella submitted claims to Medicare and Medicaid for the most intensive and expensive claim code for such visits when, in fact, he was not performing services sufficient to justify use of that code.

Dr. Latella admitted in a plea agreement that, in June 2018, the United States Attorney for the Northern District of Iowa was conducting a civil investigation about concerns that Dr. Latella was “upcoding” claims submitted to Medicare and Medicaid and billing for more intensive visits with patients at Webster City area nursing homes than he had performed.  The United States Attorney’s investigation indicated that Dr. Latella was billing over 93% of his nursing home visits to Medicare under the most intensive and expensive claim code.  For these claims to be valid, a doctor typically must spend 35 minutes at the patient’s bedside and on the patient’s facility floor or unit.  Medicare paid more than $94 for these claims, but would only have paid no more than $32 if the least expensive claim code, for routine ten minute visits, had been billed.  In July 2016, a Medicare contractor sent Dr. Latella a letter warning him that his billing patterns were significantly more expensive than other doctors.

In July 2018, Dr. Latella submitted sworn written answers to the United States Attorney, in which Dr. Latella falsely declared that, with respect to certain Medicare claims in 2017 and 2018, he had spent approximately 35 minutes for each of 12 patients’ care at two nursing homes.  With respect to one particular date in October 2017, Dr. Latella falsely swore he “started visiting the nursing home patients at 7:30 a.m. and completed my visits with each patient at approximately 5:30 p.m.”  In truth, a federal agent had conducted in-person surveillance of Dr. Latella on that date, and Dr. Latella only was on site at the first nursing home for a total of 47 minutes and did not visit the second nursing home at all on that date.  The administrator of the first nursing home estimated that Dr. Latella spent approximately five minutes with each nursing home patient during his visits to that nursing home.

Dr. Latella made further false statements about claims in January and February 2018, which the Medicaid Fraud Control Unit discovered through videotaped surveillance.  For example, Dr. Latella billed nine claims for services allegedly provided to nine Medicare patients, on February 2, 2018, at a nursing home, but the surveillance showed that Dr. Latella was only on site at the nursing home for a total of 14 minutes.

Dr. Latella provided the United States Attorney with fraudulent, re-created treatment notes in order to cover up his overbilling scheme.  Dr. Latella’s staff had a practice of shredding all notes for all nursing home patients immediately after billing the taxpayers for those services; at the time of the audit, therefore, Dr. Latella had no records of any of the treatment he had ever provided to patients at the nursing homes.  To re-create the notes, Dr. Latella contacted the nursing home administrators and nursing managers of various nursing homes and asked for copies of patients’ charts.  In truth, elderly residents of nursing homes did not receive the care for which taxpayers paid him, and these vulnerable nursing home residents’ family members cannot know whether and to what extent those nursing home residents received medical care from Dr. Latella over the years.

Dr. Latella was the medical director of two nursing homes at which he was billing fraudulently.  Dr. Latella also was the Hamilton County Coroner, provided services to inmates in the Hamilton County Jail and in the custody of the United States Marshal’s Service, and he also evaluated workers’ compensation claims for a major Webster City employer.

In total, Dr. Latella admitted that, between January 1, 2014, and November 30, 2018, he submitted 1,140 false claims to Medicare, which were not justified, and he was paid $107,980.59 by Medicare for those claims.  Dr. Latella also admitted that he caused Medicaid to make unjustified payments in the total amount of $9,218.73 for these claims.  As a part of his plea agreement, Dr. Latella has agreed to pay no less than $107,980.59 to Medicare and $9,218.73 to Medicaid for economic losses caused by his commission of the offense.

“Like all providers, doctors who treat Iowa’s elderly population have a duty to provide needed medical services and bill accurately for those services.  By his alleged actions, Dr. Latella scammed the healthcare system and left his elderly patients and their families wondering if the patients received care they needed,” said Peter E. Deegan, Jr., United States Attorney for the Northern District of Iowa.  “When our office’s civil investigators made an official inquiry into his billing practices, Dr. Latella tried to throw the government off the scent by lying and creating false records.  This settlement and prosecution demonstrate my office’s focus on ensuring Medicare and Medicaid beneficiaries receive the care to which they are entitled, public monies are well spent, and individuals or entities responding to my office’s civil investigative demands provide complete and truthful responses.”

“Government health care rules require bills be submitted only for services actually provided – anything more is fraudulent and a disservice to patients needing vital care,” said Curt L. Muller, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “We will continue to protect the integrity of government health care programs and taxpayers funding these vital services by holding providers fully accountable.”

The civil matter arose from an affirmative investigation. False Claims Act cases can also be brought under the qui tam provisions of the Act, which encourage whistleblowers to bring suit on behalf of the United States and share in any financial recovery.  The civil case was handled by Assistant United States Attorneys Melissa Carrington and Jacob Schunk.  The criminal case was prosecuted by Assistant United States Attorney Tim Vavricek.  The cases were investigated by the Department of Health and Human Services, Office of the Inspector General, and the Iowa Medicaid Fraud Control Unit.


The Minimum Data Set is the uniform assessment tool for nursing homes to develop a plan of care and reimbursement. Recently, the Trump Administration arbitrarily decided to remove Section G of the MDS.  Section G assesses a resident’s Functional Abilities and Limitations.  Seems kind of important, right?

The decision set for October 1, 2020 is being met with apprehension and confusion in the industry — as it could potentially result in unintended financial and administrative consequences for providers who rely on G to receive proper reimbursements.

  • How will nursing homes be reimbursed for their Medicaid residents without G in the MDS?
  • Will there be more guidance before the October 1 deadline?
  • Will this shift result in decreased Medicaid reimbursements?
  • Will there be additional administrative burdens?

Many states use the old Medicare reimbursement system — the Resource Utilization Group (RUG) model — to determine Medicaid rates, but the RUG system was phased out last October in favor of the new Patient-Driven Payment Model (PDPM). Under PDPM, operators do not assess as often. But the removal of Section G could have nursing homes feeling like they’re taking a step forward and then a step back.

Jodi Eyigor, director of nursing home quality and policy at trade group LeadingAge, confirmed there are still many questions about CMS’s announcement to take out Section G.

“It didn’t seem very clear. When you look at the actual draft, it does seem to indicate that GG will be used for all residents, regardless of payer type and regardless of their stay, but we’ve reached out to CMS to confirm that, and we haven’t received confirmation yet,” Eyigor said.

Some of the same concerns coming out now also arose when PDPM was implemented last year, she added, pointing to the questions about how the states’ reimbursement for Medicaid will be affected.

“So there were questions that came out earlier in the fall that still were not answered,” she added.


 A convicted serial killer who spent nearly 30 years behind bars walked out of a federal prison and will live in Fort Mill, S.C.  Catherine Wood worked as a nurse’s aide at the Old Alpine Manor nursing home in Michigan when she and Gwendolyn Graham, murdered five women ages 60 to 98.  It was reported that the serial killer duo even chose their victims by their last names, wanting to spell out the word murder with their initials.  All of the victims suffered from dementia or Alzheimer’s disease.

The case in 1987 made national headlines, and her victims’ families said her future neighbors in York County should be very worried. They did not mince words, saying they believe Wood may kill again.

“I feel sorry for the people who have to live around her, quite frankly,” said John Engman. His mother-in-law, Mae Mason, was one of those murdered. “I think she is a danger to society. I would certainly think they (authorities) are going to keep an eye on her — at least for two years. But after that, she can go wherever she wants.”

Wood testified that Graham suffocated the victims with washcloths and she acted as a lookout. But investigators believed Wood was more involved, and there could have been as many as a dozen victims.

Graham was serving a life sentence without the possibility of parole, but Wood walked out of a federal prison in Tallahassee, released over the objections of families of the women she helped kill, fearing she’ll kill again. She served nearly 30 years for her second-degree murder conviction.

The parole board had denied Wood’s release eight times before, finding she was a potential danger and wasn’t remorseful.

Retired Walker, Michigan Police Sgt. Roger Kaliniak, who helped investigate the murders at Alpine Manor Nursing Home in 1987, fears the 57-year-old Wood will kill again.

“She’s a serial killer and she could do it again, and most of them do,” he said. “I believe that Cathy Wood was the mastermind, she was the one that was pulling strings on Gwendolyn Graham. Gwendolyn Graham handled the dirty work and Cathy Wood was the brains behind it. ”

The South Carolina parole board said the terms of Wood’s parole will keep her away from the elderly, children and vulnerable adults. But her parole ends in June 2021.

“My fear is that she will find some old person, old people, incorporate herself into their family, take their property, take their lives and move on and do it again,” Engman said.

Graham and Wood, dubbed “The Lethal Lovers,” worked together to smother the five patients as part of a lover’s pact, according to the New York Times. It’s those salacious details that led to the case being featured on Oxygen’s “Killer Couples” in 2014. The channel provided an episode description saying, “A pair of female serial killers turn a nursing home into a hotbed of sex, scandal, and murder.”

Two years later, Graham and Woods were the inspiration behind a 2016 episode of “American Horror Story,” where two fictional nurses named Miranda and Bridget decide to kill their patients.

The case was also the basis of the 1992 true crime novel, “Forever and Five Days: The Chilling True Story of Love, Betrayal and Serial Murder in Grand Rapids Michigan” by Lowell Cauffiel.

An overview of the book reads in part, “Wood and her lover, Gwen Graham, make a pact to kill those whom they were hired to care for. No one notices when an elderly person dies a quiet death, but as these two slip deeper into their plan, the terrible secret becomes unbearable.”

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.