Inadequate Staffing in Nursing Homes Continues

Substandard care and insufficient staffing are widespread and serious problems that have been much in the news lately.

 

The nursing home industry has complained for decades that facilities just don’t get enough money to hire more staff and that basic safety standards are too “burdensome.” But why do facilities take in new residents if they can’t – or won’t – hire sufficient staff? Why do companies buy and operate facilities if they are not committed to at least meeting (if not exceeding) the standards of care which they are paid to provide? If regulation and enforcement are really so burdensome, why do so many nursing homes have violations year after year after year?

 

In the Elder Justice Newsletter, we highlight citations, including deficiencies related to abuse, neglect and substandard care, that have been identified as not causing any resident harm. The goal of this brief newsletter is to shed light on the issue of so-called “no harm” deficiencies, which typically result in no fine or penalty. Do YOU think these deficiencies caused “no harm”?

 

If you believe that nursing homes should be held accountable for substandard care, please take a moment to visit our Action Alert Center and send a free message to your political leaders - it CAN make a difference! If you would like to join our news alert list, or have any questions, please email info@ltccc.org.

 

https://nursinghome411.org/elder-justice-no-harm-newsletter-volume-1-issue-10/ 

Assisted Living, Growing Fast, Strains to Keep Up With Safety

https://www.nytimes.com/2018/12/13/business/assisted-living-violations-dementia-alzheimers.html

Brookdale Charleston, an assisted living facility in South Carolina, settled a wrongful death claim from the estate of a resident, Bonnie Walker, who died in an alligator attack in 2016 after she wandered away from the home. Brookdale called the death an “unfortunate accident.” Credit Leigh Webber for Kaiser Health News

By Jordan Rau

·         Dec. 13, 2018

They found Bonnie Walker in a pond behind her assisted living facility in South Carolina. There were puncture wounds on her ear, her temple, her jaw and her cheeks.

Her pacemaker was inside one of the alligators that lived in the pond.

Like four in 10 residents in assisted living facilities, Ms. Walker, 90, suffered from dementia. Shortly after midnight one day in July 2016, she slipped out of her facility, Brookdale Charleston, as she had done a few days before. This time, no one noticed her missing for seven hours.

“No one should have to pass away that way,” her granddaughter Stephanie Weaver said.

Assisted living facilities were originally designed for people who were largely independent but required help bathing, eating or other daily tasks. Unlike nursing homes, the facilities generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.

Dementia care is the fastest-growing segment of assisted living. But as these residences market themselves to people with Alzheimer’s and other types of dementia, facilities across the country are straining to deliver on their promises of security and attentive care, according to a Kaiser Health News analysis of inspection records in the three most populous states.

In California, 45 percent of assisted living facilities have violated one or more state dementia regulations during the last five years. Three of the 12 most common California citations in 2017 were related to dementia care.

In Florida, one in every 11 assisted living facilities has been cited since 2013 for not meeting state rules designed to prevent residents from wandering away.

And in Texas, nearly a quarter of the facilities that accept residents with Alzheimer’s have violated one or more state rules related to dementia care, such as tailoring a plan for each resident upon admission or ensuring that staff members have completed special training, according to nearly six years of records.

“There is a belief in our office that many facilities do not staff to the level” necessary to meet the unanticipated “needs of residents, especially medical needs,” said Fred Steele, Oregon’s long-term-care ombudsman. “Many of these are for-profit entities. They are setting staffing ratios that maybe aren’t being set because of the care needs of the residents but are more about the bottom line of their profits.”

Uneven Regulation

These concerns, though particularly acute for people with dementia, apply to all assisted living residents. They are older and frailer than assisted living residents were a generation ago. Within a year, one in five has a fall, one in eight has an emergency room visit and one in 12 has an overnight hospital stay, according to the Centers for Disease Control and Prevention. Half are over 85.

“Assisted living was created to be an alternative to nursing homes, but if you walk into some of the big assisted living facilities, they sure feel like a nursing home,” said Doug Pace, director for mission partnerships with the Alzheimer’s Association.

Yet the rules for assisted living remain looser than for nursing homes. The federal government does not license or oversee assisted living facilities, and states set minimal rules.

The government does not publish quality measures as it does for nursing homes. Inspections usually are less frequent, and fines are generally far lower than what a nursing home might incur for a similar mistake.

Lindsay Schwartz, an associate vice president at the National Center for Assisted Living, an industry group, said facilities must balance safety with allowing people with dementia to move about as freely as possible and to socialize.

“Dementia is a difficult disease,” she said. “Freedom of movement is incredibly important for overall health, mind, body and spirit. You can’t keep people in isolation.”

The industry says rigid government regulations don’t mesh with the individual approaches that assisted living facilities aspire to create for residents.

But residents’ families, their lawyers and advocates say the violent behavior of agitated residents and escapes could be avoided with better training and more staff. Eliza Cantwell, a Charleston plaintiffs’ lawyer, said too many facilities were accepting residents they weren’t prepared to adequately care for because they wanted to maximize their income.

“They don’t have the qualified personnel to take care of these people, and they’re taking care of them anyway,” she said.

Ms. Cantwell is representing Ms. Weaver in a suit against Brookdale for emotional distress, which Ms. Weaver says came from being one of the first people to find her grandmother’s body. Brookdale has already settled a wrongful-death claim from Ms. Walker’s estate.

The company declined to discuss Ms. Weaver’s lawsuit and said in a statement that “our everyday focus and priority is to keep residents safe.” Brookdale called Ms. Walker’s death “an unfortunate accident” and said it had retrained its staff.

A year after Ms. Walker’s death, after four inspections, the South Carolina Department of Health and Environmental Control fined Brookdale for 11 violations, including not properly performing night checks and letting staffing drop below required levels. The penalty: $6,400.

“I worked as a law enforcement agent for the Department of Natural Resources, and I’ve written wildlife tickets larger than what D.H.E.C. did,” Ms. Weaver said. “This was nothing.”

‘Get Him Away From Me’

Nearly a quarter of the nation’s 30,000 assisted living facilities either house only people with dementia or have special areas known as memory care units. These wings have locked doors and other safeguards to prevent residents from leaving. The facilities often train staff members in techniques to manage behavior related to these diseases and provide activities to keep the residents engaged and stimulated.

These units usually are more expensive, with monthly costs averaging $6,472, compared with $4,835 for regular assisted living, according to a survey by the National Investment Center for Seniors Housing & Care, a group that analyzes elder care market trends. Senior housing investors earned nearly 15 percent annual returns over the last five years, higher than for apartment, hotel, office and retail properties, according to the center. Beth Burnham Mace, chief economist at the center, said memory care unit construction was outpacing all other types of senior housing.

Aggressive behavior, a hallmark of dementia, is a major problem in assisted living facilities. One national study, published in 2016, found that 8 percent of assisted living residents were physically aggressive or abusive toward residents or staff.

In the dementia unit of the Point at Rockridge, an assisted living facility in Oakland, Calif., a resident identified in court papers as Ian began to follow another resident, Olivia Deloney, an 88-year-old with dementia. Before retiring, she had been dean of students at a school for the blind.

“That man is crazy,” one employee recalled Ms. Deloney saying, according to the employee’s sworn statement. “Get him away from me.”

In September 2015, Ian grabbed Ms. Deloney and threw her to the ground, breaking her right hip, a video shows. When paramedics were putting her into a stretcher, Ian tried to kick her, and the emergency workers had to keep him away, the police report said.

Afterward, the administrators told Ms. Deloney’s daughter, Simone Stevens, that they had not known that Ian, a retired university facilities engineer, was dangerous, her lawsuit said.

“They just made it sound like it was like a freak accident: ‘He’s really just a calm and likable resident,’” Ms. Stevens said in an interview.

A state investigation report said the Point had been trying to address his behavioral problems before the attack. State regulators declined to punish the Point, saying in their report that there was “insufficient” evidence that the facility had “clear knowledge” Ian would be a danger to other residents.

But when Ms. Stevens sued the Point, her lawyer, Felicia Curran, discovered that Ian’s agitated behavior, including pushing and shoving, had been the reason his wife initially placed him there. At the Point, he had punched one aide in the shoulders, grabbed another by the neck and jumped on a third and beaten her, employees said in statements taken by Ms. Curran.

“It was an everyday thing for him to chase staff and be physically aggressive,” one declared. Aides posted a photo of him in their kitchen, warning colleagues to watch out for his violent outbursts, and at one point, employees locked themselves in bathrooms for protection, according to records in the case.

“They should have never had him there in the first place,” Ms. Stevens said.

Tracee DeGrande, the president of Integral Senior Living, which owns the Point, wrote in a statement that the episode was not typical. “Our staff associates work hard to care for residents, many of whom would have nowhere to go if we didn’t provide a place for those living with dementia and Alzheimer’s disease,” she wrote.

After the attack, the Point evicted Ian. Ms. Deloney returned to the facility, but, less stable after surgery, she fell and broke her hip again. She stopped eating and died that December, according to her family’s lawsuit, which blamed the Point for not increasing supervision in light of Ms. Deloney’s weakened state.

The Point paid $1.9 million to settle the case. Ms. DeGrande wrote that the “settlement was in no way an admission of responsibility for what ended up as a difficult and sad situation.”

North Carolina requires one of the tightest staffing ratios in the nation for dementia units: one worker for every eight residents during the day and evening.

In a lawsuit, Michele Mullen asserted that Franklin Manor Assisted Living in Youngsville, N.C., did not meet North Carolina’s staffing minimums on a third of the days her mother, Claire Murphy, lived there in 2015 and 2016.

She said she would find her mother with her pants wet with urine all the way down to her knees, according to a deposition she gave in the lawsuit. Ms. Mullen said aides had repeatedly misplaced her mother’s walker. She would see her mother holding on to the hallway railing as she tried to get to her room. On New Year’s Day in 2016, her mother fell and was hospitalized for a fractured arm.

Gregory Nicoluzakis, the general counsel for Saber Healthcare Group, which owns Franklin Manor, said in an email Wednesday that Ms. Mullen’s allegations were inaccurate. “We believe it is telling that Ms. Mullen admitted her mother to our facilities on three separate occasions despite having the choice of other providers,” he wrote.

Drew Hathaway, a lawyer for Ms. Mullen, said there were no better alternatives nearby that had memory care units. “There are not that many facilities in these rural areas,” Mr. Hathaway said. “That’s the sad reality.”

Franklin Manor was fined in 2016 for not following doctors’ orders that two residents needed to use walkers. In February, the state cited it for not supervising five residents, all with histories of falling, who had fallen and injured themselves. Mr. Nicoluzakis said Franklin Manor was in compliance with state regulations.

Ms. Mullen ultimately removed her mother from Franklin Manor; Ms. Murphy died last December.

“I would say, ‘Mom needs to go to the bathroom.’ ‘Mom needs help with this,’” Ms. Mullen recalled in her deposition. “And they would look at me and actually say, ‘Why don’t you do it?’”

 

This article was produced in collaboration with Kaiser Health News, an editorially Independent program of the Kaiser Family Foundation. The author is a reporter for Kaiser Health News.

Inadequate and Dangerously Low Staffing Issues in Nursing Homes

December 11, 2018 - Staffing is perhaps the most important factor in a nursing home resident’s quality of care and ability to live with dignity. Unfortunately, inadequate staffing is a widespread and persistent problem. In fact, the federal government has recently indicated serious concerns about inadequate staffing, especially on nights and weekends, and ordered states to conduct more inspections on weekends to crackdown on this problem.

While some nursing homes provide sufficient levels of qualified care staff, in the absence of limits on profits or administrative expenses, too many nursing homes fail to allocate funds to maintain sufficient staffing.  Thus, the ability to find out about the staffing levels in individual nursing homes is critical.

Today, LTCCC announces the publication of the latest, user-friendly data on the staff assigned to provide resident care, select non-nursing staff, and facilities’ use of contract staff to provide resident care. This information can help the public, news media, and policymakers identify and assess the extent to which nursing homes in their communities are providing sufficient staffing to meet basic clinical and quality of life needs. The data are for the 2nd quarter of 2018, the most recent period reported by the federal Centers for Medicare & Medicaid Services (CMS).

Visitors to our website, www.nursinghome411.org, can download easy-to-use charts for every state that include (for each facility in the state in compliance with the reporting requirement):

1. The facility’s direct care RN, LPN, and CNA staffing;
2. The ratios of care staff to residents;
3. Select non-nursing staff hours per day, including administrators, social workers, and activities staff;
4. The extent to which the facility relies on contract staff to provide resident care.

To facilitate ease of use, the individual state files are easily sortable. For example, a state file can be sorted to identify which facilities have the highest reported levels of RN care and which have the lowest.

A few facts about the reported data:

• US nursing homes provide an average of 3.5 total care staff hours per resident per day. A 2001 landmark federal study indicated that at least 4.1 hours is needed to meet a typical resident’s needs.
• US nursing homes provide an average of .5 RN care staff hours per resident per day. The 2001 federal study indicated that a minimum of 10 – 50% more is needed to meet a typical resident’s clinical needs.
• US nursing homes provide an average of .2 hours activities staff time and .1 hours of social work staff time per resident per day. LTCCC believes that lower activities staff time may contribute to social isolation and impact a resident’s psychosocial well-being.

On December 18, LTCCC will be hosting a free webinar, Staffing: How to Find Out About Staffing in Your Facility & What it Means for Your Resident’s Care & Quality of Life. The invitation is available at https://nursinghome411.org/upcoming-webinars-nursing-home-care-resident-centered-advocacy/.

Long Term Care Community Coalition
www.nursinghome411.org
One Penn Plaza, Suite 6252
New York, NY 10119
United States

Worst Corporate Conduct of 2018

The American Association for Justice today released a new report, Worst Corporate Conduct of 2018.

 

The report examines recent examples of corporate misconduct that negatively affect many of your clients, including:

• Navient’s predatory student lending practices;
• Energy companies’ denial of their role in perpetuating climate change;
• State Farm’s attempt to rig the justice system to avoid accountability;
• General Motors’s and Takata’s slow response in replacing potentially lethal airbags;
• Theranos’s deception of patients and investors with a product that didn’t work;
• Nestlé’s refusal to eliminate child slave labor from its supply chain; and,
• USA Gymnastics’s and Michigan State University’s failure to protect athletes from a sexual predator.

In addition to analyzing these instances of corporate misconduct, the report delves into the art of the corporate apology. Companies spend millions of dollars trying to figure out the best way to say sorry for the harm they caused without facing consequences for their actions. In fact, many of the companies highlighted in Worst Corporate Conduct of 2017 were leaders in saying sorry in 2018. But when corporate apologies are not enough to change behavior, civil justice allows citizens, consumers, employees, and investors to hold corporations accountable when they cause harm and deter future misconduct.

Drugs and Advertising

When Do Drug and Healthcare Ads Push Ethical Boundaries? You’d be right if you suspect that drug makers are spending A LOT more on TV advertising. Pharmaceutical companies have more than doubled ad spending in just the past four years, making it the second-fastest growing ad category in the nation. Other healthcare providers – from local hospitals to nationally known cancer treatment centers – are also upping the advertising ante. But when do healthcare promotions cross ethical boundaries and the ancient pledge to all patients of  “do no harm”? You should know!

 

BY THE NUMBERS 1 in 20 One in 20 Google searches are health-related and the first place consumers turn for answers, 57 percent versus 32 percent who start with a doctor.	VIDEO BOOKMARK 10 Questions You Should Ask Your Doctor Parsing fact from hype starts with good doctor-patient communication. Doctor Mike shares the questions he would ask in this video.
THE DOCKET ·         SEE OUR NEWSLETTER IN ACTION ·         FEATURES AND BENEFITS ·         BROWSE PAST ISSUES ·         SIGN UP NOW ·         CONTACT US	POSITIVE BUT PAINFUL ADS Some patients say healthcare ads that feature happy, healed people and miraculous recoveries spread false hope.

 

Under-Enforcement and Rollbacks: Children Die at a Nursing Home

Following is a joint statement issued by the Long Term Care Community Coalition and the Center for Medicare Advocacy.  The statement is available at https://nursinghome411.org/ltccc-comments.  

Under the Trump Administration, the Centers for Medicare & Medicaid Services (CMS) has been advancing “burden” reduction measures in nursing homes. The focus of these measures is to reduce both minimum safety standards for resident care and financial penalties when those minimum standards are violated. This rollback builds on the long and, too often, significant under-enforcement of standards necessary to protect residents from harm.

Perhaps nowhere is this more evident than in the tragic events that recently unfolded in a nursing home in New Jersey, where (as of the publication date) 11 children died from an outbreak of the adenovirus. The unnecessary and heart-breaking deaths at the Wanaque Center might have been prevented if the standards of care had been properly enforced after earlier citations.

Inspection reports indicate that the nursing home had previously been cited numerous times for not meeting infection control standards. In 2016, the nursing home was cited for failing “to demonstrate proper infection control techniques during medication pass . . . .” In 2017, the nursing home was cited for failing “to ensure infection control practices were followed.” In 2018, the nursing home was cited for failing “to follow proper infection control procedures during medication pass and for the care of a urinary catheter.” All of these violations were cited as not causing “actual harm” or “immediate jeopardy” to any residents. Despite these repeated violations, Medicare’s Nursing Home Compare indicates that the nursing home has not received “any fines in the last 3 years.”

This unfortunate pattern is repeated every day in communities across the country. According to CMS, 95 percent of all health violations in nursing homes are cited as causing “no harm” to the resident. As our examinations of “no harm” deficiencies indicate, too often these classifications do not, in fact, accurately reflect the pain, suffering, and humiliation that residents may have experienced as a result of a facility’s violation. The failure to identify resident harm when it occurs means that nursing homes are not held fully accountable for failing to meet minimum standards of care and safety. This lack of accountability is due to the fact that nursing homes rarely face financial penalties when deficiencies are cited as causing “no harm.”

The under-enforcement of the nursing home standards is at odds with the duties of both CMS and the state agencies charged with protecting residents. By law, the HHS Secretary is required to assure “that requirements which govern the provision of care . . . and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents . . . .” The recent deaths of children in New Jersey sadly demonstrate that this essential mandate is not being realized.

Our organizations call on CMS and the states to properly enforce the nursing home standards of care and cease efforts to rollback resident rights and protections. Nursing home residents will remain in danger until there is proper enforcement of the quality of care and quality of life standards.