Articles Posted in Staffing

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Over the last six years, complaints against Ventura County nursing homes are up almost twentyfold despite a California law that pumped nearly $900 million of Medi-Cal money into nursing homes throughout California. Remarkably, just prior to receiving the additional funds, Ventura County ombudsmen filed only 10 complaints against local nursing facilities, yet over a the period of July 2009 to May 2010 the same ombudsmen filed 194 complaints.

“The numbers show that (the law) did not do what it was supposed to do: increase the quality of care for residents in nursing homes,” Sylvia Taylor Stein, executive director of the Long Term Care Services of Ventura County ombudsman program, told the Ventura County Star. “They were given a checkbook with no oversight.”

By way of example, Oxnard’s Shoreline Care Center received $877,356.00 in additional Medi-Cal funding from 2004 to 2008, but records show that the facility actually provided less nursing hours per patient per day than it did prior to the funding increase. It’s not surprising that the nursing home took in $4.1 million in profits after the law was passed.

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Closing arguments began in what is now one of the longest trials in Humboldt County history involving allegations of neglect at 21 nursing homes owned by Skilled Healthcare. Michael Thamer, a lawyer dedicated to defending the rights of nursing home residents, will argue that Skilled Healthcare, because of deliberate decisions to keep nursing home staff at the lowest possible numbers, repeatedly exposed its residents to substandard care, including the failure to regularly bathe its patients, allowing residents to lie in soiled bed sheets for hours, and failing to treat bed sores.

”In my opinion, they (staff members) are set up to fail before they even start,” Thamer told the court.

Under California law, nursing must provide at least 3.2 hours of nursing care per resident, per day. These hourly requirements apply to direct patient care, and must be performed by registered nurses, licensed vocational nurses and certified nursing assistants. According to the plaintiff, Skilled Healthcare totally failed in this regard, and regularly understaffed its facilities for financial gain.

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California Watch is out with a disturbing report alleging that California nursing homes that received more than $880 million in additional taxpayer funds under a law designed to boost care, took the money did the opposite by cutting staff and wages. [“Nursing homes received millions while cutting staff, wages“] In its investigation, California Watch found 232 California nursing homes that either cut staffing, or paid lower wages to workers after receiving money from the state.

It appears that many of the nursing homes investigated used the state money to improve their financial health, not the health of its residents, and those that cut the most staff had, not surprisingly, more deficiencies issued by state inspectors than those facilities that did not cut staff.

“There was an implicit good faith agreement that things would get better … and that was broken,” state Sen. Elaine Alquist, D-Santa Clara, told California Watch. “It was broken for the people of California and for a very vulnerable population – those that need the greatest care and those that can’t advocate for themselves.”

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In their ongoing investigation into California nursing, Tracy Weber and Charles Ornstein of ProPublica are out with an article on temporary nursing agencies being a haven for unfit nurses. Temp nursing agencies are used frequently by local hospitals and nursing homes to fill nursing positions that have been vacated for some reason; usually for day or two, but sometimes open-ended.

In its investigation, ProPublica found numerous instances in which the agencies, desperate to find certified nurses, failed to perform background checks or ignored warnings from hospitals about weak nurses in order to fill nursing orders. It is a profitable undertaking; the temporary nursing industry is a $4 billion industry.

Some of the other ProPublica findings were startling:

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At the end of last week, a Medicare rate adjustment that cuts $16 billion in nursing home funding went into effect. That cut, combined with state cuts, is creating conditions that are likely to put nursing homes in a state of crisis. In fact, the president of the American Health Care Association is predicting the nursing facilities will close their doors.

Already numerous nursing homes have closed their doors because of money problems, and many others have reduced staffing, creating conditions for substandard care. The crisis could not come a worse time, as baby boomers steamroll toward retirement and the need for skilled nursing care. Just last year U.S. nursing homes housed 1.85 million people, about 100,000 more than the previous year.

In Griswold, Conn., the community’s only nursing home shut down earlier this year because of rising costs and an inability to pay for $4.9 million in needed renovations for the 90-bed facility.”A 92-year-old woman was screaming and crying as she was loaded into the ambulance, saying ‘This is my home,'” Griswold First Selectman Philip Anthony said. His 88-year-old mother was a resident of the same home at the time.

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Researchers analyzing 82 different studies on nursing home care found that nursing homes that are run as not-for-profit businesses offer better care than their for-profit counterparts. In the United States, less that one-third of all nursing homes are non-profit.

The 82 studies were from both the U.S. and Canada, and were completed between 1965 and 1983. Of the studies, 40 showed that non-profit nursing homes provided much better care than for-profits, while only three of the studies found that for-profit nursing homes provided better care. The remainder had mixed findings.

Importantly, the study suggested that non-profit nursing facilities did better in four important quality measures: higher quality staffing, lower rates of pressure ulcers and bed sores, less use of physical restraints, and fewer deficiencies cited by government regulators. Staffing issues, bed sores, and government investigations represent by far the basis for most of the nursing home abuse and neglect litigation in this law firm.

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In increasing numbers, young and middle-aged mentally ill patients are being housed with older people in nursing homes. It has proved to be a dangerous practice for older residents. The younger, stronger, mentally-disturbed residents have lashed out at the older, frailer residents who often are defenseless against the attacks. Sons and daughters of the elderly victims of attacks are left wondering why their loved ones were not protected better.

In the past seven years, there has been a 41 percent increase in the number of mentally ill patients housed in nursing homes, which as led to a correlated increase in peer-on-peer physical abuse. The reasons for the increase are multi-fold, including the fact that states have failed to provide adequate facilities for the mentally ill. It is also financially advantageous to house the mentally ill and the elderly together. But while it may make financial sense, it puts the elderly at risk and inadequate measures have been taken to protect the elderly.

Under state and federal law, nursing home residents are guaranteed freedom from physical abuse. At Walton Law Firm LLP, we have represented victims of violent attacks in nursing homes. These attacks are often a result of negligence on the part of the facility including a failure to provide adequate staffing. If you have questions about the care of your loved one in a nursing home, please contact Walton Law Firm LLP for a free and confidential consultation.

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The New York Times is reporting this morning that 90% of all nursing homes were cited for violations of federal health and safety standards. Approximately 17% of U.S. nursing homes had deficiencies that caused actual harm. As mentioned in this blog previously, nursing facilities that operate “for-profit” were more likely to have problems than non-profit homes.

Federal inspectors received 37,150 complaints in 2007 about nursing home conditions, the bulk of which involved bed sores, abuse and neglect of residents, medication errors, and nutritional issues. Failure to sufficiently staff was noted as a particular concern in the report, including the allegation that nursing homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Not surprisingly, researchers learned that elderly patients receive better care at homes with a higher ratio of nursing staff members to patients.

The U.S. has approximately 15,000 nursing homes, housing nearly 2 million people. Under the laws of most states, including California, these homes are inspected once a year.

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I recently attended a nursing conference where the central theme was elder abuse and neglect. One of the presenters was Charlene Harrington, Ph.D. of UCSF, a professor of nursing and sociology, who is considered an expert on nursing home staffing.

According to Harrington the nursing home staffing picture in California isn’t pretty. She said that there are over 12 million deficiencies in U.S. nursing homes annually, and stated that approximately one-quarter to one-third of all nursing homes provide substandard care.

According to Harrington, sufficient staffing is the number one indicator of the quality of care one can expect to receive in a nursing home. California requires that a licensed skill nursing facility provide at a minimum of 3.2 hours of nursing, per patient, per day. While this is a minimum standard, most California facilities view it as the threshold, striving only to meet it. In fact, RN care has been declining in California, which now has one of the lowest RN per patient, per day ratios in the country.

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