Articles Posted in Staffing Issues

nursing home neglect

Payroll Records Indicate Nursing Home Staffing Shortages Create Serious Gaps in Patient Care

Only recently did the Centers for Medicare & Medicaid Services (CMS) begin collecting and reviewing daily payroll records from more than 14,000 nursing homes. The publishing of the data became required by the Affordable Care Act of 2010. Kaiser Health News recently analyzed the submissions and caught that most U.S. nursing homes have been operating grossly understaffed and reporting a false review of average employee shifts. Kaiser claims these nursing homes had:

  • Significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends when personnel cared for nearly twice as many residents as normal.

The Elder Justice Coalition is reacting to a July 7th New York Times article that outlined just how extensively nursing homes have hidden low staffing numbers. The advocacy group is calling for an immediate congressional review of staffing practices within nursing homes.

Actual Payroll Data Reveals Staffing Crisis

The article, investigated and published in collaboration with Kaiser Health News, was based off a review of payroll hours submitted to the Centers for Medicare and Medicaid Services (CMS).  The actual hours made news not only because they show a serious crisis in terms of resident to staff ratios, but also because up until recently, nursing homes had supplied their own staffing data to CMS. With the new payroll-based submission process, nursing homes have no ability to fudge numbers.

“We can no longer choose between caring for your family and our own, and so, we have decided to stand together as part of what will be the largest strike of nursing home workers in the history of our country.” 

            -Services Employees International Union (SEIU) statement on nursing home employee strike

In a move to influence contract negotiations between SEIU Healthcare Illinois and Illinois Association of Healthcare Facilities (who represents 53 Chicago-area nursing homes that use SEIU members for staffing), 5,000 SEIU members are planning to strike. The two main issues at hand are low pay and low staffing numbers, creating an industry of underpaid and over-utilized nursing home employees who feel they must work excessive amounts of overtime in order to maintain a living wage.

A new trend has emerged in several states including Pennsylvania & New Mexico: Attorneys General partnering with private law firms to sue large nursing home chains for negligent care, Medicare/Medicaid fraud, and deceptive marketing tactics. An article in a December edition of Reading Eagle, a Reading, PA newspaper, puts a spotlight on this growing movement to improve the quality of care received at nursing homes in all states. In Pennsylvania alone, Attorney General Bruce Beemer has filed 3 lawsuits (one of which has since settled) against 3 of Pennsylvania’s largest nursing home chains in the past year and a half. The case versus Reliant Senior Care (now Priority Healthcare Group) settled for a reported $2 million and was the largest nursing home settlement in PA won by an attorney general. The other two chains who are still locked in a legal battle against the state are Golden Living Centers and Grane Health Care.

Sending a Message

Nursing home industry advocates are obviously unnerved by partnerships between attorneys general and private law practices who have a history of success in helping right the injustices caused by big business on the American people. While these advocates argue that private law firms are giving donations to campaigns for attorneys general to essentially guarantee they’ll be called upon for future work, the law does not seem to be on their side. The State of Pennsylvania was unsuccessfully sued by the nursing home industry for such practices.  Elderly advocates believe working relationships between public and private legal entities will send a message to the industry that American taxpayers expect more from facilities receiving Medicare & Medicaid tax dollars.

A Casper, Wyoming nursing home with a history of negligent care, cost-centered staffing practices, and hazardous living conditions just settled a lawsuit with a blind resident who was hit by a facility-owned, staff-driven minivan while waiting for a ride. Although the man survived the accident, he now deals with pain and numbness from an incident that could have been prevented by greater supervision and improved employee training.

Repeat Offender

Between January 2014 and 2016, Poplar Living Center was cited 90 times by Centers for Medicare & Medicaid Services (CMS) for a multitude of violations, some so egregious that they twice lost federal funding. Most of the complaints made by CMS against Poplar Living Center are common themes heard about many nursing facilities: Not enough staff to handle high resident volumes, inadequate staff training, rundown infrastructure, and negligent care.

Pressure sores (also known as pressure ulcers or bed sores) are far too common injuries that affect residents of nursing homes that do not receive proper care. Essentially, these injuries are breakdowns of the skin, which usually develop on “bony prominences” in the body–like the heel or lower back. Wherever pressure is placed on the skin from bones for prolonged periods of time, these sores can develop. Expectedly, immobile seniors who may spend significant times in bed are at heightened risk of having skin breakdowns as a result of laying without repositioning for so long.

Fortunately, steps can be taken by caregivers to avoid those injuries. Ensuring movement, repositioning, cleansing, and similar steps can make all the differences. Failures in this regard continue to occur, however. When pressure sores do develop, they can occur along a range of seriousness, usually referred to as the four “stages” of pressure ulcers.

A Stage 1 pressure sores is one where the skin itself has not been broken, but instead appears reddened and raw. The skin is often firmer than those around it. A Stage 2 pressure sore is where the skin itself breaks away leaving an open wound. It often looks like a blister on the skin that goes through several layers. Some fluid may be visible in a Stage 2 sore, and in some case there may be permanent skin death.

Fairness is at the heart of the civil justice system. If an individual (or their family) is hurt by misconduct then it is only fair that they receive help to compensate for the harm. But it goes beyond redress. A desire to prevent future injuries is also a crucial component of the civil law, including in nursing home neglect cases. By holding wrongdoers accountable and forcing them to pay for the consequences of their errors, then there is a natural incentive to work to prevent an accident before it actually causes harm.

That is why when families mention that they are coming forward to ensure a similar accident does not happen to another family, they are not merely using a stock phrase–they really mean it.

The accountability found in the civil justice system is on top of state and federal regulatory systems. The one benefit of regulators is that they are able to inspect facilities and demand changes at any time safety is an issue. This may work to prevent harm before even a single accident occurs.

Our Chicago nursing home neglect attorneys were not surprised to learn of a study by researchers at the University of Iowa, reported on by Reuters, which found that black residents of long-term care facilities are more likely to suffer from pressure sores. The difference in care is not a result of nursing homes providing better quality care for white residents, but rather that residents were more likely to develop pressure sores in nursing homes where a majority of the residents are black. Like many types of nursing home abuse or neglect, this could be a result of understaffing or fewer resources.

The study also found that residents in predominantly black nursing homes were at least 30 percent more likely to suffer from bed sores that those in facilities with a small population of black residents. These disparities echo an investigation by the Chicago Reporter from 2009 that revealed that Chicago nursing homes where the majority of the population was African-American had much lower CMS quality ratings than facilities where the majority of residents are white. Their investigation also revealed that Illinois had the most poorly-rated African-American nursing homes in the country.

Our Chicago nursing home lawyers are all too familiar with this epidemic, having represented hundreds of families in lawsuits involving bed sores caused by nursing home negligence. Nursing home residents have a high risk for these wounds because many of them are elderly, and often wheelchair bound or bed ridden. Bed sores develop when pressure builds in an area of the body and restricts blood flow, leading to necrosis. This can be aggravated by body moisture from sweating or incontinence. Common areas for pressure sores include a person’s heels, tailbone, elbows, and shoulders. In order to prevent pressure sores from forming, nursing homes need to employ sufficient staff who can spend time examining each resident’s skin condition and also turning and repositioning residents to redistribute weight. Other preventative measures include pressure relieving mattresses, wheelchair pads and heel protectors.

All across the country, nursing homes are being run with less than the optimum number of staff. They are being understaffed in a hope to cut costs and increase profits. When nursing homes fail to properly staff their facilities, the chance of accidents and mistakes greatly increases. State and Federal laws set a minimum standard that nursing homes must comply with. The problems arise when facilities choose to ignore these government regulations.

People choose to go to nursing homes not because they want to, but because they are at a point in their lives where they need more care and attention than can otherwise be provdided to them. Many nursing home residents have been finding out that the nursing homes promise to provide them the care and treatment they need is often a fabrication. The nursing homes that choose to understaff their facilities have been rewarded with large profits by failing to provide the required number of nursing hours and as a result, patients of these homes have not received adequate care.

Some problems that can occur when a facility is understaffed are falls, pressure sores, dehydration and malnutrition, all of which stem from an overall lack of quality care and attention. It is easy to blame the staff of the nursing home when problems arise, but in reality the staff is often doing the best it can with the resources it is provided. If there are not enough staff members to provide supervision for the residents who are at risk for falls then it is likely a resident will fall, and it is no stretch of the imagination to assume that if there are not enough staff members to turn and reposition residents who are at risk for the development of pressure sores, that a resident will eventually develop pressure sores.

The nursing home lawyers at Levin & Perconti have handled all types of abuse and neglect lawsuits against Alden nursing homes throughout Illinois for many years. Today’s Chicago Tribune tells the story of at least thirteen children in the Chicago area who fell victim to abuse and neglect at Alden Village North, a nursing home located at 7464 N. Sheridan Road in Chicago.

The Tribune’s article exposes the sad truth that abuse and neglect not only happens to the elderly living in Illinois nursing homes, but also to younger residents who require ongoing medical treatment that they cannot receive at home. Parents and family members place their trust with nursing home staff to care for their loved ones, but unfortunately neglect and abuse occur, often due to negligent hiring and short-staffing. One of the victims in the Tribune article was just two years old when he died of asphyxiation because staff at the facility failed to properly monitor his tracheotomy tube for over 3.5 hours. The child had a habit of playing with the tube but staff did nothing to prevent this behavior and did not notify his physician of his actions.

In another sad case, a nine-year-old boy who suffered from severe cognitive deficits died due to nursing home neglect. Staff failed to properly care for his g-tube, failed to notice a change in his condition and failed to communicate these changes to his doctor. As a result, he died from bowel obstruction and an infection at a local hospital.
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