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Poor Staffing Contributed to Nursing Home COVID Deaths

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New Study Highlights Ongoing Issues with High Staff Turnover as Major Contributor to COVID Nursing Home Deaths

As almost all U.S. nursing homes are working to vaccinate residents and staff, ongoing issues impacting the care residents require are proving to be the cause behind some of the most horrendous coronavirus neglect cases and disastrous infectious disease outbreaks in history. Authors of a new study published in Health Affairs on Mar. 1 highlight the persistent problems caused by an unstable long-term care workforce as one of the significant underlying threats that contributed to the staggering death tolls of nursing home residents start of the COVID-19 pandemic. At least 172,000 deaths from the virus had been reported among either residents or employees of nursing homes and other long-term care facilities by late February. In Illinois, the number of nursing home deaths as of Mar. 5 was 9,894.

As one of the nation’s leading nursing home abuse and neglect law firms, our attorneys found the study’s comprehensive findings were both devastating, but unfortunately, not shocking.

In summary:

  • The researchers looked at turnover rates in 15,645 nursing homes across the country, including almost all of the facilities certified by the federal government.
  • Federal data of a total of 492 million shifts worked by 4.4 million staffers were reviewed.
  • S. nursing homes had a 94% staff turnover rate before the pandemic began — with even higher movement at low-rated facilities.
  • Facilities with the lowest one-star rating from the Centers for Medicare & Medicaid Services (CMS) had a median turnover of 135.3%. In comparison, the best five-star facilities had a turnover of 76.7%.
  • The researchers found the average annual rate was 128%, with some facilities experiencing turnover that exceeded 300%.
  • Disparities in pay also contributed to the differences in staffing stability. Facilities in low-income areas and those with more significant proportions covered under Medicaid – had a higher turnover.

Turnover rates were correlated with facility location, for-profit status, chain ownership, Medicaid patient census, and star ratings reported on the Nursing Home Compare website.

Lead author and health economist and assistant professor at the University of California Los Angeles Anderson School of Management, Ashvin Gandhi, told the New York Times that, “The high turnover rate likely made it harder for nursing homes to put in place strong infection controls during the pandemic, and led to the rampant spread of the coronavirus.”

Understaffing Leads to More Resident Deaths and Injuries

This study told us what we have known for some time – that the more than one million residents who live in long-term care facilities, such as nursing homes and rehabilitation centers, have been suffering from inadequate staffing – and low pay for decades and the COVID crisis only magnified the proof. Most victims that come from these understaffed homes have suffered a combination of injuries such as:

  • abandonment
  • bedsores, pressure sores, and decubitus ulcers
  • malnutrition and dehydration
  • sepsis
  • infectious diseases
  • clogged breathing tubes
  • over-prescription and medication errors
  • physical or chemical restraints
  • falls
  • financial or material exploitation
  • intimidation, humiliation, and harassment
  • physical, verbal, and emotional abuse
  • sexual assault
  • choking
  • burns
  • self-neglect
  • wandering (elopement from facilities)

Understaffing challenges also force employees to be responsible for an overwhelming number of patients with high care needs.

The Case for Publicly Disclosing High Staff Turnover Rates

The report concluded with a call by the research team for federal and state officials to consider making staff turnover a publicly disclosed nursing home quality metric.

“Recent concerns regarding the spread of COVID-19 in care facilities have heightened awareness of the possible implications of nursing staff stability for infection control, which may prove a particularly important consideration during the current pandemic and in future public health emergencies. Facilities with lower turnover rates may be better positioned to withstand challenges, such as absences because of sickness. Staff members at such facilities may also be more familiar with the infection control protocols of their facility.”

The study also showed that for-profit and chain-owned facilities saw more significant turnover, reflecting negatively on their failures to support nursing staff’s needs and the call for stricter standardization and oversight on their employees.

Delayed Staffing Enforcement Checks Soon to Return in Illinois

Risky cost-cutting measures and unethical practices create a ripple of adverse effects that nursing home residents ultimately pay for. Simply put, nursing homes need more staff, funding, supplies, and resources to support resident needs, especially in the greater Chicago area. For example, Illinois requires 2.5 hours of direct care for residents each day. Yet, in 2019 a quarter of the residents in Chicago-area facilities lived in understaffed conditions, and that number, once reported for 2020, will be far more since the pandemic began. As a result, our attorneys have worked on hundreds of cases where proper infection control protocol has become slowed or wholly ignored due to understaffing.

In 2019, state legislators passed a law that allows the Illinois Department of Public Health (IDPH) to fine nursing homes that don’t meet the required 2.5 hours of direct daily nursing care for residents. The penalties for Illinois providers that understaff their facilities began in 2020, but the state delayed those plans until mid-year due to the pandemic. Facilities typically report staffing data to IDPH quarterly, but the agency now says it will evaluate compliance after the first quarter of 2021.

Call Levin & Perconti If an Illinois Nursing Home Failure in Staffing Caused a Resident’s Injury or Death

If you suspect an understaffed nursing home facility has contributed to the decline of a loved one’s health or put them in danger during this unprecedented time, please contact us for a free consultation. Call us at 877-374-1417 or 312-332-2872 to speak with one of our experienced nursing home negligence lawyers in Illinois. You will never pay any fees unless we successfully resolve your claim.

Also read: Steven Levin Speaks with Chicago’s ABC7 About Coronavirus and Understaffed Nursing Homes

Source: High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information. Ashvin Gandhi, Huizi Yu, and David C. Grabowski, Health Affairs 2021. 40:3, 384-391 

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