{"id":40879,"date":"2020-06-10T15:21:22","date_gmt":"2020-06-10T15:21:22","guid":{"rendered":"https:\/\/virusreports.net\/special-report-pandemic-exposes-systemic-staffing-problems-at-u-s-nursing-homes\/"},"modified":"2020-06-10T15:21:22","modified_gmt":"2020-06-10T15:21:22","slug":"special-report-pandemic-exposes-systemic-staffing-problems-at-u-s-nursing-homes","status":"publish","type":"post","link":"https:\/\/virusreports.net\/special-report-pandemic-exposes-systemic-staffing-problems-at-u-s-nursing-homes\/","title":{"rendered":"Special Report: Pandemic exposes systemic staffing problems at U.S. nursing homes"},"content":{"rendered":"
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(Reuters) – One night in April, as coronavirus swept through the Hammonton Center for Rehabilitation and Healthcare, Robyn Esaw, a double amputee, signaled for help with her bedpan. She said she hit the bedside button that turns on a red hallway light. None of the few remaining staff showed up – and one of them turned the light off. Esaw only got help, eventually, by wheeling herself to the nursing station and yelling. <\/p>\n

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National Guard soldiers walk in a group outside of the Hammonton Center for Rehabilitation and Healthcare one of numerous nursing homes to have staffing shortages during the national outbreak of the coronavirus disease (COVID-19) in Hammonton, New Jersey, U.S., May 19, 2020. REUTERS\/Lucas Jackson<\/span><\/p>\n<\/figcaption><\/div>\n<\/div>\n

On another night in another room of the New Jersey home, Barbara Grimes noticed her roommate sitting in a puddle of urine, which seeped into a wound on her tailbone. No one checked on the roommate for three hours. The woman, Grimes said, had given up on calling for help. <\/p>\n

That same month, Hammonton staffers moved David Paul and another man into a room last occupied by two residents infected with the coronavirus, one of whom later died of COVID-19. The floors were still dirty, the bathroom littered with trash, Paul said. Paul and the other man, he said, soon tested positive themselves, and his roommate died. In all, the Hammonton outbreak resulted in 238 infections and 39 deaths, state data shows. <\/p>\n

\u201cYou cannot live here and really believe that these people care about you,\u201d said Esaw, 70, who has lived in the home for nine years and knows Grimes and Paul well. <\/p>\n

Nursing homes worldwide, filled with elderly residents who are particularly vulnerable to COVID-19, have suffered a harrowing toll in the pandemic.\u00a0 <\/p>\n

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Special Report<\/span>In shielding its hospitals from COVID-19, Britain left many of the weakest exposed<\/span><\/p>\n<\/div>\n<\/div>\n

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In the United States, longstanding problems with staffing shortages and chronic turnover have left nursing homes especially exposed. An estimated 40% of the country\u2019s more than 100,000 COVID-19 deaths are connected to long-term care facilities such as nursing homes or assisted-living centers, according to a Kaiser Family Foundation tally. <\/p>\n

About a quarter of nursing homes responding to a recent federal survey reported shortages of direct-care staff during at least one of the last two weeks in May, according to a Reuters analysis of survey data from the Centers for Medicare and Medicaid Services. <\/p>\n

A separate Reuters analysis of federal nursing home data shows that, before the virus hit, about four in 10 homes nationwide would not have met the minimum staffing regulations in California, which has among the highest standards in a nation where some states have few or no requirements for nursing staff levels. About 70% of U.S. nursing homes would fail to meet a stricter staffing standard advocated by some experts, the analysis showed. <\/p>\n

The coronavirus pandemic has laid bare and deepened these historical staffing problems, according to interviews with nearly two dozen nursing home workers and residents nationwide. Nursing home staffers are quitting in large numbers, these workers said, because of illness fears and what they described as a slipshod emergency response by management. <\/p>\n

As outbreaks hit homes nationwide, administrators often sought to downplay the danger, 17 workers at eight homes run by eight different companies told Reuters. Managers hid the severity of outbreaks, the workers said, in part because they were desperate to retain staff who were scared and disillusioned with poor working conditions and pay as low as $11 per hour. Some managers pressured sick or infected workers to show up, said five workers at four facilities. <\/p>\n

At Hammonton Center, overworked nursing assistants have regularly had to bathe, clean and feed as many as 30 residents by themselves, far more than usual. Staffing on two occasions was so thin that nursing assistants found residents who had been dead for several hours in rooms no one had time to check, two Hammonton employees said. <\/p>\n

Centers Health Care, which runs the facility, declined to comment on most accounts of residents and workers cited in this report. It denied any lapse of care at the home. The company disputed the contention that residents were not discovered for hours after they died. <\/p>\n

Reports of overwhelmed staff extend far beyond Hammonton. At Life Care Center of Nashoba Valley in Littleton, Massachusetts, so many staff had quit or called in sick that managers left a teenage nursing-assistant trainee on a shift caring for nearly 30 dementia patients, said a current worker and a former worker. Part way through the shift, one more nursing assistant was assigned to help her in response to staff complaints, the workers said. <\/p>\n

The vast majority of more than 40 nurses and nursing assistants at the Life Care home have quit since April, six current and former workers told Reuters. Twenty-six people died, according to federal data, including a nursing assistant. The outbreak caused 87 confirmed infections, the data show. <\/p>\n

The rapid staff exodus left residents without the most basic care, the workers said. \u201cThese are people who all need to be changed. They\u2019re incontinent. A lot of them need help eating,\u201d said Lisa Harmon, a nurse who supervises weekend shifts. \u201cThere\u2019s only so much one person can do.\u201d <\/p>\n

Tim Killian, a spokesman for the home\u2019s owner, Life Care Centers of America Inc – one of the nation\u2019s largest operators – acknowledged that a large portion of the Massachusetts home\u2019s staff quit under \u201cextremely challenging\u201d conditions. He said facility leaders could not recall a teenager being assigned to care for dementia patients alone. <\/p>\n

Echoing other industry advocates, Killian said nursing homes have generally reacted well to an unprecedented challenge, despite little government help. The U.S. government has taken heavy criticism for being slow to react to nationwide shortages of protective gear and testing kits. <\/p>\n

\u201cIt\u2019s just ridiculous to think that nursing homes, absent direct and substantial government support, could manage a global pandemic,\u201d Killian said. <\/p>\n

\u2018HIDING IT FROM US\u2019 <\/h3>\n

Staffing had long been a problem at the Massachusetts Life Care home, with nursing assistants often caring for too many residents, workers said. The shortages became a crisis in the outbreak, they said, as management failed to provide protective gear or to communicate how the virus was spreading. <\/p>\n

In March, veteran nursing assistant Patti Galvan noticed residents getting fevers and coughing. She brought her own mask, but a manager told her not to wear it, saying it wouldn\u2019t prevent infection. Other workers said management told them to remove masks they brought from home because they would cause other workers to ask for protective equipment the facility could not provide. <\/p>\n

Killian acknowledged protective-gear shortages, which created \u201ctension\u201d between management and workers, but said administrators were powerless to solve nationwide supply problems. <\/p>\n

Staffers started getting sick and staying home, but managers \u201cweren\u2019t taking it seriously,\u201d said Galvan. <\/p>\n

\u201cThey were just hiding it from us,\u201d said Galvan, who left more than two months ago after getting flu-like symptoms and has no plans to return. \u201cIf they were honest with us, and were more caring and more responsible, they wouldn\u2019t have lost us all.\u201d <\/p>\n

Galvan had worked at the facility for three decades. <\/p>\n

Amy Lamontagne, the facility\u2019s executive director, said management never withheld information. \u201cThere was no secret-keeping,\u201d she said. <\/p>\n

Killian said management couldn\u2019t inform staff about coronavirus infections until it had confirmed test results or, when testing wasn\u2019t available, a formal diagnosis from a nearby hospital. <\/p>\n

Colleen Lelievre, a nurse who still works at the facility, said testing wasn\u2019t needed to recognize the unusual number of residents with COVID-19 symptoms in March. But management, she said, never leveled with the staff about why so many residents were being hospitalized. <\/p>\n

As more workers quit or called in sick, those who remained regularly worked 80- to 90-hour weeks, said Harmon, the weekend nursing supervisor. Physical- and occupational-therapy assistants filled in for nursing assistants. <\/p>\n

The depleted staff couldn\u2019t bathe and feed every resident, workers said. In a dementia unit, workers were unable to keep residents from wandering into hallways and other patients\u2019 rooms, potentially spreading infection. Staff had no time to sit with dying residents, said Harmon, who sometimes left her phone with them so they could call relatives in their final hours. <\/p>\n

Despite these conditions, the facility reported no staff shortages in response to the government\u2019s nursing-home survey. Killian said the facility had no shortages in late May because the number of residents had declined to the point where the home was \u201cfully staffed\u201d with many fewer workers. Lamontagne said the 120-bed facility now has 65 residents. <\/p>\n

Overall, 192 of Life Care\u2019s more than 200 nursing homes responded to the federal survey, and about 29% of those reported staff shortages, according to the Reuters analysis. <\/p>\n

Harmon and Lelievre said the Massachusetts home still has far fewer staff than it needs. The facility has very few nursing assistants, Lelievre said on Saturday, making it nearly impossible for staff to safely move some residents out of their beds, which often requires two people. <\/p>\n

Lamontagne, the executive director, had a different take: \u201cWe\u2019re doing fine with our staffing,\u201d she said. <\/p>\n

Several workers questioned why the facility wasn\u2019t more prepared, since its owner had, weeks before, managed the site of one of the first major U.S. outbreaks, at the Life Care facility in Kirkland, Washington \u2013 with 45 deaths linked to the home, according to local public health authorities. <\/p>\n

\u201cThey didn\u2019t have any plan,\u201d said John De Mesa, a nursing assistant who said he contracted the virus in March. <\/p>\n

Killian said the gap between the Washington and Massachusetts outbreaks gave the company little time to act on lessons learned. <\/p>\n

In late March and early April – as many Life Care residents were hospitalized – the Massachusetts National Guard came to the home to administer tests. Administrators brought in corporate staff and workers from a nearby Life Care facility to give the appearance of a fully staffed home around the time of the Guard visit, Harmon and Lelievre said. Most of the added staff left within a week, they said. <\/p>\n

Killian dismissed the contention that the extra staff were deployed for appearances, saying all staffing decisions aim to improve care. <\/p>\n

The home told workers they could not get tested along with residents, staffers said. The state at the time, in early April, was restricting testing in nursing homes to residents only. <\/p>\n

After workers complained about the lack of testing, management sent a text message to the staff on April 5. <\/p>\n

\u201cWe encourage you to direct any questions or concerns about your health to your personal physician,\u201d read the message, which was reviewed by Reuters. <\/p>\n

Some workers sought out their own testing. Life Care did not test workers until mid-May, Harmon and Lelievre said. Staff had to bill their insurers for the tests, they said. Those with no insurance had to pay upfront and seek reimbursement from Life Care. <\/p>\n

Thirty-four workers at the facility had tested positive by the end of May, according to federal data. Those who became ill with COVID-19 were not paid for their time away, Harmon and Lelievre said. Killian said sick workers could use accrued paid time off. <\/p>\n

HISTORY OF STAFFING PROBLEMS <\/h3>\n

Insufficient staffing and frequent turnover have caused quality-of-care problems at nursing homes for decades, studies and government inquiries have shown. <\/p>\n

Most nursing-home revenue comes from Medicaid and Medicare, the federal health programs for the poor and elderly. The fixed payments, some researchers say, incentivize companies operating on thin margins to cut staffing to the bone. Industry lobbyists have long sought higher reimbursements, which they argue haven\u2019t kept pace with costs. <\/p>\n

The American Health Care Association, an industry trade group, testified before Congress twice last year and requested help in attracting workers. Since the pandemic hit, the group has asked state officials for help recruiting nurses from less-impacted regions, as New York City hospitals did. \u201cJust like hospitals, we called for help,\u201d the group said in a statement. <\/p>\n

\u201cIn our case, nobody listened for months.\u201d <\/p>\n

The federal government conducted its nursing home survey last month to seek data on staff and equipment shortages during the pandemic. At least 3,200 nursing homes – 23% of the 13,600 facilities that submitted data – reported staffing shortages in late May, according to the Reuters analysis. About 2,000 facilities did not respond to the survey. <\/p>\n

U.S. regulators set few standards for nursing-home staffing, requiring only the presence of a registered nurse for one eight-hour shift and a licensed nurse, with a lower-level credential, in the building at all times. <\/p>\n

At least two-thirds of states, including California, set minimum-staffing standards for nursing care, though the requirements vary widely and often contain loopholes. Some, including Indiana and Virginia, have no minimum standards for direct-care nursing staff. <\/p>\n

California requires its 1,200 nursing homes to provide 3.5 hours of daily direct care, part of a 2017 law setting some of the highest standards nationally. If applied nationwide, about 37% of nursing homes would fail to meet that requirement, according to the Reuters analysis, which examined federal data on staffing during the last quarter of 2019 for nearly 15,000 nursing homes. <\/p>\n

About a third of California homes don\u2019t meet the state\u2019s own staffing standards because regulators last year granted them exemptions from requirements for overall staffing or for certain positions. The state said it granted some waivers because of workforce shortages. <\/p>\n

Annual turnover of nursing staff at homes in California – among the few states that track that data – has increased from 44% in 2014 to 53% in 2018. <\/p>\n

Some researchers believe California\u2019s requirements don\u2019t go far enough. Charlene Harrington – a nursing professor emerita at University of California, San Francisco, who has studied nursing-home staffing shortages – advocates for 4.1 hours of per-patient direct care. She cites a 2001 federal study that concluded quality of care can decline below that level. At least 70% of nursing homes nationwide would fail to meet that higher bar, the Reuters analysis shows. <\/p>\n

Some scholars and industry advocates blame staffing problems on systemic weaknesses in U.S. nursing-home funding. <\/p>\n

\u201cNo one wants to pay the taxes for them, even though they\u2019re all of our grannies, or mothers,\u201d said Vincent Mor, a professor at Brown University\u2019s school of public health, who has studied nursing home quality and staffing. <\/p>\n

Some experts blame nursing home owners, mostly for-profit companies, for skimping on staff to make more money. Harrington, the UCSF nursing professor, called industry complaints about government funding \u201cnonsense,\u201d arguing that major companies would leave the business if it were unprofitable. <\/p>\n

IN THE DARK <\/h3>\n

When outbreaks hit, some nursing home managers pressured sick workers to show up unless they had a positive coronavirus test, or to return to work before the recommended self-quarantine period, five workers at four facilities said. <\/p>\n

Nursing assistant Gabby Niziolek, 20, said she started feeling sick in late March during a shift at Plaza Healthcare and Rehabilitation Center in Elizabeth, New Jersey. Some co-workers had started feeling ill, she said, and she noticed residents losing their appetite and turning a pallid color. <\/p>\n

When she asked to leave, her manager told her to finish her shift, Niziolek said. The next day, after she got tested, she said she was told to return to work while awaiting results. When the results came back positive, Niziolek\u2019s boss asked if she was showing symptoms. She said she was, and stayed home. <\/p>\n

\u201cIf you\u2019re positive and you don\u2019t have symptoms, they still want you to work,\u201d Niziolek said. <\/p>\n

Plaza Healthcare and Rehabilitation Center did not respond to requests for comment. <\/p>\n

Residents and staff at New Jersey\u2019s Hammonton Center were kept in the dark for weeks about the extent of the facility\u2019s outbreak, said three residents and six staffers. <\/p>\n

As illness spread in late March, managers told workers that the sudden jump in residents with fevers, appetite loss and shortness of breath stemmed from cases of \u201caspiration pneumonia,\u201d a condition that usually isn\u2019t caused by an infectious disease. Weeks later, managers said that residents who had been hospitalized tested positive for the coronavirus. <\/p>\n

Workers weren\u2019t informed at the start of shifts that they would be working on hallways filled with residents believed to be infected, staffers said. <\/p>\n

Home operator Centers Health Care said it couldn\u2019t be sure that symptomatic residents had the virus until testing became more widely available in April. <\/p>\n

A nursing assistant who was among the first to test positive for the virus said she reported the diagnosis to her supervisor and told several co-workers, as her doctor had advised. Five days later, when she was at home sick, a manager called to chastise her for telling co-workers, she said. <\/p>\n

Centers Health Care said in a statement that its staff are \u201cworking tirelessly around the clock.\u201d The company said staffing shortages are an industry-wide issue, but that it has ensured it meets state minimum staffing requirements during the pandemic by redeploying staff as needed within its network of facilities. The company declined to detail its staffing levels. <\/p>\n

Hammonton nurses and aides said that about half of the facility\u2019s direct-care staff have left, and that the facility replaced some with workers from temporary staffing agencies. <\/p>\n

Hammonton Center reported some staff shortages to the government, as did about half of the 38 Centers Health Care homes that responded to the survey, according to the Reuters analysis of the data. <\/p>\n

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Grimes, who has lived at Hammonton for six years, said she started noticing that her roommate had a \u201chorrible cough\u201d that kept getting worse. She told nurses about the condition, and her roommate was hospitalized in April. The woman later died, but Grimes said staff never told her the cause. <\/p>\n

Grimes said she got moved to a separate wing for those who had not contracted the virus – but staff never explained, she said, whether her roommate had tested positive. Last month, after getting a second test, Grimes learned she was positive, though she said she only had a slight fever. <\/p>\n

\u201cWe don\u2019t know when somebody gets sick; we have to sniff it out like a bloodhound,\u201d she said. \u201cYou can only guess what happened when that person is getting carried out on a gurney.\u201d <\/p>\n

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Reporting by Chris Kirkham and Benjamin Lesser; Editing by Janet Roberts and Brian Thevenot<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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(Reuters) – One night in April, as coronavirus swept through the Hammonton Center for Rehabilitation and Healthcare, Robyn Esaw, a double amputee, signaled for help with her bedpan. She said she hit the bedside button that turns on a red hallway light. 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