The Dark Truth About Nursing Homes

By Kaitlin Musante

Courtney Cargill scribbled her initials and destination (“library, etc”) on the sign-out sheet and checked out of her nursing home. Walking nearly a quarter of a mile to the nearest gas station, she purchased two items: a plastic jug and a gallon of gas. She then removed her clothes, doused her body in gasoline and lit herself on fire, surveillance footage shows.

The 57-year-old’s death four years ago sparked a nationwide conversation about the treatment of the elderly. Blaming her suicide on the lack of care at the nursing home where she was staying, South Pasadena Convalescent Hospital, her family took on nursing home mogul Shlomo Rechnitz of Brius Management Co. Inc., in a wrongful death lawsuit. The family accused him of “maximizing profits from the operation of the facility by underfunding, understaffing and undertraining the staff” with “callous indifference to the potential for injury they were inflicting upon the resident population,” according to court documents.

“She was basically treating herself,” her sister Cathy Cargill said in an interview with The Sacramento Bee. “I just think her needs hadn’t been met for so long. She just couldn’t handle it anymore I guess.”

While Rechnitz was forced to give up ownership of South Pasadena Convalescent Hospital and government regulators decertified the home, the greater problem of understaffing remains. A July report from Kaiser Health News showed that most nursing homes had fewer caretaking staff than they had reported to the government, confirming resident suspicions that staffing levels are often below the state-mandated requirements.

Even nursing homes that accurately report their staffing levels and meet these requirements still fall short of the necessary care. A study by the National Consumer Voice for Quality Long-Term Care showed that 97 percent of nursing homes don’t have enough nurses and nursing assistants to provide adequate care to avoid risk to residents. Without at least 4.1 total hours of direct care each day, residents are much more likely to be harmed. California’s minimum requirement is one of the highest in the nation at only 3.2 hours, and many states have no requirements at all.

This severe understaffing can lead to issues with food, medication and the quality of care, Executive Director of Long Term Care Ombudsman Services of Ventura County Sylvia Taylor-Stein said.

“In nursing homes, there is a very, very small labor force to draw from,” Taylor-Stein said. “That’s what creates all of these problems: there’s not enough staff, there aren’t enough certified nursing assistants, there aren’t enough people taking care of the residents. The people working in the nursing homes can be doing a fabulous job, but there’s just too many people for them to care for.”

Taylor-Stein pointed to a general lack of interest as the root of the issue, saying that the low pay and “messy” aspects of the job make it unappealing to Californians specifically.

“We have a very transient population,” Taylor-Stein said. “We are a huge state, but we also don’t have that many young people wanting to go into this field. In other parts of the country, in smaller states that don’t have as many opportunities and it’s more homegrown, there are more people willing to do this work.”

Nursing homes across the nation, however, lose potential nursing assistants to hospitals with more appealing hours and pay, contributing to the overall issue. This can take a toll on both the residents and the caregivers, Taylor-Stein said.

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Former certified nursing assistant Irvine Gonzalez said he found himself over-worked and unable to effectively care for all patients in need due to the severe lack of staffing when he started his job at an Aristacare in New Jersey.

He said that patients would sit in pools of their own urine and feces while waiting for a nursing assistant to finish with another patient, leading to severe bed sores and bacterial infections. Nursing assistants would run from room to room to keep up with the constant number of flashing call bells. He recalled instances when some dementia patients would lay in the halls after falling for hours at night, unbeknownst to him and his fellow nursing assistants busy with patients elsewhere.

“A lot of these people don’t even have family who come visit them, so aside from the nurse, no one is monitoring them,” Gonzalez said. “If the nursing assistant can’t be there, they’re going to get poor treatment.”

Gonzalez blamed this understaffing and low-quality care on the fact that most managements focus on profit rather than the safety of both the residents and staff.

“It was definitely more of a business than a caring thing, as much as they would like to make it sound like it wasn’t,” Gonzalez said. “It’s all business. If they could do the job with four instead of six or seven, they’re going to do it with less, as long as they can get by.”

However, David Gifford, Senior Vice President at the American Health Care Association, a nursing home trade group, told The New York Times that there are legitimate reasons for lower staffing levels. Weekends, for example, have fewer activities and increased family visitations, requiring less staff members, he said.

Nursing home resident Anita Medina, who wished for her location to remain undisclosed, disagreed with Gifford, saying that a lack of staffing even on weekends has led to dangerous situations in her home. She recalled a time where her roommate fell from her bed, knocking her head hard enough to require a hospital visit and a number of stitches. Yet, even when she tugged on the call rope hanging in her room, which was supposed to send a staff member running in their direction, no one came.

Medina, who said she can’t afford to leave the home due to the high costs of living elsewhere, also said that the lack of staff training at her facility has fostered an unwelcoming and hostile environment.

“[The staff are] like bullies in a school and nobody can reprimand them because they have good reasons or good excuses,” Medina said. “They talk to you like ‘stop that’ or ‘go sit down’ or ‘sit over there.’”

According to a study by the National Center for Biotechnology Information, patients in understaffed nursing homes are at a higher risk of suffering from elder abuse and a lack of personalized care, leading to a variety of health risks.

Marin County native Tracey Ayres discovered this when she checked her mother into Flagship Healthcare Center after her mother broke her femur while making the bed.

Ayres said she expected that her mother would spend about six weeks in physical therapy, healing and learning to walk again, before she was released.

Instead, her condition only worsened. As days passed by without improvement, nurses and the physician’s assistant told Ayres that her mother may never recover, Ayres said.

“In one moment, she went from being a pretty active, independent senior to someone who we were told that basically would spend the rest of their life in bed dying,” Ayres said. “We just didn’t believe that was the only alternative.”

And it wasn’t––Ayres discovered weeks later that the pins holding together her mother’s femur had come undone. Despite daily physical therapy and checkups from medical professionals, the issue went unnoticed by Flagship’s staff, Ayres said.

“The bone was as broken as the day she had hurt it,” Ayres said. “She basically lost her mind. She was out of her mind with pain, constantly, 24 hours a day. I blame Flagship for all of that. They should have gotten her in to see a doctor, they weren’t giving her proper level of care, and there weren’t enough people to adequately care for her.”

Ayres said that in order to get a nurses’ attention, she would need to stand around the computer station and interrupt, only to be told that someone else, who often never showed up, would help.

“Nobody would even look at me,” Ayres said. “I could never find anybody to answer my questions or to help with anything. If I did, it took a very long time. It seemed like nobody wanted to help or talk with me. They were way too sparsely staffed and they might be meeting requirements for state mandates, but they aren’t meeting requirements for optimal patient care.”

While Ayres was eventually able to hospitalize her mother for another surgery, improving her physical condition, she said the emotional effects of the lack of care at Flagship have stayed with her mother.

“By the time she left, she was no longer the same person,” Ayres said. “She had lived with this pain for ten weeks. When she returned to her house, the house she had lived in since 1964, it took her four months to even believe it was her house. She did not know where she was. That’s how much damage she sustained during her time at Flagship.”

She basically lost her mind. She was out of her mind with pain, constantly, 24 hours a day. I blame Flagship for all of that.
— Tracey Ayres

While the ombudsmen, who work as advocates for the elderly attempt to nip issues like these in the bud, it becomes more and more difficult the less frequently they visit, Taylor-Stein said. Due to Ventura County mandates, volunteer ombudsmen in the area visit each nursing home at least twice a week, and problems still arise almost every time, Taylor-Stein said. In Los Angeles, the ombudsmen are only required to visit facilities once a quarter.

This is not nearly enough time to effectively eliminate all potential problems, Taylor-Stein said.

“If you were in a nursing home and you saw an ombudsman only once every three months, you probably wouldn’t even know what they do and you certainly wouldn’t feel comfortable talking to them,” Taylor-Stein said. “I think a lot of our success and complaint reduction has been because our volunteers get to know the residents really well and the residents trust them and are willing to talk to them.”

In Ventura County alone, residents issued over 900 official complaints last year. Before the county issued the requirements, complaints could total over 4,000. These numbers are even higher across the state, Taylor-Stein said.

But the solution isn’t as easy as simply sending out more volunteers. While the Ventura County program is privately funded, most ombudsmen programs are run through the government and are given an extremely low budget, Taylor-Stein said.

“In the state of California, seniors are not a priority and this program is not a priority, so it makes it hard for these programs to exist and do an adequate job across the state,” Taylor-Stein said. “Without our private funding, we couldn’t do it. Our state needs to start caring.”

As far as the issue of understaffing itself, Taylor-Stein said she doesn’t see the problem resolving anytime soon unless serious changes are made to staff salaries and management systems.

In the meantime, while elders continue to suffer, Taylor-Stein stressed the importance of uniting to help.

“They don’t have a voice,” Taylor-Stein said. “When you think about someone who is 90 years old, they are bedridden, they may have debilitating arthritis, they may have heart failure, and no one in that position feels strong. So much of their power has been stripped away by their age and by their debilitating diseases, so it’s really crucial that they are able to have someone who looks out for them. We need to be their voice. ”

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