Neglect From Unsafe Staffing

A recent article discussed John Pernorio, a Heritage Hills nursing home resident, who repeatedly “mashed” the call button at his bedside. Pernorio injured his spine in a fall on the job and
was unable to walk. Pernorio’s antibiotics made him need to use the restroom more frequently, but he was unable to go on his own without assistance. After the aide finally responded to his bedside alarm, he had been lying in his soiled briefs for hours.

This was not the first time this had happened. Pernorio said it was “degrading” and “I spent 21 hours a day in bed.”

According to the payroll records, during Pernorio’s stay at Heritage Hills, daily staffing levels were 25% below the minimum under state law despite the nursing home saying they provide high-quality care to all residents. The unsafe shortage of nurses and aides in the nearly 15,000 facilities is “at the root” of many disturbing shortfalls in care for millions of Americans who live in them; this includes the nation’s most vulnerable people.

Residents are allowed to develop festering pressure injuries because they are not turned properly. They lie in their feces as no one attends to them. Additionally, they are subject to devastating falls because no one helps them get around. They are given chemical and physical restraints to sedate and pacify them.

States like California, Florida, Massachusetts, New York, and Rhode Island have sought to improve nursing home quality by mandating the highest minimum hours of care per resident. These states also show how sometimes a state mandate does not guarantee better staffing. Instead, many facilities operate with fewer workers than are required without permission from regulators. There are usually no consequences for these actions.

The Biden Administration worked to implement safe staffing levels. Federal rules issued in April require 4 out of 5 homes to boost staffing. This plan has minor flaws, for example, the underfunded health inspectors for enforcement. Serious health violations have become more widespread since the pandemic, and after sweeping through nursing homes, 170,000 residents were killed and drove employees out the door.

Another issue is still on the rise: pay remains so low. The average turnover in nursing homes is extraordinarily high: Federal records show that half of employees leave their jobs each year. The most passionate nurses and aides are burnt out in these understaffed homes as they are “stretched too thin to provide the quality care they believe residents deserve.”

Shirley Lomba, a Providence, Rhode Island medication aide, said, “It was impossible.”

Much of the for-profit nursing home industry argues that staffing problems directly result from low reimbursement rates by Medicaid, the program funded by states and the federal government that covers most people in the nursing home. Based on court evidence and additional research, owners, and investors often extract and pocket the hefty profits that could be used for care.

Chair of the Health Policy Department at Vanderbilt University School of Medicine, David Stevenson, said, “Staffing is the most important part of providing high-quality nursing home care.”

Pernorio, president of Rhode Island Alliance for Retired Americans, said, “From the minute the ambulance took me in there, it was downhill.”

After waiting an hour, Pernorio would telephone the facility’s main office; a nurse would answer the call and turn off his light, then leave again. Although
Pernorio praised some workers for their dedication and efforts, others frequently did not show up for their shifts. Staff members allegedly told him they could earn more “flipping hamburgers at McDonald’s than they could cleaning soiled patients in a nursing home.”