CW: Neglect & Death
In August, The Texas Attorney General announced a lawsuit against the federal government to stop a law that requires minimum staffing standards in nursing homes across the country. The rule, proposed last year by the US Department of Health and Human Services (HHS) and finalized earlier this year by the White House, requires any skilled nursing facility receiving federal funding to provide a certain number of hours of care to each patient every day. It also required that these facilities have a registered nurse on-site at all times.
Attorney General Ken Paxton says the staffing rule violates the Major Questions Doctrine, which states that when a government agency seeks to act on or decide a major national issue, it must do so with clear congressional authorization. The lawsuit alleges the rule exceeds the authority of the Centers for Medicare & Medicaid Services (CMS), in addition to “inflicting enormous costs, requiring the hiring of tens of thousands of registered nurses and nurse aids who do not exist, and shutting down many long-term care facilities.”
“This power grab by Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” said Attorney General Paxton. “We are taking the federal government to court over this rule that could worsen rural care shortages by shutting down facilities due to new hiring quotas that are impossible to fill.”
The worries are similar to those expressed by a coalition of US politicians earlier this year, when they introduced legislation to block the staffing rule.
Other lawmakers, including Texas Congressman Lloyd Doggett, have backed the rule and even advocated for it to be strengthened. Organizations that advocate for the elderly, such as American Association of Retired Persons hailed the rule “long overdue.” “Far too many residents and families have experienced tragic consequences because of poorly staffed facilities,” said Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer for AARP.
Thousands of stories poured in from across the country regarding the conditions in nursing homes. At one facility, a resident purchased a bullhorn with a siren in order to get the staff’s attention. The resident had frequently been left sitting in his own feces.
In another instance, a nurse working the day shift found a patient choking on vomitus and seizing. The previous night, there had been one nurse and one CNA on duty. They were expected to provide care to more than 100 residents.
Understaffing can also lead to injuries or death. Tragically, more than 2,000 people have wandered away from assisted-living and long- term care facilities or been left alone outside since 2018 according to The Washington Post. Approximately 100 of those people have died.
One of those people who died was 83-year-old Ki Soon Hyun She walked out of Mt. Hood Senior Living on Christmas Eve of 2023. On Christmas Day, police officers who were searching the neighboring woods found her body.
Hyun had been a resident of Mt. Hood Senior Living for less than 24 hours before she wandered away. Hyun’s family says Mt. Hood Senior Living did not notify them that she had gone missing. Nor did they contact authorities until hours later.
In Arizona, Robert John Pollmann had lived in a nursing home for less than two weeks before disappearing. On June 23rd, he disappeared. The temperature was in the triple digits. Two days later Pollmann was found dead in a desert wash.
For people like Pollmann, the weather was the only difference between life and death. In cases where a cause of death could be determined, the Washington Post found that 61% died from exposure to extreme temperatures. Others died after wandering into ditches, drowning in nearby bodies of water.
These incidents “shouldn’t happen” says Elizabeth Halifax. Halifax is a professor at the University of California San Francisco and president-elect of a national advocacy group for long-term care residents. Unfortunately, elopements do occur. “It’s because there’s insufficient staffing,” Halifax told Lucas Manfield, a Willamette Week healthcare reporter. According to a national industry survey, 86% of nursing facilities report being moderately or severely understaffed.
Since the beginning of the COVID-19 pandemic, nursing homes have lost more than 200,000 employees. The nursing home workforce is experiencing a shortage of employees not seen since 1994 according to the American Health Care Association and National Center for Assisted Living.
Working in long-term care can be difficult. Some jobs often don’t pay well, provide limited training, and cause a high rate of injury.
For example, certified nursing assistants are a crucial member of the staff in long term care facilities. According to The Bureau of Labor Statistics, certified nursing assistants were paid an average of just $18.33 an hour in 2023. CNAs assist people with activities of daily living including eating, bathing, and toileting.
CNAs are also at risk of workplace injury. A 2012 study from RTI International found that 60.2% of CNAs had been injured at work. Injuries varied from cuts and back injuries to black eyes and human bites, and were caused by a number of factors, including lifting, bathing, and handling residents, resident hostility, and accidents involving medical equipment.
High patient to staff ratios also impact care. According to KFF, despite the general increase in the acuity levels of nursing home residents, the average number of hours of nursing care received per day in nursing homes has decreased by 9% since 2015. In 2015, the average number of hours of nursing care received was 4.13. By last year, that number had dropped to just 3.77 hours per day.
Nursing homes are entrusted with the care of some of the most vulnerable Americans. Understaffing leads to unnecessary suffering and deaths. People’s lives are at risk without proper care, and employees deserve better working conditions. This crisis will only affect more people as the years go by, and it needs to be addressed.
Sources:
Carlesso, Jenna, and David Altimari. “CT Nursing Home Residents, Workers Want More Staff, Transparency.” CT Mirror, CT Mirror, 16 Feb. 2023, ctmirror.org/2023/02/16/ct-nursing-home-bill-staff-shortage/.
Chidambaram, Priya, and Alice Burns . “A Look at Nursing Facility Characteristics between 2015 and 2023.” KFF, KFF, 5 Jan. 2024, http://www.kff.org/medicaid/issue-brief/a-look-at-nursing-facility-characteristics/.
Dake, Lauren. “Family of Woman Who Died near Sandy Memory Care Facility Sues State, Facility for $10 Million.” OPB, NPR, 18 Apr. 2024, http://www.opb.org/article/2024/04/17/senior-elder-memory-dementia-care-sandy-oregon-ki-soon-hyun-mt-hood/?outputType=amp.
“Nursing Assistants and Orderlies.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 29 Aug. 2024, http://www.bls.gov/ooh/healthcare/nursing-assistants.htm.
Manfield , Lucas. “Residents of Nursing Homes Keep Wandering Away-and It’s Because the Facilities Aren’t Following State Law.” Willamette Week, City of Roses Newspapers, 28 Aug. 2024, http://www.wweek.com/news/2024/08/28/residents-of-nursing-homes-keep-wandering-awayand-its-because-the-facilities-arent-following-state-law/.
Rowland, Christopher, et al. “Dozens of Assisted-Living Residents Died after Wandering Away Unnoticed.” The Washington Post, WP Company, 17 Dec. 2023, http://www.washingtonpost.com/business/interactive/2023/assisted-living-wander-patient-deaths/.
Rau, Jordan. “Biden Administration Sets Higher Staffing Mandates. Most Nursing Homes Don’t Meet Them.” KFF Health News, KFF , 25 Apr. 2024, kffhealthnews.org/news/article/nursing-home-staffing-federal-mandates-biden-cms/.
Ryman, Anne. “Seniors Are Wandering Away from Arizona Care Facilities and Dying in the Heat.” ABC15 , The E.W. Scripps Company, 9 Sept. 2024, http://www.abc15.com/news/local-news/investigations/seniors-are-wandering-away-from-arizona-care-facilities-and-dying-in-the-heat.
Travis, Avery. “Texas Attorney General Ken Paxton Sues Biden Administration over Nursing Home Staffing Rule.” KXAN , Nexstar Media Group, 16 Aug. 2024, http://www.kxan.com/investigations/texas-attorney-general-ken-paxton-sues-biden-administration-over-nursing-home-staffing-rule/amp/.