Attorney General’s Hidden Camera Investigation Leads to Arrests

Two days ago, Attorney General Eric Schneiderman announced that another hidden camera investigation has resulted in the arrests of nursing home employees. Two certified nurses’ aides, who worked at Erie County Medical Center Skilled Nursing Facility (also known as Terrace View Long Term Care Facility), were arrested and charged with “Falsifying Business Records in the First Degree (class E felony), Endangering the Welfare of an Incompetent or Physically Disabled Person (class A misdemeanor) and Willful Violation of Public Health Laws (unclassified misdemeanor).”

According to video footage, the CNAs, Donna Laury and Nakeia Green, allegedly neglected to follow a 79-year-old resident’s personal care plan, “failing to use two people when performing incontinence care and failing to use a mechanical lift to transfer the resident.” The employees are accused of falsifying documents to cover up their alleged neglect.

Due to Alzheimer’s disease, dementia and the inability to get around on her own, the 79-year-old resident relies on nursing staff to assist with daily activities. Many nursing home residents are in similar situations, where their well-being depends on the care of others. While many residents do receive the care they need, there are many instances, including this one, where caretakers are neglectful or abusive, and do not provide proper care. What is it about the culture of a facility that lends itself to this type of behavior?  And is it evidence of a systemic problem?

Magician, Mat Franco, Wins America’s Got Talent

I am very pleased to learn that a magician, Mat Franco, won America’s Got Talent (a variety talent competition) on September 17, 2014. Magic is something that is best seen live, which makes his win all the more impressive. You may be wondering why I am blogging about a magician on a blog devoted to advocating for the elderly in long-term care facilities. Magic, both performing and watching, is a passion of mine. I have often thought about donating my time to perform in nursing homes. I intend to do that this winter with my wife, Christine, who is a balloon twister. I am curious to find out how those with cognitive deficits react to magic. We could all use a little mystery and wonder in our lives, regardless of age.

When selecting a nursing home, it is important to make sure there are many activities for residents, especially for those with dementia. You want to ensure that your loved one has access to activities in which they can participate and enjoy. A social worker can assist you in determining what activities are best.

Do Staffing Levels Affect Quality of Care?

Back in January of 2006, the Office of the Attorney General released a report titled “Staffing Levels in New York Nursing Home: Important Information for Making Choices.” This report, although dated, has some interesting information regarding nursing home staffing levels in New York State, as well as recommendations to consider when searching for a nursing home.

While there are multiple factors that determine the quality of care in a nursing home, staffing levels are an important one. The number of hours of care provided to a resident and quality of care show “a strong relationship.” In New York State, staffing levels in a nursing home are usually measured in “the average number of hours of daily care that staff members provide each resident of the home.” This measurement is commonly referred to as “hours per resident day,” and is “calculated by adding up the total number of hours worked by the nursing staff and dividing it by the number of resident-days during the reporting period.”

A study done by the Centers for Medicare and Medicaid Services (CMS) found that quality of care declined once staffing levels fell below three separate thresholds. Once the amount of care provided by Registered Nurses (RNs) fell below 0.75 hours per resident day (45 minutes), quality of care declined. If RNs and Licensed Practical Nurses (LPNs) together provided less than 1.3 hours per resident day (1 hour, 18 minutes), the quality of care suffered. In addition, quality of care started to decline when Certified Nursing Assistants (CNAs) provided less than 2.8 hours per resident day (2 hours, 48 minutes). These thresholds mean that any nursing home in New York must provide at least 4 hours and 6 minutes of total nursing care, for the quality of care not to suffer.

The level of care provided to residents also should take into account specific needs of residents. If residents have special needs, they may need additional care and a nursing home may need to employ additional staff. Additional care may be required when residents are pediatric, have suffered traumatic brain injuries, have AIDS, are on ventilators, are on respite care, or have behavioral needs. With any of these cases, additional care is necessary, and nursing homes must ensure that their staff can provide the necessary and proper care.

When considering which nursing home you or a loved one should choose, keep in mind that staffing levels are only numbers. The Office of the Attorney General also recommended prospective residents and their loved ones:

  • Visit the home and look around
  • Learn about the management and staff, including the level of turnover
  • Speak with caregivers
  • Speak with others who have experience with nursing homes, including knowledgeable professionals

These recommendations should be part of any nursing home decision.

What Does a Five-Star Rating Really Mean?

The New York Times placed Medicare’s nursing home rating system front and center in a recent, in depth article, by Katie Thomas, and a recent editorial . In the past, I have written about Medicare’s rating system, pertaining to New York State nursing homes. While The Times article mentions nursing homes in New York, it focuses on nursing homes in California, specifically Rosewood Post-Acute Rehab, which has a five-star rating despite having over 100 consumer complaints and around a dozen lawsuits filed against it.

Nursing home ratings, like Rosewood’s, cannot be taken at face value because much of the data behind them is self-reported and can be changed or misreported by facilities’ employees. The ratings are determined by three criteria, staff levels, quality statistics and health inspections. The Times editorial acknowledges that staff levels and quality statistics “are reported by the nursing homes and accepted at face value by Medicare without verification.” If this data is not authenticated by Medicare, facilities can easily get away with manipulating it for their benefit.

The data from annual health inspections, while not self-reported, can be manipulated, as well. Nursing homes often know when inspections will occur, and increase staff hours during the inspection, only to decrease them once the inspection was complete. The administrator of Medford Multicare Center for Living, a facility in New York, described the inspection period as “our Super Bowl.” The current rating system seems to shift the focus and effort of nursing home staff and administrators to obtaining high ratings, and away from providing consistent, quality care.

In an attempt to rectify part of the problem, the Affordable Care Act “requires Medicare to use payroll data to verify the accuracy of staff levels.” However, the agency, “still working on the verification system,” has not yet put this requirement into effect.

Even though the rating system is imperfect, Katie Thomas writes that, starting this year, Medicare plans to use a comparable system for hospitals, dialysis centers and home-health-care agencies. While the five-star rating system makes it easy for families and loved ones to compare facilities, these recent stories show that the data behind the ratings are not always accurate. When deciding on a nursing home, be sure to look beyond the ratings. They do not always represent the true quality of care.