Indiana Has A Serious Problem With Nursing Home Understaffing

Many Indiana nursing homes understaffed

Associated Press

March 8, 2010

INDIANAPOLIS ”” Many of Indiana’s nursing homes employ fewer critical staff members than are needed to care for often-frail residents ”” and staffing levels are particularly low at the state’s for-profit nursing homes, a newspaper has found.

The Indianapolis Star reported Sunday that Indiana has among the nation’s highest percentages of for-profit chain nursing homes. And those for-profit homes dominate the ranks of the state’s most poorly performing homes ”” 35 out of 52.

The Star reviewed thousands of pages of nursing home documents and analyzed data compiled by regulators and provided by the industry. Its investigation found a system that tolerates nursing homes that skimp on quality to maintain profits.

It found that pay and benefits are low, especially in for-profit homes, for the grueling work of caring for elderly and other frail residents, and positions often sit empty.

In some cases, the result has been a lack of care, including the case of a South Bend nursing home where staff failed to keep a cut on a woman’s leg clean and it became so infected it had to be amputated. The woman later died from the infection.

The Star’s report comes after federal officials in August identified the state as having the most poor-quality nursing homes of any state in the U.S.

The Star said its investigation revealed the root cause of the state’s ranking: That the most critical caregivers are more scarce in Indiana nursing homes than anywhere else.

Indiana ranks 51st ”” lower than every other state and the District of Columbia ”” in the amount of time certified nursing assistants spend with residents. The number of hours registered nurses spend with residents ranks only slightly better and the Star said that profit appears to play a key role in the disparity.

“Overall, those statistics tell me that we’re in an acute state of crisis here, and this absolutely needs to be an emergency call to action,” said Robyn Grant of the state advocacy group United Senior Action. “Enough is enough. We can’t wait.”

Indiana’s nursing home industry ranges from homes owned by chains, some with CEOs that earn millions of dollars a year, to nonprofit homes operated by the Little Sisters of the Poor.

Certified nursing assistants are nursing homes’ front-line caregivers, the ones who help residents into wheelchairs, take them to the bathroom and generally watch over them.

The Star found understaffing is the norm in many Indiana homes where, on average, CNAs spend just less than 15 hours a week with each resident. The national average is 17 hours a week.

Residents get 1.27 hours less a week with CNAs in for-profit homes than in the state’s other homes ”” mainly nonprofits. And at for-profit homes that are part of regional or national chains, that difference is even greater ”” 1.55 hours.

Last year’s U.S. Government Accountability Office report named 580 U.S. nursing homes as the “most poorly performing,” with 52 of those in Indiana ”” about 10 percent of Indiana’s total number of nursing homes.

The GAO report concentrated on violations found by inspectors, but that report isn’t the only indicator of trouble.

The average number of violations state health inspectors found per facility increased 71 percent from 2003 to 2008, according to a November national analysis led by Charlene Harrington, a University of California researcher who is one of the nation’s top experts in the field of long-term care.

The national average rose by 8 percent during that time.

During the same period, the percentage of Indiana homes cited for problems that placed residents in jeopardy or resulted in actual harm grew from 32 percent to 45 percent.

Nationwide in 2008, only a quarter of all homes were cited for such severe problems.

There are about 40,000 Hoosiers in the state’s nursing homes ”” with taxpayers picking up the tab for about two-thirds of them at an annual cost of $1 billion. Both numbers are predicted to explode as aging baby boomers become infirm.

State officials hope changes to the Medicaid reimbursement plan in January will encourage nursing homes to improve, but the head of the state’s Medicaid oversight commission is still concerned.

“We’ve got to do something about it,” said state Rep. Bill Crawford, D-Indianapolis, who plans to bring up the quality issue when the commission meets this summer.

Nursing home industry officials acknowledge that many Indiana facilities struggle to maintain staffing and provide high-quality care, but they say operators face many challenges, including government reimbursement rates that are inadequate to cover costs.

They also say operators have stepped up efforts to improve quality.

“It (the GAO report) was telling us what we already suspected and what we were already dealing with,” said Robert Decker, president of the nursing home industry group Hoosier Owners & Providers for the Elderly.