A flood of overtime for nurses at county nursing homes

Dennis Biondo, Executive Director

A veteran nursing assistant, whose job would include bathing, feeding and dressing nursing-home residents, worked an average of 80 hours a week for nearly the entire year at the Allegheny County-owned Kane Regional Centers.

For a licensed practical nurse, giving medications and tending to the wounds of 30 or more residents would be common. Does that get trickier near the end of a 12- to 16-hour shift, a norm for many of the LPNs employed by Kane?

Charged with considering a resident’s entire medical history during care, one registered nurse worked the equivalent of about 90 eight-hour overtime shifts in both 2012 and 2013.

That's just a slice of about 125,000 hours of overtime worked by the nursing staff of the four Kane nursing homes in each of those two years, according to county salary data analyzed by PublicSource.

Kane doesn’t limit overtime worked by its employees, according to Executive Director Dennis Biondo. That includes nursing staff on the front lines of caring for Kane’s 940 elderly and disabled residents, the vast majority of whom are low income and supported by Medicaid.

Nursing-home industry experts said that, while frequent overtime is common in the field, it has the potential to compromise the quality of care, leaving fatigued caregivers in situations that could have serious consequences.

“Presumably they’re not at their optimal best having to work that much,” said Joe Angelelli, a gerontologist and assistant professor at Robert Morris University. “It leads to conflict and errors, even injuries.”

The Institute of Medicine recommended that states block nursing staff from working more than 12 hours in a 24-hour period and more than 60 hours in a week “to reduce error-producing fatigue,” according to a handbook written in 2008.

The book cites studies that say extended work shifts and frequent overtime are “associated with difficulties staying awake on duty, reduced sleep times, and nearly triple the risk of making an error.”

Three of the four Kane nursing homes have below average ratings on the national five-star rating system, Nursing Home Compare. But there is no direct evidence that the use of overtime at the Kane centers has led to any specific errors or incidents.

“I haven’t seen that as being a problem,” Biondo said. “Do folks make mistakes? Yeah. But I don’t see that when someone makes a mistake it’s because they just worked a double shift.”

Allegheny County Controller Chelsa Wagner said recently there’s been an over-reliance on overtime in county government.

“The consistent overtime shows that you are running the operation with fewer resources than is appropriate,” she said.

The Kane Regional Centers — located in Pittsburgh, McKeesport and Ross and Scott townships — had more overtime costs than any other county department, but they also have the highest number of employees, with more than 1,000 working full-time.

Allegheny County Executive Rich Fitzgerald and County Manager William McKain declined to comment on the PublicSource findings. Fitzgerald is responsible for the administration of all county departments and McKain supervises the departments, according to the county’s home rule charter.

County spokeswoman Amie Downs said in an email statement: “Costs at all of our facilities in the county are constantly being monitored and measured by the county manager and his staff, and he will continue to do so moving forward.”

Downs declined to speak to the issue of how overtime might affect quality of care at Kane.

Kane employees earned about $6.4 million in overtime pay in both 2012 and 2013, according to county salary figures. But its not clear that hiring more workers would be cheaper than paying overtime.

To cover the overtime hours worked by nursing assistants alone, the county could hire about 45 full-time workers. That would cost roughly $2.3 million, slightly less than they spent in overtime.

The Kane staff also earned $3.34 million in overtime pay through the first half of 2014, which puts it on track to match or exceed the overtime totals from 2012 and 2013.

The homes showed a deficit of $1.9 million in 2012 and $3.8 million in 2013.  (Continue Reading)

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A flood of overtime for nurses at county nursing homes