‘Patients are getting screwed’ as Kentucky’s under-staffed nursing homes go unfixed

At Sunrise Manor Nursing Home in Hodgenville, a frail woman spent a night in 2015 sitting precariously on her bathroom toilet, shouting uselessly for help, shivering with cold, because nobody remembered to return and assist her to bed. The nurse’s aide for that unit later told state inspectors that she had been overwhelmed trying to monitor 26 residents during the graveyard shift.

At Stonecreek Health and Rehabilitation in Paducah that same year, harried nursing staff dealt with a resident screaming about excruciating pain from a neglected urinary catheter — he had an infection that soon would require emergency hospitalization — by removing his speaking valve, a plastic prosthesis in his throat, to render him mute.

At Woodcrest Nursing and Rehabilitation Center in Elsemere this year, a resident told state inspectors that he was ordered to empty his bowels in bed when nobody on staff was available to take him to the bathroom. The resident cried and said this was disgusting. A nurse’s aide who often cared for him confirmed this practice to inspectors, adding that “the facility was short-staffed all the time.”

These stories and many others taken from state inspections of Kentucky nursing homes over the last three years show a pattern — vulnerable people frequently are at risk because their caregivers are stretched too thin to be effective.

It’s a big reason why 43 percent of Kentucky’s 284 nursing homes this year were rated as “below average” or “much below average” by the U.S. Centers for Medicare and Medicaid Services because of serious problems discovered with the quality of care they provide their roughly 12,500 residents, according to a Herald-Leader analysis of federal data.

That’s among the worst collective ratings for nursing homes in the country.

The state’s nursing home lobby, while complaining about what it called a “gotcha” regulatory system, told lawmakers at a 2015 committee hearing that Kentucky’s facilities received six times as many “immediate jeopardy” deficiencies from inspectors as the national average and fines that were six times larger than the national average.

Fines are levied — and lawsuits are filed — over bedsores, infections, bone-breaking falls, choking, medication errors, untreated pain and neglect, as residents are left to lie in their own feces and urine for hours, according to the newspaper’s review.

“I don’t think the public really understands what goes on in some of these places. Reading the inspection reports, seeing what the citations are for, it opens your eyes,” said Wanda Delaplane, a nursing home reform advocate who has testified to lawmakers.

Delaplane’s 84-year-old father suffered an agonizing death at a Frankfort nursing home in 2002 from what she described as a lack of medical attention for an impacted bowel. Staff was nowhere to be found while he cried out for someone to help him, she said. A jury awarded her family $20 million in damages.

The General Assembly keeps responding to this plight with legislation that would make it harder to sue nursing homes. They have established “medical review panels” composed of doctors deciding the credibility of negligence suits before they can go to court, quickly creating a backlog of cases. They also have proposed placing caps on plaintiff’s attorneys’ fees in such suits and restrictions on how a nursing home’s safety violations can be publicized in lawyers’ advertising.

However, lawmakers won’t touch the underlying problem: There typically aren’t enough nurses and nurse’s aides on duty at nursing homes to properly care for residents. Some inspection reports describe a solitary direct-care employee rushing up and down hallways to assist so many elderly and ailing residents that injuries, even deaths, are almost inevitable.

“It’s the staffing,” said Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. Culp’s nonprofit agency visits nursing homes in Central Kentucky to monitor living conditions and inform residents of their legal rights.

“A lot of the problems we work on, it all comes down to the fact that either there isn’t sufficient staff on hand to care for people or else they’re not being adequately trained, or both. Over and over and over we see this,” Culp said. “If you’ve got one nurse’s aide and 40 residents, there’s no ability to do any basic care, much less to develop any sort of a relationship with people.”

Ombudsmen Sue Landis, from left, Sherry Culp, and Denise Wells, all of Lexington, visited with patients Tuesday at Brookdale Senior Living in Lexington.

Alex Slitz aslitz@herald-leader.com 

 

The federal government recommends an “expected staffing” level at nursing homes that would allow a resident every day to get more than one hour of care from registered nurses and two hours and 45 minutes of care from nurse’s aides.

Kentucky nursing homes, on average, fall short of that goal, reporting 43 minutes of daily care from registered nurses and two hours and 19 minutes from nurse’s aides, according to the Centers for Medicare and Medicaid Services, which collects staffing and resident population data from the facilities.

The state’s many substandard nursing homes have even worse numbers. At Hazard Health & Rehabilitation Center in Perry County, for instance, with $45,861 in fines accumulated from deficiencies over the last three years, residents can only count on 15 minutes daily with a registered nurse on average, CMS reports. (In a recent interview, facility administrator Charlotte Thornsberry said she disputed that figure, but she declined repeated requests to provide a sum that she believes is more accurate.)

Melinda Henshaw, a nurse who has worked as a unit manager in Western Kentucky nursing homes, said she quit because the conditions she witnessed upset her.

“The nurses on the floor are stressed,” Henshaw said. “They are missing so many of the changes in residents — and they know it. It’s not unusual for one nurse to have 30 residents. She’s gonna miss it when things start going bad. She does not have the time to notice everything she needs to and answer the phones and fill out the paperwork she’s supposed to. No one could do all that.”

Henshaw said her own mother was in a Kentucky nursing home and went eight hours on the overnight shift without anyone checking on her because the facility was short-staffed.

“People are going without baths. People are going without following their care plans,” Henshaw said. “I had one resident who was supposed to be up and about four hours a day so he could regain his strength. That wasn’t happening because there wasn’t enough staff to help him.”  (Click to Continue)

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‘Patients are getting screwed’ as Kentucky’s under-staffed nursing homes go unfixed