by Robin Erb
- Most poor care in nursing homes can be traced to low staffing, advocates, attorneys and others say
- Michigan has not updated its law since 1978 even as other states have boosted requirements
- An industry official calls such standards unnecessary ‘feel good’ measures and says the real issue is a worker shortage
Residents of the Mission Point of Beverly Hills awoke hungry on Sept. 6, 2023. No meals were served. Nor did aides come to help immobile residents out of bed to avoid bed sores or make it to the bathroom.
The residents, many of whom had limited or no mobility, had been left on their own for an entire shift, according to a state inspection report. The reason: a lack of staff.
Across Michigan, the state’s most vulnerable residents are living out their last days in what inspection reports characterize as sometimes squalid conditions, because many nursing homes are critically understaffed. Positions are tough to fill because nursing aides are paid less than $40,000 for work that is so physically demanding they have a higher rate of workplace back injuries than construction workers.
So far, the state and federal government have not stepped up to help.
Michigan has about 420 nursing homes that provide care to 34,000 residents. A Bridge Michigan review found that at least 167 facilities were cited at least 362 times total for lack of “sufficient” or “competent” staff in the past four years.
That is a certain undercount, since inspectors are on site sometimes just once a year. Six of those homes were cited more than six times each.
“A basic minimum level of staffing is so important to the quality of life and the dignity of people’s lives,” said Megan O’Reilly, vice president of government affairs at the national AARP office, which has advocated for more staffing.
“It almost feels like you’re being set up to fail. There’s no way to meet the need and the demand that’s in front of you,” she said.
Michigan’s minimum staffing requirements have remained unchanged since 1978 and require each resident to receive just 2.25 hours of care a day, or 2.31 hours if including time from the director of nursing, according to the National Consumer Voice for Quality Long-Term Care, a longtime national advocacy organization for residents of long-term care facilities.
That’s below the 4.1 hours a day recommended by the U.S. Centers for Medicare & Medicaid Services a quarter century ago.
Across the US, staffing minimums vary widely. Some states have no standard; at least six and the District of Columbia require at least 3.5 hours a day: DC (4.16 hours a day), Rhode Island (3.87) Illinois (3.83), Florida (3.66), Massachusetts (3.64) and California and New York (3.56)
When Michigan’s law passed, people in what many then called “retirement homes” often were more able-bodied. Today, those same people live in independent- or assisted-living facilities, leaving nursing homes to care for those with more complicated medical needs, said Sarah Slocum, a longtime consumer advocate and former head of the Michigan Long-Term Care Ombudsman office.
“There’s nobody in a nursing home who doesn’t need a bunch of help. That’s why they’re there,” she said.
Bridge found that for-profit homes were cited more than nonprofit ones.
Roughly a fifth of the state’s 66 nonprofit nursing homes have been cited at least once for staffing shortages or inadequately licensed workers over the past four years.
In contrast, more than one third of the state’s 319 for-profit homes were cited.
In all, Bridge Michigan documented about two dozen deaths at nursing homes in the past four years that were either cited by inspectors for wrongdoing or the subject of lawsuits alleging poor treatment.
To be clear, residents are frail and prone to injuries, and many of Michigan’s nursing cares provide exceptional care.
But a Bridge review reveals that others have far more persistent problems.
At the now-closed Mission Point Nursing and Physical Rehabilitation of Ishpeming, Richard Bellmore, 61, died in 2022 after he hadn’t been checked for hours, according to a lawsuit filed in his death and a 179-page report filed with the state.
At the facility, an inspector described residents who sat in their own waste, went without medical care, and were fed barely edible food.
One resident’s pillow was soaked in urine that seeped up to the resident’s hairline, a visitor told the inspector. Residents who couldn’t walk on their own were left in their beds for days, according to the reports.
State reports claim the facility’s director of nursing was frequently absent and would even climb out of the office window to avoid staff members who had questions.
Confronted by a staff member as she was climbing through the window, the director of nursing explained she didn’t want to be “bombarded,” the staff member recalled to the inspector in a Jan. 18, 2023, report.
It was “hard to get down the hallway because too many people stop her and ask her questions,” the staff member said the nursing director told her.
‘Feel good’ measures?
Over the years, lawmakers have made efforts to boost Michigan’s minimum staffing requirements. A quarter-century ago, some lawmakers suggested boosting standards to 2.75 hours a day, defraying costs with money from a 1998 settlement with tobacco companies for $6.2 billion.
Many nursing homes typically exceed those standards, with about a third, 142, providing more than four hours a day of care per resident, according to data from NursingHome411, a project by a New York nonprofit called the Long Term Care Coalition.
In all, 13 homes provided less than three hours, according to the report.
Last year, the Biden administration announced staffing requirements that would have pushed daily care requirements generally to 3.48 hours a day.
Under these first-ever federal staffing levels, more than a half hour of that care each day would be provided by a registered nurse — changes that would have saved about US 13,000 lives a year, according to research by the University of Pennsylvania.
In Michigan alone, the change could save 251 to 500 lives, according to estimates.
The $200 billion nursing home industry opposed the change, arguing that it would require finding another 102,000 workers nationwide in an industry already beset with worker shortages.
Staffing ratio levels are “feel-good” measures but arbitrary — failing to account for individual needs of residents — and put a “target on our back” for inspectors, said Melissa Samuel, president and CEO of the Healthcare Association of Michigan, an industry lobbying group.
Instead, the government should relax immigration standards and increase Medicaid reimbursements, she said.
“If you want to fix the problem of a workforce problem, then let’s fix the problem and get workers,” she told Bridge.
In the end, it didn’t matter.
The “One Big, Beautiful Bill,” signed by President Trump in July, listed such staffing requirements as “wasteful spending,” delaying the rules until 2034.
Less training than a barber
Providing the backbone of care in Michigan are more than 38,000 certified nurse aides who are paid less than $39,000 per year on average, according to the US Bureau of Labor Statistics.
Michigan requires 75 hours of training for them, with an additional two days of clinical training — less than most other states and far less than a 2008 recommendation by the National Academy of Medicine that called for at least 120 hours of training.
Michigan requires 400 hours to be a manicurist and 1,800 hours to be a barber.
Nursing aides is a tough job that requires is physically and emotionally draining — and aides can quickly get overwhelmed, said Clare Luz, a gerontologist whose work at Michigan State University
“Have you ever tried to give an elderly disabled person a shower?” she said. “You and I — we jump in the shower, we spin around, and two minutes later we can get out.”
For a medically-frail person, she said, “it can take a full hour just to give somebody a shower.”
She said a few hours of care a day for residents isn’t enough.
‘My roommate hasn’t gotten up’
At Mission Point of Beverly Hills in 2022, an inspector entering the facility heard one resident yelling “I’ve been sitting in piss for five hours.” Others complained they’d gone weeks without showers. Medications were late. One resident reported waiting nine hours to get fed.
“My roommate hasn’t gotten up in over a week,” one resident told inspectors.
The facility — along with the closed home in Ishpeming that closed in 2024 — is part of the Mission Point Healthcare Service chain of Grand Rapids.
Its Beverly Hills facility has been cited so frequently that federal officials deemed it a “special focus facility,” making it subject to more inspections.
As recently as on Oct. 26, 2023, an inspector detailed at least six days of nursing shortages.
Darious Parks, administrator of the Beverly Hills facility, now part of the Certus Healthcare chain and called Harmony Village of Beverly Hills, told Bridge by phone that improvements have been made at that facility — both in staff, and in turn, for the residents.
He said he has been on the job only a few months, and he’d heard the allegations of a “terrible” record connected to Mission Point. A former nurse aide, Parks said staffing and care has improved during his tenure.
In all 15 different Mission Point locations in Michigan were cited by state inspectors over three years for having insufficient staff, either by not having enough workers “to meet the needs of every resident” or by failing to have, specifically, enough nursing staff, according to a Bridge analysis of three years of inspection reports.
Calls from Bridge to Mission Point corporate offices were not returned.
‘Impossible to meet the needs’
Mission Point of Grandville was cited in 2023 for short staffing, too, after an 85-year-old church elder died when her blood sugar slumped after missed medications. Staff noticed her struggling, but no one notified her doctor, according to state inspectors.
The day before she was scheduled to return home, a nurse found her unresponsive, and her blood sugar level “incredibly low.”
The nurse, who later said he hadn’t been told of her low sugar the previous days, raced around the facility to find a dose of injectable or gel glucagon, used in a low-blood-sugar crisis.
There was none.
He tried to get into a medicine cabinet. It was locked.
He called 911, crushing glucose tablets to put into Johnson’s mouth in an attempt to “save her life,” he later told an inspector.
It was too late.
Inspection reports also indicate that residents went without showers because there wasn’t enough staff, doctor appointments were missed and wound care was neglected.
Falls — the leading and increasing cause of accidental death for older Americans — had surged. In a two-week period, staff reported 14 separate falls in the facility. One fall left a 78-year-old resident on the floor in only his briefs, his pelvis broken, one nurse said.
“Help, help,” he called, the nurse later told the inspector.
A woman broke her arm in another fall. After that, she was left in her wheelchair instead of being put in bed after dinner “because there weren’t enough staff,” an aide reported.
Even as the inspector visited the facility on April 13, two aides were helping a resident who had fallen to the bathroom floor, unable to locate a nurse to help.
It was “impossible” to meet the needs of all the residents,” an aide told the inspector.
Angelic Thomas said her mother, Julia Williams, never complained about her care at the facility.
Still, she said she never saw staff either.
“There never seemed to be anyone at the nurses’ station,” she said.
The facility also was cited for Williams’ death after staff failed to offer her CPR and other life-saving help when she apparently suffered from a heart attack in 2023.
At her Grand Rapids home this past summer, Thomas said she often thinks about her last visit with her mother. Julia Williams had been a housekeeper, working into her 70s. She’d been independent and strong, but in those final weeks, she seemed to be “tired, giving up,” Thomas said.
“The last conversation we had, she wanted out of the nursing home,” Thomas said of her mother.
Thomas dropped her head into her hands, rubbing her face and shaking her head.
She sighed at the memory: “I said ‘Mom, I’ll try.”
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Michigan nursing homes have few staff, little training. Misery can follow
