Low staffing, training impact care at nursing home and elder facilities

“We get referrals for people who need health care and we don’t take them and they have to get somewhere else because we’re understaffed,” said Derek Kendall, certified nursing assistant and CEO of Lucy Corr, which is a non-profit assisted living facility in Chesterfield. “They don’t get health care, they go home and are a burden to their children, or they go home with home health care that may or may not show up.”

Kendall said he would need to hire approximately 17 staff members to operate Lucy Corr at full capacity. But this is difficult as Lucy Corr is one of hundreds of nursing homes across Virginia struggling to find staff.

“We’re not hiring because there’s not enough people applying,” Kendall said. “We might get six people this week to apply for 17 positions and maybe three of them show up and of the three who show up maybe one will accept our offer.”

Just 3% of Virginia nursing homes are fully staffed and 86% reported that their overall workforce situation had worsened in 2022, according to a report from the Virginia Health Care Association and Virginia Center for Assisted Living.

Virginia is not alone as nursing homes across the country have always grappled with understaffing, Amy Hewett, VHCA-VCL vice president of strategy and communications, said. The issue was exacerbated during the COVID-19 pandemic as the American Health Care Association National Center for Assisted Living reported nursing homes faced the worst job loss of any health care sector and while the demand has grown in the past two decades, the current workforce levels are equal to what they were in 1994.

Even patients who are accepted into nursing homes suffer from the workforce shortages. Understaffing directly correlates with a lower quality of care including falls, infection, overmedicating and dehydration of patients, Jared Calfee, associate state director of AARP Virginia, said.

This was the case for Joanna Heiskill and Tracy Pompey, who co-founded the nonprofit organization, Justice and Change for Victims of Nursing Facilities, in 2021 after they each lost a parent as a result of what they said was negligent care in a Virginia nursing home.

The nursing facility Pompey’s father stayed in was aware that he had been vomiting stool for hours and had twisted intestines before he died after a nurse found him unsupervised and facedown on the floor.

“I do believe they were short staffed on that night because they were running around, according to the records, and he wasn’t supervised,” Pompey said.

To help boost staffing levels and attempt to improve nursing homes, the Virginia General Assembly passed legislation that would set minimum staffing requirements for nursing home facilities. SB 1339, introduced by Sen. George Barker, D-Fairfax, and HB 1446, introduced by Del. Bobby Orrock, R-Caroline, and co-chief patroned by Del. Vivian Watts, D-Fairfax, will go into effect in 2025 and both require nursing homes to offer each resident at least an average 3.08 hours of care per day or face administrative sanctions.

Watts has proposed bills relating to minimum staffing requirements for 20 years.

“It was just wrong, these are people… and you can’t just treat that person as a dying body,” Watts said. “And as the years went by I realized more and more the magnitude of the problem in Virginia and that it wasn’t just a few nursing homes.”

The bills had not passed before because of the cost, but were boosted by Medicaid’s value-based purchasing program which provides financial rewards for facilities that hire more staff. Also, the delayed effect of the legislation means there is enough time to go through the regulatory process and find funding for the law before the next biennial budget cycle in 2025, Watts said.

But despite the legislative win, minimum staffing requirements is just a starting point to improving nursing home conditions, Kendall said.

“This bill will not solve the issue, this bill is going to measure,” Kendall said. “It will show the General Assembly that we’re short staffed at hospitals and nursing homes not because we just don’t hire people, but because people don’t exist.”

Many nursing homes, including Lucy Corr, have tried to attract new employees with higher pay and bonuses, but burnout from working through the pandemic and competition with other industries are the main barriers to filling vacant positions, Kendall said.

“There’s a lot of people in my position who are just not coming back, because if you can do this you can do anything… they’re just people who are emotionally exhausted,” Kendall said. “The problem is they can make their money anywhere else and this is hard work.”

Another challenge to meeting staffing ratios is funding the training of the people who are interested in working at nursing facilities, Hewett said. Registered nurses are needed to teach training programs, but oftentimes they are paid less for teaching than what they could make practicing. Also, some facilities, including Lucy Corr, fund and offer their own training programs but there is no way of ensuring that graduates will stay and work.

Both Heiskill and Pompey also emphasized that their parents’ outcomes could have been different if the nursing home staff were better trained.

“The minimum staffing requirement is good, but we strongly feel that you can’t separate that from training,” Heiskill said. “You could have one or two people there that were well trained to recognize that my mom was sitting in a chair getting ready to pass away in her room. There were symptoms and signs that nobody saw it and the same with Tracy’s father.”

Even further than staffing and training, Heiskill and Pompey said there needs to be greater accountability for how the practices of nursing facilities comply with the law because both have encountered facilities with fraudulent practices.

As a former nurse, Pompey said she has worked in facilities with administrators that knew when inspectors were coming and would falsify charts, clean areas that were usually neglected and require more nurses to work than usual.

Some facilities will also accept more patients than they can adequately care for because their profits are dependent on how many beds are filled, Heiskill said. Administrators in the facility Heiskill’s mother stayed in also presented false information to Medicare and were able to steal money from her mother.

Heiskill was unaware of the fraud and learned about it from a report of an investigation into the circumstances of her mother’s death. Heiskill was unable to retrieve the stolen money and there was no disciplinary action taken against the nursing facility, she said. Both of the facilities Heiskill and Pompey’s parents stayed in were shut down and reopened with similar practices but under different names, they said.

“Making a difference and holding these nursing facilities accountable has to start there where the laws are written,” Heiskill said. “We need to have more of our representatives go visit the nursing facilities to see firsthand what’s happening.”