GREENSBORO — One in three U.S. nursing homes has fewer nurses and aides than before the COVID-19 pandemic highlighted the truth of a profit-driven industry with too few caring for society’s most vulnerable.
Even before the coronavirus began sweeping through facilities, most homes kept staffing at levels below what many experts see as adequate. Now, things are even worse.
“It’s already so low. To drop further is appalling,” says Charlene Harrington, a professor at the University of California, San Francisco, whose research on nursing homes has frequently focused on staffing.
An Associated Press review of federal data found 32% of nursing homes had worse staffing levels in June than at the start of the pandemic. The number of facilities reporting a drop would almost certainly have been worse had occupancy rates not fallen due to more than 135,000 COVID-19 fatalities.
In homes posting lower staffing ratios, the average resident had 21 fewer minutes of contact with staff daily, or about 11 hours a month, translating to scarcer help at mealtime, fewer showers and less repositioning to prevent painful bedsores. In the worst cases, when someone falls, chokes or is otherwise endangered, it means there are fewer to discover the problem or hear their calls for help.
Tamika Dalton saw it first-hand with her 74-year-old mother, who moved to Blumenthal Nursing and Rehabilitation Center in Greensboro, North Carolina, in January 2019 as her multiple sclerosis worsened. At the time, the facility earned four stars out of five under Medicare’s staffing ratings.
But once COVID-19 hit and Dalton visited at her mother’s window, she saw fewer and fewer aides pass by, and her mother sometimes left in a soiled diaper for hours. Her hair was often matted and her toenails grew long. A bedsore the size of a fist festered on her backside. Sometimes, unable to dial a phone herself and with no aides in sight, she would holler to a passing custodian for help.
“She would call out for help and no one would come,” she said. “There was no one around.”
Blumenthal’s staffing fell in the year after Theresa Dalton entered the facility, even more in the first year of the pandemic, and still more in the months since. By June, four months after the retired minister died of COVID-19, the facility’s staffing was down 15% from the start of 2020, and 25% from the start of 2019.
“They did that for their own pockets,” Dalton says of the lower staffing. “There’s a lot of greed.”
Requests for comment to Blumenthal and its operator, Choice Health Management Services, were not returned. In a letter to state regulators, an attorney for the facility said complaints were taken seriously and that some problems, like the bedsore, were exacerbated by the patient’s failure to follow orders.
“The facility never fell below staffing expectations,” the letter said.
The American Health Care Association, which lobbies for care facilities, said its polling of members last month found 99% of nursing homes and 96% of assisted living facilities said they had staffing shortages.
In a June survey, AHCA found 84% of nursing homes were losing revenue due to fewer patients coming from hospitals, and that nearly half of nursing homes and assisted living facilities had made cuts.
In a statement, AHCA officials called for additional federal funding, changes to Medicaid and government programs to bolster caregiver hiring and development.
“The labor shortage in long-term care is the worst it has been in decades. Many facilities are now in danger of closing because of workforce challenges,” the organization said. “If we want to improve the workforce situation in nursing homes, we need policymakers to make a long-term investment.”
Nursing aides, overwhelming female and disproportionately members of minority groups, are the core of resident care in nursing homes, working jobs with routine injuries, low pay and high turnover.
Some aides fled homes over fears of exposure to COVID-19. Others have been lured by easier work at similar or higher pay from restaurants and stores. And some were laid off by homes as occupancy fell.
For those left behind in homes with skeletal staffing, the job can feel untenable.
Kristin Pullins rejoined the staff at Montrose Health Center in Montrose, Iowa, last August, immediately struck by how different staffing was from when she worked there a year earlier, when the home had a different owner. Instead of two licensed nurses on a given shift, now there was just one.
“We just weren’t able to answer their call lights quick enough,” says Pullins, a registered nurse. “As soon as I could get in and get out, I had to go, because I had so much to do.”
With fewer on hand, Pullins said bedsores, wounds and falls increased. When one resident had stroke-like symptoms as her shift ended, Pullins said a supervisor said he’d have to wait an hour until the night nurse arrived. Staff was spread so thin that Pullins had to keep working when she had COVID-19.
By the time Pullins quit in February, staffing at Montrose was 9% lower than a year earlier.