Nursing homes always have the right number of nurses and aides to care for their residents, right?
That would be nice.
In reality, the nursing homes I see as an attorney representing families whose loved ones are hurt or killed through carelessness are almost always understaffed.
Many of my clients describe the “ghost town” effect, especially at night and on weekends: empty halls and hard-to-find staff.
What is Nursing Home Understaffing, Really?
Nursing home understaffing is when there are not enough nursing home staff to meet the specific needs of all the residents.
Nursing homes provide care to residents through people (staff): nurses (registered nurses and licensed practical nurses), nursing aides (also called State Tested Nursing Assistants or STNAs in Ohio), therapists (physical, occupational, speech) and their assistants, janitorial / environmental staff, dietary / nutrition, and sometimes doctors.
In my experience, critical understaffing is in the nursing staff–nurses (RNs and / or LPNs) and aides (STNAs)–because they are the ones providing direct medical care, observation, and evaluation. Without enough nursing staff, people die.
Without enough physical therapists, by contrast, residents might miss a session or two. Not usually life-threatening.
Nursing homes know what their resident’s individual care needs are, because they evaluate every single resident’s needs on admission, and at least every 90 days thereafter under federal regulations.
How Many Nurses and Aides Should a Nursing Home Have?
The “State Minimum” Myth
States like Ohio have minimum numbers of nursing staff for the number of residents. Sounds good, right?
Wrong.
This is really the bare minimum number of staff any nursing home has to have for the least care-intensive residents possible. If you don’t have at least this number of staff, you ought to be shut down.
What Ohio’s minimum numbers misses is any relationship to the care needs of the residents in the nursing home.
For example, imagine a nursing home with 99% independent seniors who need minimal direct care–maybe just help taking medications. Pretty light load for the nursing staff.
Now compare that with a nursing home with the same number of residents, but in which 99% of the residents require extensive care–help sitting up in bed, two people to help them transfer from bed to wheelchair, help getting dressed eating, brushing their teeth, combing their hair, intensive medical treatments like bandage changes and complex medicine regimes, etc. an incredibly heavy load for nursing staff.
Which nursing home should have more nursing staff? If all you use is the state minimum, they could both have a bare-bones staffing level. That would be insanely stupid and result in residents dying.
Not to mention, even these state-minimum levels are far too low according to a 2016 report.
Staffing Based on Residents’ Needs (Acuity)
The right way to determine the number of nursing staff needed for a particular nursing home is to consider the individual resident’s care needs. This is sometimes called “acuity.”
Almost every nursing home is required by Medicare to evaluate each resident’s care needs using a tool called the MDS. This provides information on how much care a resident requires, from how independent they are taking care of daily needs like going to the bathroom and brushing their teeth, to how many medical conditions they have that require intensive care.
Medicare uses this information to assign each resident a score that represents how much nursing staff time is likely required to care for them. The score is actually a set of “groups” of care level, called “Resource Utilization Groups,” or RUG scores.
This makes sense: how much staff resources will you utilize as a resident?
Nursing homes can use this information to forecast the right amount of each type of nursing staff–Registered Nurses, Licenses Practical Nurses, and State-Tested Nursing Assistants–for their residents’ needs.
Most either never do this evaluation, or ignore it.
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What are “Expected Staffing Levels”?
Expected Staffing Levels is the amount of nursing minutes available per resident based on the residents’ collective care needs, according to Medicare.
Medicare didn’t just put the care need evaluation forms (MDS) together, and break residents into Resource Utilization Groups. Medicare also paid for studies to figure out the right amount of nursing staff required based on a resident being in one of those groups. Take all the RUG scores together, add up the number of minutes of each type of nursing staff for each resident, and presto, you have your Expected Staffing Levels.
That’s right: Medicare paid for studies so that nursing homes could immediately know the amount of nursing staff–for each type of nursing staff, down to the minute–they need to have to care for residents.
So all the nursing homes staff at the Expected Staffing Level, right? Or higher?
Nope.
Why do Nursing Homes Routinely Under-Staff?
In particular for nursing homes that are for-profit companies (instead of nonprofit or religious), profit is king.
And how do nursing homes (or any company) make profit? By having more income (revenue) with less cost (expenses).
The number one income source for every nursing home I have ever sued has been the number of residents (and, often, they get paid more for resident who have the highest care needs, reflected by the Resource Utilization Group score). Want revenues to go up? Fill those nursing home beds with residents, the sicker and needier, the better.
The number one expense for every nursing home I’ve ever sued has been nursing staff. Want expenses to go down? Hire fewer nursing staff members, pay them less, and have them work fewer hours.
The result is an almost undeniable temptation to under staff: have as many residents cared for by as few nurses and aides as you can get away with.
And with Ohio’s under-funded inspectors, they can get away with some pretty egregious under staffing levels.
How Well Staffed are Ohio Nursing Homes?
Ohio nursing homes are some of the worst-staffed nursing homes in the country, according to various reports.
According to a report card published by the advocacy group Families for Better Care, Ohio has some of the worst staffing levels in the country in 2013 and 2014. Ohio got an “F” for “Direct Care Staffing Above Average,” ranking 48th in the country.
Ouch.
Compare that with the low number of deficiencies, and you can see there’s a gap between the nursing home performance, and inspections.
Here’s a map of the 2014 rankings (note Ohio got a D overall–in part because of few numbers of cited deficiencies):
The state-by-state report card for nursing home quality in 2014 from the organization Families for Better Care, available at www.nursinghomereportcards.com
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What are some of the Worst-Staffed Nursing Homes in Ohio?
Based on Medicare’s star-rating system, the below nursing homes rank among the worst in Ohio for staffing AND how residents do (“quality outcomes”). (This is based on information pulled from the US News database, not our trial database.)
Austinburg Nursing and Rehabilitation Center
2026 State Route 45, Austinburg, OH 44010
Austinburg Nursing and Rehabilitation Center in Austinburg, OH, is rated 1.0 stars overall. It is a large facility with 139 beds and has for-profit, corporate ownership. Austinburg Nursing and Rehabilitation Center is not part of a continuing care retirement community.
Cambridge Health and Rehabilitation Center
1471 Wills Creek Valley Drive, Cambridge, OH 43725
Cambridge Health and Rehabilitation Center in Cambridge, OH, is rated 1.0 stars overall. It is a large facility with 144 beds and has for-profit, corporate ownership. Cambridge Health and Rehabilitation Center is not part of a continuing care retirement community.
Hanover House
435 Avis Avenue NW, Massillon, OH 44646
Hanover House in Massillon, OH, is rated 1.0 stars overall. It is a large facility with 181 beds and has for-profit, corporate ownership. Hanover House is not part of a continuing care retirement community.
Horizon Post Acute Care
3889 East Galbraith Road, Cincinnati, OH 45236
Horizon Post Acute Care in Cincinnati, OH, is rated 1.0 stars overall. It is a large facility with 162 beds and has for-profit, individual ownership. Horizon Post Acute Care is not part of a continuing care retirement community.
Lake Pointe Health Care
3364 Kolbe Rd, Lorain, OH 44053
Lake Pointe Health Care in Lorain, OH, is rated 1.0 stars overall. It is a large facility with 158 beds and has for-profit, corporate ownership. Lake Pointe Health Care is not part of a continuing care retirement community.
Logan Health Care Center
300 Arlington Avenue, Logan, OH 43138
Logan Health Care Center in Logan, OH, is rated 1.0 stars overall. It is a large facility with 144 beds and has for-profit, corporate ownership. Logan Health Care Center is not part of a continuing care retirement community.
Manor at Whitehall
4805 Langley Avenue, Whitehall, OH 43213
Manor at Whitehall in Whitehall, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Manor at Whitehall is not part of a continuing care retirement community.
Manorcare Health Svcs-Belden Village
5005 Higbee Avenue NW, Canton, OH 44718
Manorcare Health Svcs-Belden Village in Canton, OH, is rated 1.0 stars overall. It is a large facility with 139 beds and has for-profit, corporate ownership. Manorcare Health Svcs-Belden Village is not part of a continuing care retirement community.
Maria Joseph Living Care Center
4830 Salem Avenue, Dayton, OH 45416
Maria Joseph Living Care Center in Dayton, OH, is rated 1.0 stars overall. It is a very large facility with 280 beds and has for-profit, corporate ownership. Maria Joseph Living Care Center is not part of a continuing care retirement community.
Marietta Center
117 Bartlett Street, Marietta, OH 45750
Marietta Center in Marietta, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Marietta Center is not part of a continuing care retirement community.
Mchs-Westerville
140 Old County Line Road, Westerville, OH 43081
Mchs-Westerville in Westerville, OH, is rated 1.0 stars overall. It is a large facility with 174 beds and has for-profit, corporate ownership. Mchs-Westerville is not part of a continuing care retirement community.
Mentor Woods Skilled Nursing and Rehabilitation
8881 Schaefer St., Mentor, OH 44060
Mentor Woods Skilled Nursing and Rehabilitation in Mentor, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Mentor Woods Skilled Nursing and Rehabilitation is not part of a continuing care retirement community.
Omni Manor Nursing Home
3245 Vestal Road, Youngstown, OH 44509
Omni Manor Nursing Home in Youngstown, OH, is rated 1.0 stars overall. It is a large facility with 200 beds and has for-profit, corporate ownership. Omni Manor Nursing Home is not part of a continuing care retirement community.
Park East Care and Rehabilitation Center
3800 Park East, Beachwood, OH 44122
Park East Care and Rehabilitation Center in Beachwood, OH, is rated 1.0 stars overall. It is a very large facility with 274 beds and has for-profit, corporate ownership. Park East Care and Rehabilitation Center is not part of a continuing care retirement community.
Regency Manor Rehabilitation & Subacute Center
2000 Regency Manor Circle, Columbus, OH 43207
Regency Manor Rehabilitation & Subacute Center in Columbus, OH, is rated 1.0 stars overall. It is a very large facility with 275 beds and has for-profit, corporate ownership. Regency Manor Rehabilitation & Subacute Center is not part of a continuing care retirement community.
Signature Healthcare of Warren
2473 North Rd NE, Warren, OH 44483
Signature Healthcare of Warren in Warren, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Signature Healthcare of Warren is not part of a continuing care retirement community.
Stone Crossing Care Center by Lamplight Communities
836 West 34th Street NW, Canton, OH 44709
Stone Crossing Care Center by Lamplight Communities in Canton, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, partnership ownership. Stone Crossing Care Center by Lamplight Communities is not part of a continuing care retirement community.
The Chateau at Mountain Crest Nursing & Rehabilitation Center
2586 Lafeuille Avenue, Cincinnati, OH 45211
The Chateau at Mountain Crest Nursing & Rehabilitation Center in Cincinnati, OH, is rated 1.0 stars overall. It is a large facility with 199 beds and has for-profit, partnership ownership. The Chateau at Mountain Crest Nursing & Rehabilitation Center is not part of a continuing care retirement community.
The Meadows at Osborn Park
3916 Perkins Ave, Huron, OH 44839
The Meadows at Osborn Park in Huron, OH, is rated 1.0 stars overall. It is a large facility with 130 beds and has county ownership. The Meadows at Osborn Park is not part of a continuing care retirement community.
Tuscany Gardens
7400 Hazelton Etna Road SW, Pataskala, OH 43062
Tuscany Gardens in Pataskala, OH, is rated 1.0 stars overall. It is a large facility with 123 beds and has for-profit, corporate ownership. Tuscany Gardens is not part of a continuing care retirement community.
Villa Angela Care Center
5700 Karl Road, Columbus, OH 43229
Villa Angela Care Center in Columbus, OH, is rated 1.0 stars overall. It is a very large facility with 225 beds and has for-profit, corporate ownership. Villa Angela Care Center is not part of a continuing care retirement community.
Vista Center at the Ridge
3379 Main Street, Mineral Ridge, OH 44440
Vista Center at the Ridge in Mineral Ridge, OH, is rated 1.0 stars overall. It is a large facility with 168 beds and has for-profit, corporate ownership. Vista Center at the Ridge is not part of a continuing care retirement community.
Walton Manor Health Care Center
19859 Alexander Rd, Walton Hills, OH 44146
Walton Manor Health Care Center in Walton Hills, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Walton Manor Health Care Center is not part of a continuing care retirement community.
Westmoreland Place
230 Cherry St., Chillicothe, OH 45601
Westmoreland Place in Chillicothe, OH, is rated 1.0 stars overall. It is a large facility with 150 beds and has for-profit, corporate ownership. Westmoreland Place is not part of a continuing care retirement community.
Winchester Place Nursing & Rehabilitation Center
36 Lehman Dr., Canal Winchester, OH 43110
Winchester Place Nursing & Rehabilitation Center in Canal Winchester, OH, is rated 1.0 stars overall. It is a large facility with 181 beds and has for-profit, corporate ownership. Winchester Place Nursing & Rehabilitation Center is not part of a continuing care retirement community.
To do your own research on Ohio nursing homes using US News’s site, see http://health.usnews.com/best-nursing-homes/area/oh.
Nursing Home Understaffing Articles
Understaffing: Ohio’s Nursing Home Crisis
The new data has made it clear that as many as 70 percent of nursing homes nationwide had been overstating their actual staffing levels by an average of 12 percent. Of 56 central Ohio nursing homes, about 40 percent had below-average staff levels, according to a national analysis of the new data.This information is significant because this is really the bare minimum number of staff any nursing home has to have for the least care-intensive residents possible. If you don’t have at least this number of staff, you ought to be shut down. 40 percent of Central Ohio nursing homes fall below this minimum. What Ohio’s minimum numbers misses is any relationship to the care needs of the residents in the nursing home Expected Staffing Levels is the amount of nursing minutes available per resident based on the residents’ collective care needs, according to Medicare. Medicare didn’t just put the care needed evaluation forms (MDS) together and broke residents into Resource Utilization Groups. Medicare also paid for studies to figure out the right amount of nursing staff required based on a resident being in one of those groups. Take all the RUG scores together, add up the number of minutes of each type of nursing staff for each resident, and presto, you have your Expected Staffing Levels. That’s right: Medicare paid for studies so that nursing homes could immediately know the amount of nursing staff–for each type of nursing staff, down to the minute–they need ...
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Eadie Hill Trial Lawyers Files Second Suit Against Communicare Nursing Home
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Nursing Home Accused of Knowingly Understaffing
The complaint alleges that the nursing home patient was allowed to suffer multiple falls after becoming a patient of the dementia unit, ultimately suffering an injury to the head including massive subdural bleeding and brain swelling. The patient was admitted to the hospital after the second fall, where she died two days later. The complaint alleges that those responsible for the care at Life Care Center of Rochester “knowingly understaffed the facility and placed its patient population in serious and clearly foreseeable danger of harm and injury.”
The complaint states that the named defendants “have engaged in a history and pattern of practice of wrongfully choosing to place corporate profits over the needs of their patients.” In support of that allegation, the complaint states that Life Care Centers of America, Inc. was the subject of a Federal False Claims Act lawsuit brought by the U.S. Justice Department that was settled for $147 Million in 2016.
According to the complaint, the family of the victim plans to challenge the constitutionality of Indiana’s Adult Wrongful Death Statute.Indiana’s Adult Wrongful Death statute states that the total damages that may be recovered against a negligent defendant proven to have killed the victim is $300,000 for loss of the “love and companionship” of the deceased individual. (I.C. 34-23-1-2(e)) Indiana law does not allow any recovery for the pain and suffering of a victim killed by a defendant’s negligence. (I.C.34-9-3-4)
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Understaffing: Ohio’s Nursing Home Crisis
- In 2015, 70 percent of Ohio nursing homes were staffed below what researchers say is necessary to provide safe, compassionate care.
- The most recent federal nursing home data also found that across the country, 62 percent of nursing homes were below that level.
- Numerous studies and interviews with researchers indicate that nursing staffs should provide an average of 4.1 hours of care for a resident each day.Ohio's nursing homes averaged 3.9 hours, the newspaper found. Dozens of facilities could not provide 3 hours of care per resident day.
- Ohio calls for its 960 nursing homes to provide a minimum of 2.5 hours of care per resident a day, which researchers said is exceedingly low.
- Nonprofit nursing homes in Ohio tended to have significantly better staffing. They offered an average of 4.47 hours of care per resident day, compared to the average of 3.77 hours that for-profit facilities offered.
- The nursing homes in the state with the highest number of hours per resident day had the highest ratios of registered nurses. Researchers say registered nurses should provide 45 minutes of care per day to each resident. The nursing homes with the most hours of care per resident offer three times that.
- In Ohio, 84 percent of the nursing homes in 2015 delivered care at a rate below 4.5 hours per resident day.
- In Northeast Ohio, two nursing homes were among the lowest ranking in terms of care in the state in 2015: Sapphire Health and Rehabilitation in Akron with 2.67 hours of care per resident day and Falls Village Skilled Nursing and Rehabilitation in Cuyahoga Falls ...
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“We Don’t Have Enough Staff to Take Care of You”
Russell Kennedy says his 90-year-old mother is confined to a wheelchair and can barely hear, relying on staff at the Goshen nursing home to perform simple tasks like getting out of bed and putting in her hearing aid. He says they ring the bell for help and people don't come because they just don't have the staff to handle it.By not providing enough staff for residents, the Sapphire Nursing Home is putting its residents at risks of serious injury or even death. Nursing home understaffing is when there are not enough nursing home staff to meet the specific needs of all the residents. Nursing homes provide care to residents through people (staff): nurses (registered nurses and licensed practical nurses), nursing aides (also called State Tested Nursing Assistants or STNAs in Ohio), therapists (physical, occupational, speech) and their assistants, janitorial / environmental staff, dietary / nutrition, and sometimes doctors. In my experience, critical understaffing is in the nursing staff–nurses (RNs and / or LPNs) and aides (STNAs)–because they are the ones providing direct medical care, observation, and evaluation. Without enough nursing staff, people die. According to the News12 article, a nurses aid actually told the woman and her family that they cannot take care of her.
The facility reportedly lost half its ...
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Report: Corporate Nursing Homes Providing Sub-Standard Care
The same lawsuit claims that the resident, Martha Jane Pierce, was the victim of severe medical neglect. Her son came to visit her and noticed that something was amiss. The article reports that he:Allenbrooke Nursing and Rehabilitation Center, appeared to have been severely underfunded at the time, with a $2 million deficit on its books and a scarcity of nurses and aides. “Sometimes we’d be short of diapers, sheets, linens,” one nurse testified.
That same year, $2.8 million of the facility’s $12 million in operating expenses went to a constellation of corporations controlled by two Long Island accountants who, court records show, owned Allenbrooke and 32 other nursing homes. The homes paid the men’s other companies to provide physical therapy, management, drugs and other services, from which the owners reaped profits.
A nurse at the facility verified the conditions and attributed them to lack of staff and lack ...peeled back the white sock that had been covering his 82-year-old mother’s right foot for a month, he discovered rotting flesh.
“It looked like a piece of black charcoal” and smelled “like death,” her daughter Cindy Hatfield later testified. After Mrs. Pierce, a patient at a nursing home in Memphis, was transferred to a hospital, a surgeon had to amputate much of her leg.
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The Corporate Understaffing Game in For-Profit Nursing Homes
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One of the Worst Nursing Homes in Cleveland?
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Nursing Home Staffing Tricks: Inspection Bump
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