December 1, 2014

Understaffing hard on nursing homes, residents alike

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Darrell Hoemann/CU-CitizenAccess.org

A sign advertising open positions is leaned against the wall in front of the Heartland of Champaign nursing home, Dec. 11, 2014.

For many, nursing homes seem like the best option for aging family members because facilities offer the promise of 24-hour care.

It is a promise, though, that many Champaign County and central Illinois nursing homes are finding hard to keep because of understaffing, particularly when it comes to registered nurses.

“There needs to be a certain level of service,” said Tami Wacker, regional ombudsman for the East Central Illinois Area Agency on Aging, an advocacy organization that works on behalf of long-term care residents. “Once it’s promised, it needs to be delivered.”

Registered nurses who work in central Illinois homes average less time tending to each resident than registered nurses working elsewhere in the state or country, a CU-CitizenAccess.org analysis of Medicare data from 81 nursing homes found.

While registered nurses in Illinois average spending about an hour with each resident a day, registered nurses in the 81 homes average only 43 minutes.

And figures are even lower for Champaign County.

Not including Clark-Lindsey Retirement Village, registered nurses working in Champaign homes spend an average of about 37 minutes a day tending to each resident. Clark-Lindsey is not representative of other homes because it has an exceptionally high amount of time that nurses spend with patients compared to state and national averages.

The 81 nursing homes reviewed include facilities in Champaign, Urbana, Savoy, Gifford and Mattoon. They also include homes in Arcola, Gibson City, Paxton, Gilman and more than a dozen other cities.

“If you’re paying for the service of being in a long-term care facility, you expect to have adequate care,” said Jennifer Young, who works with Wacker as a long-term care ombudsman.

Nationally, registered nurses average about 50 minutes per resident per day, according to the Medicare data, which is comprised of staffing information gathered from self-reports submitted by nursing homes.

Yet, those statistics do not adequately reflect quality of care or lack of effort, those familiar with nursing home management argue. Rather, they say, the statistics highlight the difficulties of finding qualified and committed staff, a challenge especially true in rural areas.

David Voepel is the executive director of the Illinois Health Care Association, a group that represents hundreds of geriatric facilities, long-term care homes and rehabilitation centers. Voepel said some association members have been unsuccessfully advertising vacant staff positions for months.

“We’ve come full circle with this issue, with members that have told us we’ve been advertising for 60 to 90 days for RNs,” he said. “They just aren’t there.”

“When you’re talking a town of 2,500 people, there are no RNs available,” Voepel added.

Young – who oversees facilities in Piatt, Douglas, Dewitt and Champaign counties – also said hiring has been a problem for nursing homes she has worked with.

“From what I see, most of the facilities in Champaign County are understaffed, and not because they want to be,” Young said.

Hiring issues are not excuses, advocate says

The Medicare data show central Illinois nursing homes more closely reflect state averages when also taking into account lower-level staff.

Registered nurses, certified nursing assistants and licensed practical nurses working in the sample of 81 central Illinois facilities combine to spend an average of about three hours and 42 minutes on each resident a day.

The three levels of staff combine to spend an average of three hours and 21 minutes in Champaign County nursing homes. That average, again, does not include Clark-Lindsey.

Even though Clark-Lindsey’s staffing ratios are much higher than both state and national averages, Deb Reardanz, the facility’s president and chief executive officer, said it is still an area she worries about.

“One of the biggest challenges in long-term care is finding qualified staff – and not just qualified, but committed staff,” she said. “I think everyone goes into this field with the best of expectations, but it’s hard work.”

The national average for the three levels of combined staff is more than four hours.

Wacker, who has been working for the East Central Illinois Area Agency on Aging for more than a decade, said she understands the challenges of finding qualified staff. Nonetheless, she said, nursing homes need to stand by the commitments they make to residents.

“If you go buy a car and you don’t get what you need, we as consumers circle back, and we make sure we’re getting what we’ve been promised,” she said. “I do believe there’s a little bit of accountability to the consumer and to the resident and to the family members.”

The 2010 Illinois Act on Aging, passed during a period of widespread nursing home reform throughout the state, attempted to address the staff-to-resident ratios by setting yearly benchmarks.

The act mandated that by Jan. 1 of this year the minimum staffing rations “shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care.”

Wacker said the reform has helped, but more needs to be done.

Low staffing leads to residents waiting for help

Although Champaign County and central Illinois nursing homes largely measure up to state averages when it comes to combined-staff ratios, problems linked to low staffing are nevertheless routinely documented in Illinois Department of Public Health complaint investigations.

In September, an inspection at Heartland of Champaign found that nine out of nine surveyed residents had issues with staff failing to respond to call lights, which signal resident distress, in a timely manner.  One resident had to wait from half-past midnight until two in the morning for staff to answer a call light. Another resident said he had to sit “wet in his bed” for three hours during the night with his call light on.

“I was watching the clock,” the resident said. “I was wet and needed someone to change me.”

A family member visiting a resident told inspectors that staff members “work hard,” but the facility was understaffed.

Young said complaints related to call lights are common.

“Residents’ needs aren’t being met as quickly as they would wish,” she said. “That is probably our biggest complaint that I’ve dealt with.”

In June, another inspection at Heartland of Champaign noted similar problems when multiple residents told inspectors that it takes staff anywhere from 10 minutes to an hour to answer call lights.

An employee told inspectors it typically takes about three minutes.

“When you have an admissions and marketing person who takes someone through a tour of a long-term care facility, I can guarantee you they’re not saying to the family member or potential resident, ‘You know, you may have to wait that hour for that call light to be answered,’” Wacker said.

Additional reporting by Claire Everett/CU-CitizenAccess.org