Does Greed Affect Nursing Home Staffing and Resident Care?

Nursing Home AbuseNathan Hughey | 02/10/22

Much has been said about the critically low staffing levels at nursing homes and assisted living facilities since the dawn of COVID. Unfortunately, staffing issues were a problem even before the pandemic.

However, since 2020, more residents have died due to neglect, and more exhausted staff members have left the industry due to low pay and substandard working conditions. Meanwhile, the owners of nursing homes and other care facilities often live in multi-million dollar homes and drive fancy cars.

How does this happen, and why is there no accountability?

The legal team at Hughey Law Firm stands beside families and nursing home staff members attempting to address the critical state of the nation’s long-term care facilities and hold the owners of these facilities accountable when their greed drives them to cut corners, hire inadequate staff, and harm their residents.

“COVID-Era Staffing Shortages Lead to Death, Injury, Families Being Shut Out”Greed Affect Nursing Home Staff and Resident Care

In Rawlin at Riverbend, a 72-bed nursing home in Springfield that reportedly provides memory care services to residents with dementia, 20 residents died in a two-month time frame between November 2020 and January 2021. Only six of those deaths were attributed to COVID. Staff members stated that if the facility’s owner, Onelife, had provided enough staff to care for the residents properly, it could have prevented many of those deaths.

At the same time that staff members were walking out due to the sheer frustration of the low pay and horrendous working conditions at the facility, the family members of residents were shut out of the facility due to pandemic restrictions and unable to serve as witnesses—and even reporters—of the conditions their loved ones were living and dying in.

The Cascade of Issues Arising From Staffing Shortages at Assisted Living Facilities

According to a September 2021 survey of nursing home and assisted living providers conducted by the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), 86 percent of surveyed providers stated that their workforce situation had gotten worse in the past three months.

Fifty-seven percent of nursing home providers and 48 percent of assisted living providers noted that it had gotten much worse. Only one percent of nursing home providers and 4 percent of assisted living providers reported fully staffed facilities. An alarming 59 percent of nursing home providers reported high-level staffing shortages.

#1. Overworked and Overwhelmed

According to AHCA and NCAL, nearly every nursing home and assisted living facility now asks staff to work extra shifts. Almost 70 percent of nursing homes are hiring temporary workers to fill positions. At Rawlin, workers reported returning to work after suffering from COVID themselves and resuming care for residents who, in their absence, had developed bedsores after sitting in their feces for hours because there weren’t enough staff members to help them.

One staff member notes that an older woman had a bedsore the size of a softball that had gone clear to the bone. At some point in time, the facility lost its on-site registered nurse and Onelife replaced her with a regional nurse who is only at the facility a few days a week. Overworked staff members could only reach her by phone for the rest of the time.

#2. Lack of Training

The AHCA/NCAL survey noted that nearly 70 percent of nursing home providers felt that it was very difficult to find new employees, with the most commonly cited reasons for this difficulty being a lack of interested or qualified candidates and the availability of unemployment benefits discouraging people from working.

Facilities like Rawlin began relying on temp agencies to provide staff members, many of whom were not trained in wound care, much less in how to deal with an environment where residents are screaming for help from their beds, taking time to assist high-needs residents leaves others waiting, and many of the residents have dementia.

States have minimal training requirements for nursing home staff (if any), and many facilities are reluctant to provide advanced training opportunities for staff members who will more often than not spend less than a year employed there before going elsewhere.

#3. Lack of Pay

A worker who had been employed for two years at Rawlin in late 2020 reported making $12.40 an hour, which was just slightly over minimum wage in Oregon at the time. She watched as Onelife brought new hires in at $13 to $14 an hour, many of them fresh out of high school. As the deaths began to pile up at the facility, she and other staff members pleaded with management to increase pay to cut the constant turnover. They asked to be paid at least what a fast-food worker would make.

Forty percent of nursing home facilities and 34 percent of assisted living facilities participating in a survey said that the biggest obstacle they faced when hiring nursing home staff was the lack of funding to offer a competitive wage.

#4. Lack of Support

When questioned about the injuries to residents due to critical staffing shortages at Rawlin, the chief executive of Onelife, Zack Falk, stated in an email to the New York Times that staff members were mischaracterizing the severity of conditions and that the woman with the large bedsore had arrived at the facility with the condition. He also reported that all workers receive proper training, that staffing never fell below state-mandated requirements, and that the death toll was similar to that of the same period in 2019.

This is a typical management response when staff members raise concerns about the work environment.

#5. A Nursing Facility Owner’s Response to Worker’s Concerns

Online, the owner of Rawlin at Riverbend, was founded in 2016 by Greg Falk and his son Zack. In 2017, they opened Rawlin. They currently own four facilities in Oregon, which receive Medicaid funding.

According to the New York Times, since starting Onelife, the owner has bought a multi-million dollar home. And when the desperate staff members at Rawlin began organizing to join a union in the hopes of gaining the collective power to bring positive changes to the pay and working conditions there, Onelife hired a national consulting firm to come and “educate” workers on the corruption of unions.

The consultant’s services were reportedly billed at $3,500 a day plus expenses, including a tent, free food for workers, a hotel, and a rental car.

Later, when workers at Rawlin went on strike for the right to have their union membership recognized by their employer, Onelife’s CEO reportedly rolled slowly back and forth through the picket line in his sports car, while a man who worked for Onelife videotaped the picket line. Some employees reported that they were told they could not return to work if they chose to strike, and others stated that management had cornered them.

The worker strike at Rawlin lasted for 14 days, and many of the employees of the facility chose to quit their jobs at the conclusion of it. They didn’t get their union, but they did get the attention of the Oregon Department of Human Services and the local Adult Protective Services unit, who had questions for Onelife. More than a dozen allegations of neglect at the facility were substantiated.

The Extreme Risks of Understaffing

Understaffing creates a multitude of potential risks for nursing home residents, including:

  • Bedsores resulting from the failure of staff members to reposition immobile residents, as well as from contact by the skin with urine and feces in incontinent residents.
  • Residents are being dropped because one staff member is attempting to move them when two are needed.
  • Falls resulting from residents who need assistance when walking not having their needs responded to.
  • The use of antipsychotic medication in dementia patients to keep them calm and easier to handle.
  • Infections resulting from improper wound care or a failure to control infectious diseases in the facility.
  • Abuse of residents by overwhelmed staff members, or abuse committed by other residents that goes unchecked due to limited staffing.
  • The inability of staff members to ensure that residents are properly fed, hydrated, and bathed.
  • New and untrained staff members who are not shown the proper procedures for wound care, administration of medication, and other important aspects of caring for residents with high medical or psychological needs.

The Important Role of Families in Protecting Nursing Home Residents

While workers have an important role in protecting the residents of nursing home facilities from suffering the consequences of ownership greed and understaffing, families have an important role as well. As noted, conditions worsened at Rawlin during the pandemic shutdowns when visitors could not easily visit their loved ones.

When searching for a nursing home or assisted living facility for your loved one, U.S. News & World Report offers some potential red flags to look for that could indicate low staffing levels.

These red flags can also be a sign for family members that it is time to look for new and safer placement.

  • Limited activity in late mornings. If many of the residents are still in bed at 11 a.m., it can indicate insufficient staff to help all the residents get up and ready for the day.
  • Complaints to state inspectors. Every nursing home facility that receives federal funds from Medicare/Medicaid must undergo annual inspections. The copies of these inspection reports are available to the public.
  • Long response times to residents’ calls or ringing phones also indicate that there is not enough staff to respond to the needs of the residents and their family members.
  • A lingering urine odor often indicates that staff does not have the time to promptly clean and change incontinent residents.
  • Staff that doesn’t know the names of the residents they’re caring for, which can indicate high staff turnover. Annual staffing turnover at long-term care facilities is currently at around 94 percent.
  • Unresponsive residents, which could be a sign of the use of antipsychotic medications to curb challenging behaviors from residents and understaffing.
  • Unclean rooms at the facility, such as full trash cans, food trays left in the room, unmade beds, and the resident’s belongings out of place. This can indicate inadequate staffing as well as other issues.
  • Poor quality food or a limited amount of food available for residents.

A Lot of Money Funds Substandard Nursing Home Care

According to a report from SeniorLiving.org, the average cost of a private room in a nursing home in the U.S. is $290 a day, $8,821 a month, and more than $105,000 per year. Residents and their family members can save some money by getting a semi-private room, but those still run an average of $255 a day. Since 2016, every state in the nation has seen increases in long-term nursing home care costs, with some states seeing double-digit increases in prices.

Assisted living communities are slightly more affordable, running an average of $141 per day, $4,300 per month, and $51,600 per year.

The Role Personal Injury Lawyers Have in the Matter

The legal team at Hughey Law Firm believes that the responsibility to improve the living conditions for nursing home residents is on all of us.

To that end, our experienced attorneys are available to speak with residents and family members about the quality of care they’re receiving at their facility, as well as to provide legal assistance to those who have been injured or have even died as a result of nursing home neglect or abuse. Together, we can hold the often greedy owners of these facilities accountable for the harm they’ve caused.

For more information, contact us online or call (843) 881-8644.

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