Nursing home residents and their loved ones told state health officials Tuesday that care in Connecticut facilities is woefully inadequate, leaving some people stranded for hours without trips to the bathroom, diaper changes or meals, and that neglect from understaffing has caused injury, infection and death.
Alicia Hughes, whose husband, James “Rusty” Hughes, is in a Windsor nursing home, said she’s witnessed the lack of care up close.
“They have forgotten to feed him. He can’t feed himself. They’ve forgotten to bring his meal to the room,” she told health officials tearfully. “Other times they have brought his meal to the room but not opened anything for him. He can’t open packages.
“I’ve seen them let him go seven to eight hours sitting in his own waste because it’s a two-person job to change him and they don’t have the staff. … They’ve taken away his call bell on a number of occasions because he rings to get help and they don’t want to be bothered.”
Nancy Sorge’s mother, who lived in a Shelton nursing home, lost 63 pounds in three months after she was left alone without meals and developed infections because there was not enough staff to change her, her daughter said. She died last week.
“The patient care was very poor,” said Sorge, of Monroe. “Mom’s floor had 33 patients, one nurse, one [nurse] aide. Mom was left … to not be fed. She didn’t want to eat and no one was helping her.”
“I had gone in there, spending countless hours, from three to 9 o’clock at night, for the last seven months because of the low staff,” she said. “And unfortunately, my mom passed away last week … She was throwing up blood and ended up aspirating while she was down flat with nobody to care for her. Nursing homes need to take responsibility for what happens with these patients. … My mom should have died with dignity the way she was supposed to die, not the way she did die.”
The Department of Public Health is now in the process of adopting regulations that go along with the higher staffing threshold, which include certain numbers of licensed nursing employees and nurse aides on each shift and specific guidelines for therapeutic recreation and social work, among other things.
A hearing on the regulations was held Tuesday, giving the public a chance to comment virtually or in person at state offices.
Many residents and their families used the forum as an opportunity to air concerns about current staffing levels, which they described as still insufficient.
“When there are not enough staff members at a nursing facility, it diminishes the quality of care we receive,” said Susan Bilansky, who lives at The Hebrew Center for Health & Rehabilitation in West Hartford. “This is especially true for individuals who require a lot of care throughout the day. When there are not enough staff in the building, these individuals are less likely to get help getting up out of bed, getting showered or getting assistance to the bathroom.
“And there is so much more than just that. Lack of staffing and lack of care also affects our ability to connect with one another, attend activities and feel a sense of community.”
Christine Moretti, whose father lived in a nursing home until he died in March, said staff at the facility complained of burnout. One aide told her she was going to quit because there were two workers on a floor with more than 30 residents.
“What I witnessed every day there was not enough staff to give my dad basic care for feeding and toileting,” she said. “My dad lost a lot of weight from not eating. He went in in August [at] 225 pounds. By November, he was 202 pounds. I saw a huge decline in his health.”
Understaffing is a key reason serious violations have increased in nursing homes over the last 18 months, experts and advocates have said. High turnover in the workforce, gaps in training and less state oversight have contributed to a rise in immediate jeopardy orders, findings that indicate violations in a facility caused or were likely to cause harm or death. Health officials have acknowledged a backlog in nursing home inspections.
The CT Mirror reported that 17 such orders were issued in 2018, nine in 2019, 15 in 2020 and 16 in 2021. By 2022, the number jumped to 24, and the state reported 12 in the first six months of this year.
Since April 2019, 20 people have died in connection with those violations. More than a third of those deaths have occurred since October.
Nursing home administrators and industry leaders took issue Tuesday with some of the staffing regulations.
Mag Morelli, president of LeadingAge Connecticut, which represents nonprofit nursing homes, said new rules that require a certain number of licensed nursing staff and nurse aides per shift have put a strain on facilities. For example, the regulations require 1.6 hours of nurse aide care per resident between 7 a.m. and 9 p.m. Previously, it mandated 1.4 hours of “total nursing” care, meaning the shift could be filled with registered nurses or licensed practical nurses instead of nurse aides. Now there are separate requirements for licensed nursing staff and for their aides.
“By making it so restrictive and requiring so many hours of [nurse aide care], it caused a lot of angst for people,” she said. “You can’t mix and match, you can’t blend. You have two separate ratios, and it just makes it so much more difficult.”
Craig Dumont, a licensed nursing home administrator, said he is not opposed to the three-hour minimum mandate but the state must adequately fund Medicaid reimbursement for facilities.
“There have been no cost-of-living rate adjustments in the last five years when it comes to our Medicaid rates. [There are] insufficient Medicaid reimbursement rates … to assure these residents we care for day in and day out are being properly funded,” he said. “If it’s unrealistically regulated, underfunded and not resident-centered, there’s only one inevitable result: system failure. Those facilities that cannot sustain will close.”
John Anantharaj, corporate clinical director with Ryder’s Health Management, a Stratford-based management company for skilled nursing facilities, said the state must regulate temporary employment agencies, whose costs are unsustainable for nursing homes.
“If I’m a nurse working for Agency A and they offer me $50 as an LPN, and Agency B offers me $70, I call out that same day for Agency A and I work for Agency B,” he said. “There are no regulations to hold these people accountable.”
Lawmakers pledged Tuesday to increase the staffing requirements further. For several years, they have unsuccessfully tried to raise the minimum threshold to 4.1 hours of direct care per resident each day. It will again be a focal point during the legislative session that begins in February, they said.
“It’s too low, and we are planning to legislate it to 4.1 hours in the 2024 session,” said Rep. Mitch Bolinsky, R-Newtown, a ranking member on the Aging Committee. “Personal care for our residents is not a luxury, it’s a necessity. The neglect we see and the stories we hear about people who are dying tragically, it’s completely real.”