Sunday, November 28, 2004

Nurse, aide shortage imperils patients

One-fifth of residents live in nursing homes where staffing levels could affect nutrition.

By Brad Heath / The Detroit News

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Four of every five nursing home patients live in facilities with too few nurses or aides to give them the best possible care.

One in five - or about 292,000 patients nationwide - is in a home with so few workers it puts their health in jeopardy, according to a Detroit News analysis based on staffing thresholds identified by federal researchers.

Those workers get patients out of bed in the morning. They give them showers, help them to the bathroom, get them dressed, give them medications and make sure they're fed. When there aren't enough to go around, all of those things are less likely to be done.

Patient advocates say that's a key reason for widespread malnutrition and dehydration that kill thousands of patients each year and injure many more. Scientific studies repeatedly have found clear links between low staffing levels and malnutrition and dehydration.

"They need more workers in those places," said Annette Drake, a retired licensed practical nurse from Madison, Ga., whose sister died in a Detroit nursing home in 1998.

The home settled a lawsuit alleging starvation and dehydration caused a cascade of medical failures leading to the 96-year-old's death.

"They are understaffed and they can only do so much," Drake said. "But when you go there, you're looking for top-quality care and if it isn't there, patients start deteriorating."

Studies back up that point. One study in 2001 by the U.S. Centers for Medicare and Medicaid Services, the federal agency ultimately responsible for overseeing most nursing home care, found patients were more likely to suffer severe weight loss in homes with low staffing levels. The study found:

Homes without enough employees to give each patient three hours of care every day risk causing them serious harm. Facilities caring for about 20 percent of the nation's nursing home residents did not meet that threshold as of October this year. Ensuring the best care means having enough workers to give just over four hours of care. Only about a quarter of homes meet that standard.

The shortage of staff is nothing new, especially when it comes to the nurse aides responsible for the vast majority of care in nursing homes.

The work is demanding and it doesn't pay well - about $21,000 a year on average, according to government estimates. And nursing homes, like hospitals, have complained for years they can't find enough qualified caregivers.

Even if they could, nursing home administrators say government health programs that pay for most long-term care leave them with little money to hire more help.

"A lot of people would complain there would be a need for more (staff)," said Reginald Carter, president and CEO of the Health Care Association of Michigan, which represents many of the state's nursing homes. "If the government's not going to pay for more, you're not going to have more."

Bringing in enough staff to make a difference in Michigan would cost $1 billion, he said - a daunting price tag, especially at a time when many states are wrestling with considerable budget cuts. Michigan's staffing levels are near the national average, with enough nurses and aides to give each patient 3.7 hours of care each day. That's more than studies suggest is needed to reduce the chance patients will be harmed, but is less than ideal.

Illinois' staffing levels are among the worst. That's no surprise to James Burnett, who works shifts at two Chicago nursing homes and sometimes fills in at others.

The work is frantic and exhausting. Burnett has worked shifts with two aides responsible for 58 patients - and that's when no one calls in sick, he said.

"We only have one hour for lunch and have to try to feed 10-12 people in that allotted time and something always falls short," he said. "We push ourselves, but it's impossible. We might feed them all, but then we can't get a chance to give everybody water or pass out snacks. We have to rush."

The toll that inadequate staffing takes also is clear from inspection records: Busy workers at a home in Flint ignored a patient's pleas for help for nearly an hour as he tried unsuccessfully to feed himself breakfast. At another, outside Oklahoma City, Okla., inspectors watched patients who got even less help: One unable to eat on her own was given only a few bites before, frustrated, she put her head down and went to sleep.

That also can be frustrating for workers, many of whom endure low pay, long hours and hard work because they want to help patients as best they can.

"If you're caring for 20 residents, it's kind of impossible to meet the needs of each one," said Francine Rico, who has worked for six years as an aide at a Chicago nursing home. "Adequate care comes with adequate staffing."