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Quality Of Nursing-Home Care Debated

Sep 18, 2002 | The Charleston Gazette Officials testifying before the Legislature’s Select Committee on Nursing Homes on Tuesday gave different accounts on the quality of the state’s facilities.

They all agreed that nursing homes need more staff, such as registered nurses licensed practical nurses and certified nursing assistants. But when one official said West Virginia nursing homes had less staff and more problems than other facilities nationwide, another official gave statistics that said the exact opposite.

Charlene Harrington, a national expert from the University of California at San Francisco, said West Virginia nursing homes have 25 percent more deficiencies than the national average. The number of nurse aides at the facilities is 28 percent below the recommended minimum, she added.

But John Alfano, chief executive officer of the West Virginia Health Care Association, said West Virginia nursing homes’ staff-to-resident ratios are the eighth highest in the nation. The facilities also have the fifth lowest rate of deficiencies that cause actual harm.

“One group of people have statistics that are skewed in one direction and another group has numbers that are at the opposite end,” said Sen. Roman Prezioso, D-Marion, about the nursing home hearing during a Care Home Advisory Board meeting later that afternoon. Prezioso is chairman of the Senate Health and Human Resources Committee. “Each group swears that their statistics are valid, and we’re caught in the middle.”

At a press conference before the nursing home hearing, Harrington talked about a report she helped author called, “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 1995 to 2001.”

Nursing homes with not enough staff will have more problems, such as residents living with painful sores or dying of dehydration or malnutrition, she said.

These are the same facilities that are getting more money from the federal and state government. They’re not being held financially accountable, she said.

“Any increase in funding needs to be directly tied to staff increases,” Harrington said. “If not, the nursing homes will take the money and use it for other things.”

Sixty-five percent of nursing homes nationwide — about the same percentage in West Virginia — are for-profits, she said. They redirect their profits back to their investors, she said, or use funds that should go toward staffing for real estate investments or administrative expenses, such as salaries.

Non-profit nursing homes, meanwhile, are more likely to reinvest in the facility, she added.

In 2001, West Virginia nursing homes got an average reimbursement of $127 per day per bed, a 20 percent increase from 1999, said Dave Regan, president of District 1199 of the health care and social services union.

“Unfortunately, this has not resulted in increased quality of care,” he said. “Nurse aide staff levels are decreasing.”

State officials should freeze reimbursement rates unless nursing homes promise to earmark the funds for more staff or added employee benefits, he added. Nursing homes need to increase benefits and salaries so they don’t have to compete with less stressful work at fast food restaurants.

For every 100 nursing assistant slots at a West Virginia nursing home, more than 72 people will quit their jobs yearly.

“Most people don’t have the extraordinary commitment to do the extremely difficult work,” he added.

West Virginia nursing homes are expected to get a reimbursement increase in October.

Exhausted workers

Shelby Warden’s mother, 82, is blind and paralyzed on her left side. In 2000, Warden reluctantly put her mother into a West Virginia nursing home.

Warden told legislators Tuesday afternoon of the lack of quality care her mother has since received at the facility.

She once found large sores on her mother’s left leg, which the staff didn’t know about. After her mother’s arm popped out of the socket when an aide was dressing her, a doctor later noticed that her mother’s hip was also broken. The nursing home staff was not aware of this and her mother needed a hip replacement.

“This is mostly due to understaffing and the exhausted CNAs,” she said. It’s not unusual for one CNA to dress, feed and get 37 people out of bed on one floor, she added.

“Our association doesn’t tolerate abuse or poor quality,” added Alfano of the health care association. He said that most families are satisfied with the quality of care their loved ones receive.

About 92 percent of family members in a survey, for example, said they’d recommend the facility to others, he added.

Yes, they are having trouble recruiting and retaining nursing home staff, he said. But they have more staff caring for patients than the national average, he added.

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