A day before the state Legislature adopted a long-debated law requiring nursing home staffing levels – a measure hailed as a significant reform – “horrible” staffing levels were reported at a Buffalo facility.
State Health Department inspectors at the Buffalo Center for Rehabilitation and Nursing on May 3 observed problems that prompted a citation for insufficient nursing staff levels.
• A resident lying in bed covered in “a foul smelling yellow/brown liquid substance from their head to their knees.”
• The escape of a resident from the fourth-floor dementia ward who was spotted in the facility’s parking lot and brought back inside by the director of food services.
• A dementia resident with a history of “resident-to-resident altercations alleging sexual abuse” wandering hallways and common areas unattended, despite a care plan that required the resident receive around the clock, one-on-one supervision.
The understaffing was so severe that a volunteer advocate for residents said he resigned in frustration. But for residents at the Buffalo Center and the more than 600 other nursing homes in the state, it will be more than five months until the state-mandated improvements in staffing levels begin.
In following up on the inspection, the Health Department is now seeking a fine against the home, according to a letter from the agency to the facility.
The 200-bed Buffalo Center at 1014 Delaware Ave. has an overall rating of one star, “much below average,” from the U.S. Centers for Medicare and Medicaid Services.
Centers Health Care, a New York City-based nursing home chain, acquired the facility around 2015.
Health inspectors at the unannounced visit classified the lack of staffing as “widespread” and an “immediate jeopardy to resident health or safety.”
“The department will continue to hold Buffalo Center and all other providers accountable for the quality of care they provide,” said Jeffrey Hammond, a Health Department spokesman.
A Buffalo Center spokesman said the staffing issue has been corrected through an “aggressive” effort to recruit new workers by offering increased incentives and utilizing staffing agencies which are bringing in workers from outside the Buffalo area.
“Buffalo Center kept the Department of Health informed of all these efforts and the DOH re-surveyed the facility in May and again in June at which time the state looked at the current staffing levels as well as the previous days/weeks.
“Both times the state found that the facility was sufficiently staffed and subsequently cleared Buffalo Center of the deficiency,” spokesman Jeff Jacomowitz said.
He cited the Covid-19 pandemic for the staffing shortage.
“Buffalo Center went through a difficult staffing period this past spring related to healthcare personnel post-Covid-19 burnout and a statewide staffing shortage in all employment sectors,” Jacomowitz said.
Staffing still a problem
Two Buffalo Center workers who spoke to The Buffalo News on the condition of anonymity for fear of losing their jobs said staffing shortages continue to be a problem.
“There will be one nurse and one CNA for three wings on the weekends. That’s like a normal thing. It is very overwhelming and stressful. It makes you lose your passion for nursing,” one of the workers said. “We need help.”
The other worker said, “Our staffing is so short that there are days when it is only one aide per floor. I care for anywhere from 20 to 25 or more residents a day."
Grace Bogdanove, a vice president at 1199SEIU, the union which represents the workers, said Buffalo Center doesn't pay its workers enough.
DOH staffing critique
In the May review, inspectors cited a March 2020 Buffalo Center “Facility Assessment Portfolio” document that specified how many nurses and aides were necessary “to care for facility residents competently” and compared it to staffing levels during the inspection period.
Multiple shifts fell short of the specified staffing levels, inspectors concluded.
“The facility daily census dated 5/1/21 documented a census of 170 residents. The actual staffing for 5/1/21 11p.m. to 7 a.m. shift was 5 LPNs and 3 CNAs [down 7 CNAs]; the 5/2/21 7 a.m. to 3 p.m. shift was 5 LPNs and 11 CNAs [down 3 LPNs and 9 CNAs].”
A registered nurse supervisor interviewed by an inspector stated, “There have been shifts when only one LPN was scheduled for the entire building and staffing is horrible here.”
A licensed practical nurse stated, “Resident care and incontinent care are not sufficiently nor provided timely to residents because there is not enough staff.”
The nursing home’s administrator, according to the inspection report, stated there was sufficient staff “as evidenced by no negative outcomes” and that “there was no minimum staffing P&P [policies and procedures]” at the facility.
Volunteer ombudsman advocate resigns
Howard T. Rose said he recently resigned from his volunteer position of more than a decade as the ombudsman for residents at the Buffalo Center out of frustration over short staffing.
“There are good people who work there and they are frustrated too because they can’t get things done,” Rose said.
The problem of understaffing, particularly with CNAs, Rose said, existed long before the pandemic.
“They were paying them a minimal salary and when they did get people, there was constant turnover,” Rose said.
The state’s Long Term Care Ombudsman Program provides nursing home residents and their families with a volunteer who advocates on their behalf.
Rose said he frequently brought complaints of inadequate staffing to management’s attention, but nothing was done to resolve the situation.
“It was terribly frustrating. Things just were not getting done. The residents weren’t being cared for. There were always severe staff shortages. I feel so sorry for the residents,” he said.
State staffing mandates
Amid much fanfare, Gov. Andrew M. Cuomo on June 18 held a ceremony to sign the state Legislature May 4 staffing requirements into law.
Cuomo described it as “a major step forward in improving the quality of health care” and noted it was a first for the state.
“I know it was hard, but New York is better for it,” the governor said in crediting union, nursing and health care advocacy organizations.
Beginning Jan. 1, 2022, the state’s 613 nursing homes will be required to provide 3.5 hours of nursing care per resident per day. Out of the 3.5 hours, no less than 2.2 hours of care must be given by a CNA or nurse aide, and no less than 1.1 hours of care supplied by a licensed nurse.
Another state law also adopted in May requires nursing homes to spend a minimum of 70% of revenues on direct resident care with 40% of it going to “resident-facing staffing,” starting in 2022.
Stephen B. Hanse, CEO of the NYS Health Facilities Association and NYS Center for Assisted Living, declined to address the situation at the Buffalo Center because it is pending, but said recruiting nursing home staff is a major issue statewide.
Hanse cited inadequate funding from the state’s low Medicaid reimbursements, pointing out that 78% nursing home stays statewide are covered by Medicaid.
“New York unfortunately leads the nation in underfunding Medicaid nursing home care by $55 a day. The average cost of caring for residents in nursing homes is approximately $265 per day in the state and on average New York only reimburses providers $210 of that cost,” Hanse said.
Explaining that nursing home care is a 24-hour-a-day service, he said that $210 breaks down to an average of $8.75 per hour.
Taking a different position, Assemblyman Richard N. Gottfried, D-Manhattan, the longtime chairman of the Assembly’s Health Committee, believes better days are ahead for nursing home residents.
“The safe staffing law and the new mandatory spending ratios will significantly improve patient care,” Gottfried said. “Nursing home operators should spend money on patient needs like direct care staff, quality food, and other critical services, rather than siphoning money into their pockets through phony contracts and real estate arrangements.”
Hanse pointed out that the state reduced funding to nursing homes during the pandemic.
“Unfortunately, New York was the only state to cut funding to nursing homes with a 1% across-the-board Medicaid cut,” he said.
Hanse also questioned whether the 3.5-hour staffing requirement will solve the staffing problem.
“There are not enough people in the market who want to work at nursing homes,” he said. “You can impose mandates but you need workers.”