Poor wages, understaffing, and lower Medicaid reimbursement rates created what some describe as the preamble to the “perfect storm” that has raged after COVID-19 struck Washington nursing homes in early March 2020. One newspaper report based on federal data from 2018 found that more than half of the states’ skilled nursing facilities had received citations for insufficient or unqualified staff prior to the pandemic.
Interviews of workers and residents in those facilities ascribed low wages and understaffing to the reduced care residents received. One resident told inspectors she had not been bathed for almost three weeks and others told of waiting long periods of time for assistance, e.g., waiting over 15 minutes after a resident called for help for a roommate who had fallen.
One resident gave this description about the staffing issue before the pandemic to inspectors: “Sometimes there are so few people in the building, if there were an emergency, it would be a calamity.”
That calamity proved true when COVID-19 spread to 160 nursing homes across Washington state and resulted in 625 deaths.
While Washington facilities have struggled with staffing issues amid the pandemic and the varying state and federal staffing standards, one issue seems to have surfaced, i.e., “one size does not fit all.” Due to the variances that exist on specific shifts or in different wings, e.g., where staffing cuts occurred across the board in one nursing home, the state received multiple complaints from the facility’s unit for residents with cognitive impairments. This emphasized the effect that varying levels of care can have on determining staffing levels.
Compliance Perspective
Failure to maintain staffing levels that are sufficient to meet care required by acuity levels of residents a facility has admitted may result in complaints and citations during normal operations, but place residents and staff in jeopardy for serious harm when faced with a pandemic like COVID-19. This can be considered a violation of state and federal regulations, accompanied by serious fines and other sanctions.
Discussion Points:
- Review policies and procedures regarding state staffing requirements in conjunction with the variances in levels of care needed by all residents, i.e., cognitively impaired, residents needing multiple staff assists, individuals needing post-acute nursing care, etc.
- Train staff regarding abuse and neglect and providing the level of care needed by each resident.
- Periodically audit to determine if residents are receiving the care needed based on each person’s acuity level.
