New Mexico sues nursing home chain for inadequate staffing levels leading to neglect

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by Red Kryptonite (Member)

Specializes in hospice. Has 3 years experience.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,673 Posts

Maybe this combined with effective unions working for safe nurse : patient ratios will finally make it a reality. Maybe not during the time I'm working, but eventually.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,099 Posts

Traditionally, nursing home allegations have identified lapses in care — such as avoidable deaths, hygiene issues or a pattern of resident injuries from falls — then used whistleblowers to help show that the nursing home’s problems stem from inadequate staff.

New Mexico’s case includes evidence such as confidential witnesses from the nursing homes’ own staffs alleging that managers recognized that nursing assistants were too overwhelmed to change diapers or help residents shower in a timely fashion. Sometimes there weren’t enough people working to help incapacitated residents eat and drink, the complaint says, leaving residents “deprived of food and water.”

New Mexico’s lawsuit relies on an industrial simulation of how long it takes to complete basic care tasks — for example, 3.5 minutes to reposition a resident in order to prevent bedsores.

By calculating the total minutes required to properly care for residents and comparing them to the actual number of hours worked, the state found deficiencies in the total hours worked by nursing assistants of as much as 50 percent. Those numbers are especially useful, New Mexico’s complaint says, because the nursing homes regularly boosted the number of nursing assistants who work during state inspections.

The alleged lapses in care took a toll not just on residents but on their families. Cited as Confidential Witness #2, the daughter of one patient at a Santa Fe facility, Casa Real, said she repeatedly found her father unattended, dirty and complaining he was hungry. With the facility’s staff saying they didn’t have enough time, the woman took over the daily bathing and feeding that the nursing home was being paid by the government to do.

"3.5 minutes to reposition a patient" can turn into 10 minutes with 2 persons when immobile and contracted. Good for the government to use patient care hours/task divided by staffing to confirm facility understaffing.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 41 years experience. 4,291 Posts

Hallelujah if they can win this in court and set a very important precedent.

Red Kryptonite

Specializes in hospice. Has 3 years experience. 2,212 Posts

And using the club of defrauding the government by charging for care not provided, which government programs reimbursed....that has teeth.

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 10 years experience. 1 Article; 1,706 Posts

"3.5 minutes to reposition a patient" can turn into 10 minutes with 2 persons when immobile and contracted. Good for the government to use patient care hours/task divided by staffing to confirm facility understaffing.

I recall recently with a patient who was in for end of life care, went from mobilsing with one assist to needing full hoist within 2 weeks

I was starting to see this in my former job as a district nurse. 30 minutes for a non complex wound, not included the 25 minutes to drive to and from the patient

Out of interest what the are ratios like for aged care in the US?

The place where I work I have myself RN and an EN/or med competent health care assistant for 35 patients

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 16 years experience. 224 Articles; 27,608 Posts

Out of interest what the are ratios like for aged care in the US?
Nurse/patient ratios vary wildly. I've had as few as 18 residents and as many as 70 residents, both on night shift.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

Out of interest what the are ratios like for aged care in the US?

Not sure what the average is, but I worked in elder care as a CNA years back. The home I worked for had 1 RN/LPN and 2.75 CNAs (the 0.75 was a 6-hour shift), plus a "student assistant," which was an uncertified high school student who spent 4 hrs passing ice water and snacks per 30 residents. We had 2 units w/ this setup.

Most of the residents were full code, but there was a hospital unit in the building (very small, rural facility) so some extra RNs, plus there was an MD and a CRNA in house during regular hours. So there was some extra help if there was an emergency.

That's a relatively good ratio from what I hear, and it seemed overwhelming sometimes! The nurse did all meds (no med aide), all nebs, all wound care, trach care for one resident...I remember once too, she had 3 residents on IV fluids and abx at once. For CNAs it was pretty doable, but of course sometimes they couldn't cover a sick call, or we'd have a tornado warning and have to evacuate everyone to the halls after already having half of them in bed for HS.

lifelearningrn, BSN, RN

Specializes in School Nursing. Has 8 years experience. 2,517 Posts

I have yet to see a nursing home with truly safe staffing, though I'm sure they exist (maybe?) somewhere. I hope this sets a precedent.. sadly, with corporations owning our government, I'm not confident anything is going to change. Elderly care is a big cash cow right now, and it's only going to grow as the baby boomers age.

Not_A_Hat_Person, RN

Specializes in Geriatrics, Home Health. Has 10 years experience. 2,900 Posts

Out of interest what the are ratios like for aged care in the US?

There are no hard-and-fast ratios for Long Term Care. California's mandatory ratios only apply to hospitals. I've personally had 15, 17, 25, and (for one awful overnight shift) 60 residents.

No Stars In My Eyes

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience. 2,469 Posts

I got very excited when I read the title of this thread, then I read the time-it-takes-to-turn-a-patient ( 3.5 minutes) and I thought, "Yeah, and that's if the patient is able to help you..."

Like Rose-Queen said, maybe not in my working-life time......but what's been going on in LTC's everywhere is criminal and unethical, and we have to carry the weight of the burden of blame and most of it not of our own making. Some of that blame is ours partially, by going along, and trying to make it work , but what choice did/do we have. Until a big case like this came along it wasn't on most people's radar. I hope it grows and swells and reaches critical mass.

I can understand the fear of the possibility of losing a job/license , and when what you have to deal with in one shift is untenable, but you're there for the patients and so you try and try and try. It happened to me.

Red Kryptonite

Specializes in hospice. Has 3 years experience. 2,212 Posts

Until a big case like this came along it wasn't on most people's radar. I hope it grows and swells and reaches critical mass.

I heard about this story on my local radio news. According to that report, other states are already watching this case to see how it turns out, so that they can possibly replicate the tactic. :up: