Nursing home finances lead to patient suffering, staff burnout

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Darrell Hoemann

Champaign-Urbana Nursing and Rehab (302 Burwash Ave, Savoy) on Monday, April 6, 2020. The care facility has been cited for a deficiency in infection prevention and control in 2019. Photo by Darrell Hoemann/CU-CitizenAccess

A nursing home resident at Alden Town Manor Rehab & HCC died after tumbling down five concrete stairs onto the pavement, according to state inspections reports.

The 2019 report said the resident in the Cicero, Ill. nursing home rolled past the receptionist’s desk in his wheel chair. No one was at the desk at the time because the receptionist had to step away to assist another resident. 

The receptionist said, “no one can really cover for me on the weekends when I step away from the desk,” according to the report by the Illinois Department of Public Health about the 2018 incident.

The resident was categorized as a high fall risk and was never to be allowed to go outside alone. However, on the day of the incident, the resident exited the lobby through double doors that were propped open. 

As a result of the fall, the resident was diagnosed with two lacerations to the right forehead, extensive acute bilateral brain bleeds, multiple right facial fractures, a cervical spine fractures and right frontal facial, neck hematomas. The resident passed away a few days later in the hospital and the facility was later was fined $25,000 for the incident. 

Staff shortage is a widespread issue in nursing homes, said Lee Moriarty, director at Illinois Pioneer Coalition, who has 30 years of experience in long-term care.

“If you talk to anybody who lives in a nursing home, there’s never enough people to care for you, ever,” Moriarty said. 


Indeed, nursing homes in Illinois are largely understaffed and the employees are often overworked, undervalued and undercompensated, according to interviews with staff, researchers and advocates, and review of federal and state documents and research papers.

Staff members are consistently overworked

Shatonia Jackson, a Certified Nursing Assistant at City View Multi-Care Center, is in charge of making sure residents of different mental capabilities eat, wash up, take their medicines, change clothes. However, she said sometimes she has to take care of 20 or 30 patients at a time. 

“I can’t change them every 2 hours like I’m supposed to, I can only change them when I can get around to them,” Jackson said of her work at the facility, located in Cicero, Ill. “It’s impossible. It’s impossible. So of course, it’s going to look like, ‘Oh my god, she’s not doing her job.’ But I can’t. It’s just me.”

Jackson said with the low staffing level at nursing homes, it’s impossible to provide 2.5 hours of direct care for each resident every day, which is the required minimum for Certified Nursing Assistants. 

Jackson said the family tend to blame the Certified Nursing Assistants when their family members are not receiving the care they are supposed to, but the nursing homes should be to blame for not proving enough staffing despite the government giving them money to do so. 

“They want to blame it on me. Well you can’t blame it on me because there is just one me,” Jackson said. “The nursing home industry is greedy. The government gives them so much money for staffing. They’re shortening the floors, they’re shortening the dietary, they’re shortening the housekeeping.”

Ozzmon Dumas is a housekeeping staff member at Symphony at Midway in Chicago, Ill., and he said he has experienced firsthand the challenges to provide quality of care with a shortage of staff. 

“It’s messed up because we don’t have enough people to handle what we need to do. Because of that, they’ll try to discipline us, the workers, as if it was our fault,” Dumas said. “On my end, I’ll be asked to do impossible tasks.”

Both City View Multi-Care Center and Symphony at Midway did not respond to requests for comments at the time of publication. 

Advocates say staff is often undervalued by management 

Staff not being valued or cared for is the biggest reason nursing homes are not retaining their staff, Moriarty said. 

Currently, the test to determine the qualifications of nursing home managers are about knowing the regulations and rules, which doesn’t require knowledge or experience on providing care. 

Moriarty said that sends the message that running a nursing home is all about regulations. Instead, there should be mandated leadership training for nursing home management. 

“A lot of time, it’s the owners who could really have a real negative affect on the staff who work there because of the policies that they come up with sitting in an office without understand the reality of what’s going on,” Moriarty said. 

Moriarty said people who chose to work in nursing homes want longevity. They don’t want to move from home to home, but management of nursing homes often think the staff don’t care and are simply after the highest pay. 

Jackson said that as a Certified Nursing Assistant, she knows more about the residents than the nurses do, because she works hands-on with the residents personally. 

“I say to myself, ‘If I don’t do it, who’s going to do it?’ Some people just do it because it’s a job, I do it because I care,” she said. 

One of the things that can help nursing home staff build the relationship they want with their residents, as well as provide better care, is person-directed care. It refers to a system a care where the residents determine their own daily schedules and have a say in their own lives. 

Person-directed care provide better personalized care for the residents and give them a normal life even in an institutionalized facility. It also saves the staff’s time. Moreover, Moriarty said that it doesn’t cost more for the nursing homes to do so. 

However, some nursing homes, especially chain facilities owned by corporate groups, are not changing to person-directed care, Moriarty said. 

“People push back on doing it because they feel like, ‘We have a good survey. We didn’t find any issues that came up in the survey, so why change anything?’” she said. 

Part of this is due to the generation currently in nursing homes are not used to standing up for their rights, Moriarty said. However, nursing homes are getting more criticism from family members of residents because baby boomers are more vocal about the needs of their family members. 

Staff members underpaid 

“The work (at nursing homes) is incredibly challenging, it can be really rewarding but the rates that most of the day-to-day caregivers are paid are not that different from what they might get paid at Walmart, or working at a hotel or at other retail establishments or fast food restaurants,” said David Grabowski, professor of Health Care Policy at Harvard Medical School. 

Jackson said she is working two jobs at two different nursing homes to help support family. 

Dumas said that nursing homes are paying staff members as little as possible to do as much as possible. He said being overworked and underpaid can also take a toll on the staff’s physical wellbeing, as people sometimes have to pick up extra overtime for more money. 

“We’re always stressing ourselves out and put in a position where we’re physically burning ourselves out,” he said. “Personally, that’s happened to me multiple times, and burnout is something that happens very often in nursing homes. Everyone in the nursing homes can relate to that.”

Grabowski said nursing home operators often struggle to find individuals who are willing to do the challenging work given its level of pay, as it is often near minimum wage. 

A big source of labor in many markets has been new immigrants, Grabowski said. Tighter immigration policies could add to the challenge of finding staff for nursing homes. 

 One concern by the state is that when they increase funding to the nursing homes, the money doesn’t seem to be going to improving staffing. 

However, an Illinois legislation passed in late 2019 requires the state to obtain payroll data to ensure the facilities are meeting the standard of care. 

Illinois requires at least 2.5 hours of direct care each day for the residents. However, The Chicago Tribune reported in June 2019 that an investigation has found that at least a quarter of residents in the Chicago-area nursing homes are not receiving the mandated minimum. 

The legislation stated that nursing home that fails to meet the standard will start receiving fines by 2021. The legislation also boosted Medicaid funding by $240 million to help facilities reach the standard of care, of which $70 million is designated to address staffing needs. 

“(The staff is) often the most important part of our long-term care system, our nursing home system, but they’re paid the least and they’re valued the least,” Grabowski said. 

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