Nursing home solutions: Fines? Staffing? Culture?

Gail Maurer, head of the Michigan Long Term Care Division.


LANSING, Mich. (WOOD) — The details have been graphic: Nursing home patients dying of medication mistakes, of poorly treated bedsores, from falls that shouldn’t have happened, or, in one case, being allowed to choke to death.

Target 8 uncovered mistakes that caused or contributed to 112 deaths over three years at Michigan nursing homes — numbers that surprised even the state agency that inspects nursing homes.

Target 8 also found a state frustrated with federal authorities and nursing homes that say harsher fines aren’t the answer.

The obvious question is: Would it simply be enough to just hire more nurses and nurse’s aides?

CASHIER WAGES

“Everywhere you go, you’re going to have staffing issues — everywhere, unless you’re paying $18 to $20 an hour. But you’re not, so you’re always going to be short-staffed. Always,” a former nurse’s aide told Target 8.

The aide, who didn’t want to be named, said all four of the nursing homes where she has worked were understaffed, including Laurels of Sandy Creek in Wayland, where a mistake in May 2012 led to a death and a $101,000 fine.

She said she has never made more than $11 an hour — about what a grocery store cashier makes — and said she cared for up to 14 patients at a time at Laurels.

“This is a tough job. You really have got to have your heart in the right place when you’re working with elderly,” she said.

While federal records show staffing at Laurels of Sandy Creek is average, patients there still get 13 minutes per day less licensed nursing care than at the average Michigan home. They also get a half-hour less of nurse’s aide care a day.

“It’s sad,” the nurse’s aide said. “It means it’s taking time away from them.”

The average Michigan nursing home provides 1 hour and 41 minutes of licensed nursing care and 2 hours and 24 minutes of nurse’s aide care daily for each patient — a few minutes more than the national average.


“The more staffing you have on the front lines of nursing homes, the safer the residents” — Brian Lee, Families for Better Care


But the head of a national nursing home watchdog group said that’s not enough.

Families for Better Care gives Michigan an F for nursing home care and ranks it fourth worst in the nation, in part because of its high number of serious violations. Families for Better Care Executive Director Brian Lee blames that mostly on what he calls mediocre staffing levels.

“The more staffing you have on the front lines of nursing homes, the safer the residents,” Lee said.

CULTURE CHANGE

The head of the state agency that inspects nursing homes says it’s more about training and culture.

“You can have six people standing around the nurse’s station or you can have every person out talking to people,” Gail Maurer, director of the Michigan Long Term Care Division, told Target 8. “It doesn’t matter how many people you have on board if you don’t have the right culture.”

The wrong culture, she said, leads to mistakes.

On Mother’s Day 2013, a woman stopped breathing after eating soup at Medilodge nursing home in Southfield. The unit’s only nurse was eating lunch in her car, and nobody was filling in. The woman’s daughter scrambled to find help. Ten minutes later, another nurse ran in, but the suction machine he hoped would save her wasn’t working, federal records show.

“What does that tell you about the culture of the facility that that would be acceptable?” Maurer said.

Despite the troubles, Maurer said she believes nursing home care in Michigan is turning a corner. Complaints dropped 15% in the last year. The state, she said, has streamlined inspections based on a Michigan law passed in 2012.

Still, in the worst cases, she wants harsher fines — but said that’s up to the federal Centers for Medicare and Medicaid Services (CMS), which has the final say on those penalties. The most the CMS can charge is $10,000 a day, which it hasn’t changed for years.

The feds base fines on how serious the case is and a home’s history. The longer it takes to fix the problems, the bigger the hit.

IN THE RIGHT DIRECTION

The association that represents most of Michigan’s nursing homes says it would consider boosting minimum staffing, but opposes bigger fines.

“This sector of health care has been fined, has been put out of business, has seen all manner of sanctions over the years,” David LaLumia, President and CEO of the Health Care Association of Michigan, said.

The association, he said, works closely with homes to make them safer.

“It is an important issue and we should see a decline in serious adverse events if our quality improvement is effective. And I believe that it is, and I believe that we’re going to see it,” he said.


“We’ll always have adverse events, but the good places, the great places are the ones that learn from that” — David LaLumia, Health Care Association of Michigan


While acknowledging there are too many “adverse events” in Michigan nursing homes, LaLumia refused to believe that the state is fourth worst in the nation for nursing home care. He said the group that ranks the states — Families for Better Care — is funded by an attorney known for suing nursing homes.

“That group has no credibility with us,” LaLumia said.

Tax records from 2012 show that Families for Better Care got $130,000 in contributions from a Florida law firm that specializes in nursing home abuse.

That aside, an analysis of Medicare.gov records shows Michigan is tied with Arkansas for 10th in the nation in the number of serious deficiencies per home over the last three years and second in the number of nursing homes fined.

LaLumia said the industry is going in the right direction.

“It’s not there yet,” he said. “The one thing I’ve learned about quality improvement is that it will never be there, because quality improvement is not an end, it’s a process, and we’ll always have adverse events, but the good places, the great places are the ones that learn from that.”


“You just won’t find any of my family there.” — Gail Maurer, head of the Michigan Long Term Care Division


The state says any change in how Michigan and the feds police nursing homes would require legislation.

Maurer, the nurse who oversees the Michigan Long Term Care Division, said there are homes in the state where she would not place a relative, though she wouldn’t name them.

“You just won’t find any of my family there,” she said.

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Inside woodtv.com:

Target 8 investigates nursing homes

Compare Michigan nursing homes or file a complaint

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