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State Faces a Nursing Home Crisis

Indiana has the highest number of poorly performing nursing homes

Indiana State News December 2010

Photo by Andrew Spear/Aurora Select

Teresa Story, of Muncie, was appalled at the shortage of staff during her parents' stays in three Indiana nursing homes. Federal rankings indicate Indiana has the most poorly performing nursing homes in the country.

Teresa Story met caring workers when her parents, Evelyn and Glynson Story, were in three Muncie nursing homes. But understaffing, she said, short-circuited good care.

Her father was in two homes. In the first facility, two certified nursing assistants sometimes cared for 20 or more dementia patients, several of whom were physically incapacitated, as he was. The second home was not only understaffed, but didn't provide adequate end-of-life care.

"I was just appalled at the lack of attention and care he received as he was dying. I had to ask for everything," she said. Glynson had "horrific pressure sores" when he died in 2006.

When her mother was admitted to a nursing home in 2009, no health care professional did an assessment, Teresa said. At one point, she found her mother unresponsive and had her admitted to a hospital in a coma. Hospital staff told Teresa they'd never seen such severe dehydration. Teresa questions how the nursing home staff could have overlooked Evelyn's condition.

In 2009, Indiana had more poorly performing nursing homes, 52, than any other state, according to a U.S. Government Accountability Office report. The federal Centers for Medicare & Medicaid Services (CMS) found only 57 of Indiana's 500-plus nursing homes without deficiencies. Forty-six were cited for immediate jeopardy, meaning residents had been seriously injured, harmed or had died.

Robyn Grant, former long-term care policy director for United Senior Action of Indiana, said residents and families repeatedly report that staffing is "often not enough to meet even the most basic needs." Indiana's requirement? Facilities must have "sufficient" staffing to meet residents' needs.

Indiana nursing homes average 2.9 hours of direct nursing care (which includes all levels of nursing staff except the director of nursing) per resident per day. A CMS study found that care for less than 4.1 hours, including at least 45 minutes of care by a registered nurse, raises the chance of malnutrition, dehydration, pressure ulcers and hospitalization.

To solve care problems, United Senior Action has called for numerous reforms including:

  • Setting minimum staffing standards;
  • Reducing the annual turnover rate ­ — currently 98 percent — among nursing assistants;
  • Raising penalties for poor care;
  • Tightening licensing requirements for new facilities or when ownership changes; and,
  • Promoting small homes with a maximum of 10 residents.

All are measures AARP hopes to see adopted by the state. AARP is also hoping the legislature will pass a bill that would require a nationwide criminal background check for many workers in medical fields — including nursing home workers — seeking a state license.

Quality of care is AARP's top nursing home concern, said Paul Chase, associate state director for public policy. One necessary step is updating nurse assistants' training, requiring more hours and adding subjects that weren't relevant when standards were developed years ago, he said.

Who to contact when encountering problems>>

The Indiana State Health Department and trade groups have been working to improve conditions and have seen some success. By September, the number of CMS immediate jeopardy citations dropped from 46 to 25 and the number of facilities without deficiencies rose from 57 to 66, according to Terry Whitson, state health department assistant commissioner.

The Indiana University School of Public Health is in the early stages of developing a curriculum in long-term care administration, in cooperation with nursing home trade groups, said Scott Tittle, president of the Indiana Health Care Association.

Families encountering problems in Indiana nursing homes can contact the state's long-term care ombudsman at 317-232-7134 or 800-622-4484.

Families encountering problems in Indiana nursing homes have resources inside and outside the facility for help. Here is a sampling, from the United Senior Action Foundation.

Inside the facility:

  • Use the facility's grievance procedure.
  • Raise concerns at the next care plan conference or request a special conference.
  • Discuss the problem with supervisors, department heads or the administrator.
  • Take the concern to the family council.

Outside sources of help:

Rosalyn Demaree is a freelance writer living in Atlanta, Ind.