Unveiling the Nursing Home Staffing Crisis: Insights from the Consumer Voice Report
Is your loved one safe in their nursing home? The staffing crisis might be putting residents at risk. In this weekâs episode, nursing home abuse attorney Rob Schenk welcomes guest Lori Smetanka to talk about the latest findings from the Consumer Voice Report and what it means for resident care.
Schenk:
The impact of understaffing on nursing home residents sticks around. Hey out there. Welcome back to the nursing home abuse podcast. My name is Rob. I will be your host for this episode. In this episode, we are going to be talking about a recent report published by the national consumer voice for quality long term care. About. understaffing and its effect on the quality of life of nursing home residents all across the country.
We’re not doing that alone. We are doing that with a fantastic guest. This is a reoccurring guest. We’ve had her on at least a few times. Lori Smetenka of the national consumer voice will be joining us today to walk us through the report and its findings.
As we mentioned at the top of the show we are going to be talking about a particular report based on a study done by the national consumer voice for quality long term care about understaffing and its effects on the residents of nursing homes everywhere.
And, but we’re not doing that alone. We’re going to have the executive director of the national consumer voice on this. Today, and that is none other than Lori Smetanka. She’s, as I mentioned, the executive director, is a prominent advocate for long term care consumers with vast expertise in nursing homes and long term care policy.
She testifies before Congress. And collaborates with federal agencies. Previously, she directed the National Long Term Care Ombudsman Resource Center for 12 years. Lori’s dedication to advocating for individuals receiving long term care and services is widely recognized nationally, and it’s at least recognized on this show. And so we’re so happy to have her back. Lori, welcome to the show.
Smetanka:
Great to be here. So nice to see you. And thanks for having me.
Who are the National Consumer Voice for Long Term Care?
Schenk:
All right. I, we were just talking about this right before we hit record, but the last time you were on the show, we were still doing telephone calls. That was how, you got to call in and we don’t see each other. So this is a welcome change. And I’m glad to have you back.
Smetanka:
Thanks to be here.
Schenk:
The primary reason why I wanted to have you back is because consumer voice recently did a study and a report. on the issue of chronic understaffing in nursing homes and how that affects care. And so I just wanted to ask you first, can you give us a brief overview of what the national consumer voice is, and then talk about when this, when the study was done, who did the report, just the basics of it, and then we’ll get into the substance.
Smetanka:
Sure, absolutely. The National Consumer Voice for Quality Long Term Care is a national advocacy organization. We’re a non profit group. We’re almost 50 years old. Next year is our 50th anniversary. And we work to improve quality care, quality of life, and protection of rights for people that receive long term care and services.
A lot of our work focuses on nursing homes and assisted living. We work with and on behalf of the people who receive services and care in those facilities. We work to empower them so that they can self advocate and help them understand what their rights are, where they can get information. But we also work in the policy arena. We promote policies like laws and regulations that are in place to help protect and support quality care and quality of life.
When is the National Consumer Voice annual Conference?
Schenk:
And you guys have not to interrupt you, but I always interrupt everybody, but you have a fantastic annual conference and I’ve been to that I think once or twice and it’s a really great conference to to learn and to meet people and to meet the advocates. It’s it’s wonderful. Can you just really briefly talk about that as well?
Smetanka:
Absolutely. And we have had the pleasure of having you present at our conference in the past. It is a time when we have advocates from all over the country come together and learn about the hot topics of the day, and learn about advocacy strategies.
Not only from National and state experts, but also from each other where they can share best practices and get energized from their peers from around the country. This year, our conference is actually going to be in San Francisco. It’s the first time we’ve been out of the Washington DC area in more than a decade.
But it will be at the end of September 23rd through 26th. And we are planning a fantastic program and hope that your listeners will want to join us and hope you will as well.
What does the National Consumer Voice report tell us about understaffing in nursing homes?
Schenk:
Absolutely. And I’ll we’ll have a link to the that landing page. If you want to learn more about the consumer voice conference and our show notes. And I really strongly recommend if you haven’t been before to go check it out. I’ve only been, I’ve only been into it Washington, D. C., so I’m sure it’s going to be off the chain being in San Francisco. That sounds like a lot of fun.
Smetanka:
People are excited. Yeah.
Schenk:
Yeah. Okay. So let’s dive into the report. Just I’ll just give you the floor on that.
Smetanka:
Sure. Thanks so much. Short staffing is understaffing is, we think the biggest issue in nursing home care today is preventing residents from receiving quality care and experiencing quality of life. It is the one. primary thing that overarchingly affects the level of quality that people receive.
It affects the outcomes that people have. And so we have been advocating for stronger staffing levels in nursing homes for a very long time. Until just recently when the federal government actually just A couple weeks ago, released new federal minimum staffing standards. There had been no minimum federal requirements around how much staff needed to be in nursing homes.
And what we have seen, and I’m sure you’ve seen in the work that you do, Rob, is that there are far too many nursing homes that do not have enough staff. And I think it’s really important to recognize that there are not enough staff. In fact, what the data show is that nearly 75 percent of nursing homes do not have enough staff to meet all of their residents’ needs.
So one of the ways that we try to highlight the impact of that on people’s lives is to ask them to hear from residents directly about what staffing looks like in their facilities. How does it impact them when there are not enough staff available? And we’ve done a number of things over time. We’ve had dialogues with residents.
We do podcasts with them as well. We’ve shared their stories and video clips. But last fall we did a short informal survey. We put it out into the world where we asked nursing home residents to respond to a few questions about what does understaffing in their facilities mean to them. So first we asked whether or not they thought there was adequate staff in their facility.
And. 88 percent of the residents responding, and we had 120 residents from across the country respond to our survey, but 88 percent of them reported that they did not feel that they had adequate staff in their facilities to meet their care needs. 87 percent of those felt that the understaffing affected.
them every day or several times a week. So it impacted their life or their care in some fashion, either on a daily or a weekly basis. And the results that we found were pretty shocking. We asked about things like, did they were there enough staff to help them get out of bed in the morning? Or did they have to stay in bed too long?
How did it affect their meals? How did it affect their medications? Did it affect their ability to participate in activities? Did it affect their showering, for example? So we asked about, things that we all take for granted on a daily basis in terms of things that are important to us and how we live our daily lives.
And some of the results, were pretty shocking. Not only did 88 percent of them say there wasn’t enough staff, 72 percent of them said that they Have to wait to get out of bed in the morning. In fact, we even had we had a number of people who wrote in comments that said, I haven’t been out of bed in 3 days.
We’ve had residents say, I’m only allowed to get out of bed 3 times a week because there are not enough staff to get me out. We’ve had we had a number of them say that, more than almost 75 percent of them said they miss activities because there’s not staff to help them participate. So that means they can’t, go to participate in activities.
They can’t even sometimes go to doctor’s appointments because there aren’t people to get them ready. Almost 60 percent of them said they’re not being given their medications on time. And they’re living in pain for longer than, They should be in their medications are late, which is impacting their health and being.
And 74 percent of them said that either they or someone they knew in their facility had been neglected or hurt because of understaffing. Those are just really outrageous numbers. And it really highlighted. The impact that staffing does have on everyday life.
How was the report and survey conducted?
Schenk:
How was the how was the survey conducted? Did did you say these are mailers? Like how did you acquire the information from these residents?
Smetanka:
We we put it out electronically actually increasingly there are residents that do have access to computers that participate on social media. We have a number of residents that engage with us.
And our part of our our database and our mailing list that have participated on webinars with us. And we did ask some specific questions in order to ensure that it was residents that were responding, not people responding on their behalf. Sure. Because we wanted residents to respond. And so we did get 120 people.
We put it out on Through a blast and asked ombudsman to share it with residents and said to the people that we connect with as well.
Schenk:
That’s some amazing statistics. It’s like overwhelming dissatisfaction and that’s just among a, the residents that responded, but be residents that would be.
able to respond, right? Exactly. Who knows what the statistics would show if you were actually able to, through the resources through, through more resources to survey a larger statistical population what that would look like. I’m assuming it had to be much worse. So what do you, obviously the, one of the purposes of the report is to understand.
The perspective of the resident, right? But now what what are we doing with that data?
Smetanka:
We did this because, we have been for, as I mentioned for years, but specifically over the last year and a half, we’ve been in a real battle. federal rules in place that would require minimum staffing standards.
And so they were just released. We can probably do another whole episode on that, but they, they didn’t say exactly what we wanted. They weren’t the levels that are being required or not as high. As we would like but one of the things that is required under law and is still required under even these new regulations is that facilities provide sufficient staff in order to meet the needs of the residents that are in their care.
And so that’s really what we need to be hooking on to and promoting and pushing for in order to ensure that people can actually get the care and services that they need. So we use data and stories like this. This in order to really push policy issues to push for better advocacy to raise awareness media with policy makers with media, for example, on what does this mean for the actual people that are in the beds living in the facilities?
And so we’re using it for those purposes. We want residents and families to use this too, to do advocacy in their facilities. And to really push the licensing agencies to enforce understaffing because that’s not happening as much as possible, but also to, again, raise their own stories about what understaffing means for them so that we can, push for better policies and push for better enforcement and hopefully ultimately achieve quality care for all residents.
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Schenk:
I think that what you said about there prior to the new regs, the, that the nursing home was required to meet the minimal needs, the psychosocial, the medical, the nursing needs of every resident that in my opinion, is something entirely different. then a minimum staffing standard.
Because exactly because what the nursing homes in my experience do is they will say Rob, we’ve met the minimum staffing centers, at least in Georgia, which most the time they haven’t. We’ve met the minimum centers. What do you want us to do? It’s that’s the minimum. Like you can meet the minimum.
but not be at the level where you’re providing everyone with the adequate care to meet their needs. And it’s it’s two different things. Now, I think it’s wonderful that the consumer voice did the report and in a way affected the Biden administration increasing this or actually increasing it in terms of that, what it is in but but I think that it’s, Where the rubber meets the road is, do they have enough people to take care of the resident population based on the acuity of the population?
Absolutely. Yeah.
Smetanka:
And that’s a really important point that you raise. And, there’s been a lot of pushback on whether there was even a minimum needed. And, our argument for pushing for that is there has to be a floor below which you cannot go, right? Because we see too many nursing homes that without without better guidance and criteria, Just Bob them out, and they’re not, providing anywhere near what is necessary.
And we don’t believe that what’s the numbers that were put in effect are high enough for most residents. And so it is an opportunity to really hook in more into what does that necessary staff mean? What do those acuity numbers look like? And how can we promote better staffing based on acuity? So you’re absolutely right.
There are two different things and we need to be really focused on. Making sure there’s sufficient staff and I think the report helps in a little bit of that way because it helps people focus in on what are some of the things that really do affect not only quality of care, but a person’s quality of life and their daily life and what kind of staff is necessary for that
Schenk:
And to me, that’s a really important point. Number one is that your report puts things in story form, and that’s a way for most people to really intake information is, oh, it’s one thing to say that 60 percent of people, maybe get a pressure injury or whatever these are things that can sometimes be abstract, but when it’s like, in their own words, you’re hearing whenever I don’t get my pain medication, am around.
I’m my arm hurts, right? That’s that really puts the things in your mind like you can really envision that this is going to seem like an insane question. But have you received any type of feedback from the industry? Has the industry? know, this survey is no good. Like it, it’s not right.
Blah, blah, blah. Has there any, has you ever, has there to your knowledge, been any pushback with what y’all have done?
Smetanka:
Not on this survey. We have not. And when we raise resident experiences. You can’t argue with what a person’s experience is, right? And the industry has not challenged us on the resident stories that we’ve been raising.
And I think that’s been one of the things that we’ve really tried to highlight because, when they talk about the barriers for them to hire more staff, they talk about lack of money and they talk about, lack of. people to hire and, all of those things. But the bottom line is we really, certainly, we’re, and we are addressing those issues in different ways.
And, we can talk about that if you’d like, but the bottom line is, a nursing home, when it accepts Medicare and Medicaid dollars, when it accepts a person for which they say they’re going to provide care for under contract or through certificate, certification that was whatever.
They agree to meet certain standards. They agree that they’re going to meet the federal standards to provide the care and services that person needs. And if they can’t, then that is a big problem. They’re being paid for the ability to provide those services to those individuals. And when you have 88 percent of People saying that there are not enough staff to meet their daily needs when people are telling you they’re not being gotten out of bed when their food arrives cold and is and sits there for a half an hour because there’s no one to help feed them when they’re not being showered because there aren’t enough staff.
Those are regular things we hear on an ongoing basis. It really makes you wonder not only where is the money spent that we all of us are paying into the system, but it really does question the ability of these facilities and what they’re doing and. How they’re spending their money, and the focus needs to be on the people that they’re caring for.
That needs to be the focus.
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How does understaffing affect resident care?
Schenk:
And that’s something that I think is forgotten, and especially by me, because I was going to ask this question before, but I forgot it. But, what this report does is, as you mentioned, is re emphasize that it’s not just about Someone being physically injured because there’s not enough staff, whether they want two people should have done a a tra a transfer and only one.
And therefore there was a fall or somebody didn’t get their medication and therefore suffered some type of injury. This report really highlights that’s not the only injury that you get at a nursing home, right? Dignity. and respect and not getting any respect. Those are also injuries. These are things that should not be happening to people.
So some there’s more than likely a group of people out there that here. The resident doesn’t get out of bed on time. So what? That is a dignity issue. That’s a respect issue. And as you mentioned, if they’re taking CMS dollars, they are required to meet not just the physical needs and making sure they don’t drop the people or give them pressure injuries, but to meet their psychosocial and dignity and respect needs as well.
Like it’s, if you’re going to take the resident you protect them from all those things. Okay.
Smetanka:
Exactly, and there’s a big difference from saying I had to wait an extra 15, 20 minutes, maybe even an hour, to get out of bed this morning because they were run, staff were running behind.
They got caught up with another resident providing care. I didn’t get up at six o’clock, like I I had to wait, a little bit longer. It’s another thing to say, I’m only allowed to get out of bed three days a week because there are not enough staff to help me get out of bed.
That’s a completely different thing. That means that during those other days, that person is at risk for not only quality of life issues in terms of not being able to participate in activities and interact with friends and other people and, do the things that she wants to do, but it also means that she’s at risk for health issues from sitting in bed.
All day pressure ulcers and pneumonia and, all of the other things that could be affecting her from, laying in bed on an ongoing basis. So there are a lot of effects that we hear from the lack of care that’s being provided and the stories that are being provided, including.
The lack of dignity issues. And, so many residents that we talked to the very first thing that comes out of their mouth when we ask them about, how do they want to be treated? What does the lack of care mean to them? They talk about the dignity. They talk about wanting to be treated the way any of us would want to be treated.
So think about, how would you feel if you were told you had to stay in bed for, until two o’clock in the afternoon, because nobody could help you or, you you couldn’t have a shower for three weeks because there was nobody to, help you, shower, whatever the issue is that’s what residents tell us.
And what we were trying to do with this report and with the stories that we tell is to really humanize what’s going on out there and take it out of the numbers game, even though we have numbers in the report, but take it out of that and really start to humanize some of these issues.
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Schenk:
Where can families that are interested in learning more about Consumer Voice and more about this report and more about nursing home advocacy in general, where can they go to get more information?
Smetanka:
They can go to our website, which is the consumervoice.org and they can get a copy of this report online, as well as advocacy tips and strategies, information for where to get help, including for their long term care ombudsman.
They can also use this report. To, help advocate in their own facilities and connect with resident and family councils. We have information about that on our website as well. And we really encourage people to read it and use it and think about how they can tell their story and we’d be happy to work through with them on, how they can use the report in their own advocacy, both at their facility level and in their community.
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Schenk:
Simply fantastic. Lori, thank you once again for coming on the show and sharing your knowledge. And we appreciate the great work that you and your organization are doing.
Smetanka:
Thanks so much. Always a pleasure to see you and look forward to talking to you again in the future.
Guest Info:
- Lori Smetanka LinkedIn
- theconsumervoice.org/
- Louriechance on X