From unchanged diapers to cold food, families share concerns about Schenectady nursing home

2017-12-17 | Superior Telegram

Dec. 16--Growing concern over quality of care at one of the region's newest and largest nursing homes has prompted dozens of residents' families to demand improvement.

Scores of relatives crowded into the Schenectady Center for Rehabilitation and Nursing during a Wednesday evening meeting, sharing complaints that ranged from unchanged diapers to food going cold before it could be served.

The common factor underlying most of the grievances was staffing: Many relatives say the 240-bed facility just does not have enough people working there in recent months.

In the observations of five residents' relatives who spoke to The Daily Gazette, the decline began in late summer, as Schenectady-based Capital Living Group prepared to sell the Altamont Avenue facility and six other nursing homes to Bronx-based Centers Health Care. The for-profit entity operates dozens of facilities in New York, New Jersey and Rhode Island, and announced Sept. 6 that it had completed the acquisition of Capital Living's nursing homes.

The 526 Altamont Ave. nursing home, previously known as Capital Living Nursing and Rehabilitation Centre, was Capital Living Group's flagship facility, built in 2013 at a cost of $39 million and totaling 161,000 square feet. Physically, it remains a very nice place to live or undergo therapy or just visit a loved one.

The concern raised is over the quality of care delivered within its gleaming corridors.

THE MEETING

The families' meeting Wednesday with management came together through word of mouth, without a main organizer or a notification campaign, according to one man who attended. It was pushed back a week from Dec. 7 to Dec. 13 with no explanation to him, but the later date apparently allowed word to spread. He counted 36 non-employees in attendance Wednesday night, but more arrived after he stopped counting and the meeting started.

Another family member counted exactly 66 people in attendance, and said she knew of others who wanted to attend but couldn't make it.

The company said it collected 43 names on a sign-in sheet.

The meeting was scheduled to start at 7 p.m. and ran past 9 p.m., as one relative after another shared complaints, concerns and, in some cases, horror stories.

A day after the meeting, Karen Bednarowski of Rotterdam, whose mother, Betty, is a resident in the dementia unit, listed a few things she's seen at the nursing home herself:

* Bedridden seniors screaming for help for 30 to 60 minutes before assistance arrives;

* Too few people to assist residents who need help eating;

* Employees assigned to the dementia unit not knowing how to deal with the special needs of residents there;

* Long resident waits for assistance getting to the bathroom.

"How do you tell a 97-year-old woman she has to wait to go to the bathroom?" she said.

Barbara Miller of Rotterdam is of an age at which she should still have a few years before having to worry about her parents' care. Instead, she found herself thrust into the world of long-term care in 2010, when her husband, Thomas, fell off a roof and suffered a catastrophic head injury.

She now balances her career, her three children, and the role of advocate/caregiver for her 49-year-old husband, who has sharply limited physical abilities and mental awareness.

Miller moved him to what was then Capital Living in 2013, and was happy with the care he received, but says it has gone downhill recently. Some of the changes have been alarming, others have been heartbreaking, she said.

It's probably impossible to say whether more or better-trained aides could have prevented the four sepsis episodes Thomas Miller suffered in the last seven months, but there's a 100 percent corelation between the facility's switch to a thinner, cheaper diaper and the sudden increase in leakage he and other residents started experiencing this autumn, she said.

"I've come in to find my husband soaking wet," Miller said. "Even his hair was wet with urine."

She now buys her own diapers for him, thankfully not out-of-pocket: He had really strong insurance at the time of his accident.

The five family members and one staff member who spoke to The Daily Gazette all said the facility smells worse and the residents are wet more often after the facility switched to cheaper diapers and kept fewer staffers on hand to change them.

THE RESPONSE

Centers Health Care would not allow The Daily Gazette to attend Wednesday's meeting at its Schenectady facility, citing concern for resident/patient privacy.

However, it defended itself via email from the allegations of declining quality of care, noting high marks on both state and federal report cards for the Schenectady Center for Rehabilitation and Nursing.

This is verifiable through state and federal online databases -- the facility got several five-star ratings for care -- but the worst mark was for a one-star rating staff-to-resident ratios. (Centers Health said this one-star staffing rating was based on faulty data submitted through human error.)

But a key limitation with these ratings is they are not real-time. They are months old. They would not reflect any improvements or declines in recent weeks after the facility switched management.

In its statement, Centers said:

"As a highly respectable 240-bed post-acute care facility on Altamont Avenue in Schenectady, the Schenectady Center For Rehabilitation and Nursing continues to thrive, strengthening their position to be the premier post-acute care facility of choice in and around the city of Schenectady, New York. The five-star quality of care speaks for itself."

Centers Health Care also responded to the staffing complaints, saying in one email that its staffing level was not ideal and saying in another email that it had not actively cut staff. It also said it would not lower its hiring standards to fill vacancies more quickly.

"Centers management works closely with all our facility leadership to achieve sustainable staffing levels in order to provide excellent care. In our experience we have found that maintaining a stable and capable clinical staff is more impactful than simply having more people in the building. Our budgeted staffing levels are slightly less due to the real-world nursing shortages that both long term and hospitals are faced with in the upstate and Adirondacks region. Centers Health Care would like to stress staffing numbers under Capital Living were less than perfect and that Centers has proven methods to be able to help stabilize staffing."

The company indicated it does use temporary staff from personnel agencies as needed to fill out its shifts but said many of the same temporary workers are assigned over the course of time, so they are not complete strangers to the residents.

Centers Health Care said the company is open and responsive to the complaints and concerns of its residents' relatives. (Bednarowski did say Thursday that she felt the facility managers were concerned and responsive at Wednesday's meeting, and they promised a meeting in early 2018 with officials from the company headquarters.)

The company said it will evaluate the needs of the facility and, if needed, make adjustments.

The company did not respond to a question from The Daily Gazette about diaper quality.

Centers Health Care said its policy bars it from disclosing how many employees and how many patients or residents it has at its Schenectady property.

The state Department of Health indicates the 240-bed facility was 97.5 percent full at time of survey, which would equal 234 residents.

THE CHALLENGES

Jim Clyne, president and CEO of LeadingAge New York, said the financial squeeze on nursing homes of all types is growing worse because of Medicare and Medicaid policies. His organization represents nonprofit nursing homes and other continuing care providers in New York, and it has seen 55 of its member nursing homes sold from 2011 to present. There are still a couple hundred nursing homes in New York state run by nonprofits or municipalities, including Schenectady and Albany counties.

"It's a challenging environment for anyone running a nursing home," Clyne said.

He said a big part of the problem is that the Medicaid reimbursement does not pay enough to cover the costs of care at a nursing home and hasn't increased in years. Also, he said, the state and federal governments are trying to move to a value-based care model, in which providers are paid for keeping people healthy rather than treating people after they get sick.

That's hard to accomplish in a nursing home, he said, because emergency room visits and hospital care are covered by Medicare while day-to-day care in the nursing home is covered by Medicaid. Neither funding stream accrues savings from the other, and neither pays for the improvements made by the other.

"It's hard to do value-based care when you have that split," Clyne said.

It is in this environment that nursing home operators must meet their expenses.

One after another, municipalities such as Fulton, Montgomery and Saratoga counties have sold their nursing homes rather than saddle local taxpayers with the operational budget deficits they were generating. After these transactions, the for-profit private-sector buyer must look for ways to leverage efficiencies, as the corporate euphemism goes -- cut costs by paying for fewer and/or less-expensive employees and/or materials.

When one for-profit is sold to another for-profit, as with Capital Living and Centers Health, the easier cuts may already have been made.

THE STAFF

Caught in the middle of all this is the staff of the nursing home.

Those who are compassionate will suffer as they watch their patients suffer. Any who aren't compassionate will still feel the stress of being pressed by patients, families and management to do more, faster.

Those who provide the hands-on personal care -- certified nursing assistants, dietary aides -- are often paid very little for their work, some as little as minimum wage.

Eloise Downs, 52, of Schenectady, a certified nursing assistant, has worked her entire career -- 30 years -- at Schenectady Center for Rehabilitation and Nursing and the facility it replaced.

She said since Sept. 1 there have been small cost-cutting changes (fewer trash bags provided, coffee makers removed) and larger changes: temporary staff instead of permanent staff and smaller total staff.

She said she has to care for 14 people now instead of 10.

"People don't realize how much the CNAs do in those facility. We do a lot. We've got to make sure they're safe and everything."

She, too, noted the changeover in the adult diapers being supplied in recent months: Thin ones with snaps that leak instead of thick ones with liners that work better but are, she assumes, more expensive.

"I think it's a dignity issue," Downs said. "They haven't said nothing, they pretty much just did it."

She finds the changes disturbing, because she cares about her patients.

"I like doing the work, nursing was my calling," Down said. "I haven't walked away -- I love my residents, too. When [ownership was] switching over, a lot of my residents were like, 'Are you leaving?' I said no."

This last vignette illustrates a sad reality about elderly people who are slipping physically and mentally: They cling to routine and familiarity, and can become upset or even agitated when it is threatened, as through a frequently revolved staff or disrupted meal and hygiene rituals.

The union representing Downs and some of the nursing home's other employees will be entering contract negotiations soon.

"It's our intention to resolve at negotiations some of the issues the families are presenting," Melissa Tambasco, Capital Region organizer for 1199SEIU United Healthcare Workers East, said via email. "Our mutual priority is quality resident care. We all recognize that good wages and benefits are the cornerstones of a secure workforce. Our union has seen time and again the importance that a fair workplace plays in reducing staff turnover and improving worker morale. The peace of mind that comes with decent pay and good benefits allows workers to focus on what they do best: provide loving dedicated care and comfort to the infirm, frail and elderly, who need it most."

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OFFICIAL OVERSIGHT

The New York State Department of Health is responsible for investigating complaints and incidents for nursing homes related to state and/or federal regulatory violations.

A complaint against a nursing home can be submitted in writing with a form available online at https://apps.health.ny.gov/nursing_homes/complaint_form/complain.action.

Alternately, complaints can be submitted through the Nursing Home Complaint hotline at 1-888-201-4563. It is staffed from 8:30 a.m. to 4:45 p.m. weekdays and will accept voicemail messages around the clock.

All complaints and incident reports received about nursing homes are reviewed by the DOH through the Centralized Complaint Intake Unit. If it determines a facility has failed to meet federal and/or state requirements, the DOH will issue a citation to the nursing home, which must submit and execute a plan of correction.

Alternately, residents and their families can reach out to an ombudsman. The state Office for the Aging employs one of these representatives in each county of New York to work on behalf of nursing home residents to prevent problems and help solve them when they arise. In the Capital Region -- Albany, Fulton, Montgomery, Saratoga, Schenectady, Schoharie counties -- the ombudsman is Catholic Charities Senior and Support Services, reachable at 518-372-5667. The OFA itself is reachable at 1-800-342-9871.

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REPORT CARD

The Schenectady Center for Rehabilitation and Nursing does quite well by some measures.

The nursing home comparison database on Medicare.gov gives it three out of five stars ("average") for health inspections and five stars ("much above average") for quality measures, but only one star ("much below average") for staffing. This yields an overall three-star rating that ranks it 13th among the 30 nursing facilities that Medicare graded within 25 miles of the 12303 ZIP code.

Centers Health Care disputes the one-star rating as based on data that was incorrect due to human error, but it has not been changed.

The main deficit in staffing appears to be the average time per day registered nurses spend with patients -- 28 minutes, much lower than state (45) and national (50) averages.

The number of minutes with a certified nursing assistant is much closer to state and national averages. The minutes with licensed practical nurses, licensed vocational nurses and physical therapists are each higher than the state and national averages.

However, there is no indication when these numbers were recorded. The most recent health inspection is listed as May 22, 2017, more than three months before the change of ownership, which is when some patients' families say the staffing began to shrink.

The New York state Department of Health maintains its own database of assessments of nursing homes.

For the period of Nov. 1, 2013, to Oct. 31, 2017, 167 complaints were lodged with the state against the Schenectady Center, or 72.4 per 100 occupied beds, much higher than the statewide average of 45.3 per 100 occupied beds.

However, the state cited the facility for only five deficiencies, or 2.2 per 100 occupied beds -- well below the 2.7 state average. One deficiency was cited in resident rights, one in "other medical services," and three in quality of care.

The facility received 23 citations, well below the statewide average of 34, and none of those citations were related to actual harm or immediate jeopardy, compared with 2 percent statewide.

The state took no enforcement actions against the facility from Nov. 1, 2007, to Oct. 31, 2017.

The state breaks its quality ratings down to 24 measures and gives one to five stars on each.

Schenectady Center got much-higher quality grades for short-stay patients (mostly five-star ratings) than for long-term (two to five stars.)

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ONE DAUGHTER'S STRUGGLE

Karen Bednarowski of Rotterdam brought her mother, Betty, to Schenectady Center for Rehabilitation and Nursing on June 16, 2017, after being her care provider for five years at home.

Like dozens of others, she attended Wednesday night's meeting between family members and facility managers to voice concerns about changes she's seen since Sept. 1, when the current owner took over. But she says the experience has not been all negative.

"I'm not completely unhappy," she said. "I do find a lot of benefit to the facility and the staff in general."

However, there are problems and they are significant, Bednarowski said.

"Some of the staff don't know how to interact with residents with Alzheimer's," she said of the condition that affected her late father and now her mother.

When their needs are not met, these residents can become agitated and start screaming, which rattles patients who aren't otherwise upset, such as her mother.

"She gets scared and stressed when she hears people screaming for help," she said.

Bednarowski spends several hours a day on-site and finds herself doing the work of staff members who are stretched too thin.

On Wednesday, she said, before the meeting, she wound up feeding a woman who couldn't feed herself because of what appeared to be Parkinson's symptoms. The woman was profoundly grateful, which produced a very nice feeling in Bednarowski, but she wonders how many times this happens each day.

"My siblings and I have taken a lot of other residents as surrogate parents because they don't have families coming," she said. Staff has reprimanded her at times for helping too much, she said, but the one employee in the dining room Wednesday gave approval, with thanks.

The situation isn't great for her mother.

"She doesn't know where it is, we call it 'the resort,'" Bednarowski said. That ruse is defeated when her neighbors have outbursts.

"She's a people person, she wants to help, that's where I get it from," Bednarowski said.

"She's afraid to speak up for herself because she's been yelled at."

Will she take her mother elsewhere? No. Not yet.

Bednarowski believes that the situation will improve, and anyway, moving would be extremely stressful for her mother.

"For the most part I think it's a great facility," she said. "I think it all boils down to staffing issues."

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ONE WIFE'S STRUGGLE

Barbara Miller of Rotterdam brought her husband, Thomas, to what is now the Schenectady Center for Rehabilitation and Nursing in 2014. He had been in various other care facilities since suffering devastating injuries in a 2010 fall, and still has extensive physical and mental impairment.

He's now 49 years old. He cried at news of his father's death and will laugh at jokes, but he won't betray any emotion at lying in a puddle of his own making. Nor does he speak.

"But he does understand," his wife said. "I know because I know him."

He becomes upset at his situation mainly when he sees her or one of their three children upset at it.

"When we first arrived at Capital Living they had just moved in the new building and everything seemed very good," Miller said, referring to the nursing home's former owner. "You didn't have to be concerned about getting hot meals."

In 2017, she said, quality of care has declined as staffing has diminished. She said she finds only a single aide on duty at times.

"I thought, 'how can you possibly do good care with only one aide?'"

Other things, such as dirty towels, are secondary concerns.

Miller said she spends a lot of time on-site and has developed a familiarity with the other relatives as well as a compassion for the staff, due to the amount of money they are paid vs. the amount of work they do.

"I know like 95 percent of the families," she said. "I have gotten to know most of the staff, even the agency staff. I don't know how they make ends meet, honestly.

"Nobody wants to come here," Miller said. "It's a physical, emotional job. They feel very unappreciated."

Her oldest child, Justin, is among them. He works as a dietary aide at the nursing home, but expects to return to college and build a more promising career.

Miller said she wants better not just for her husband but for the future.

"There's a fine line between profit for corporations and caring for human beings, and you don't cross that line," she said.

"We're all getting older. If we don't nip this in the bud, it's not going to get better."

Until then, God and faith keep the family going, Miller said.