Last year, complaints about nursing homes in North Carolina reported to the state were up 27% from 2016. Missed medications. Untreated medical conditions. Call bells that are out of reach. And smaller meal portions, including one resident who said he was given only half a hot dog. These are some of the alleged problems found in Mecklenburg’s nursing homes by the county’s nursing home advisory committee. Members of the committee laid out their findings in a story published this week in the Charlotte Ledger Business Newsletter and North Carolina Health News. Michelle Crouch was the reporter on that story and she joins WFAE's Marshall Terry to discuss.
Marshall Terry: OK, Michelle, I mentioned a few of the things that these committee members told you they found, but there were other things as well. What were they?
Michelle Crouch: Yes. So these advisory committee members are volunteers who make unannounced visits to nursing homes. And they have to visit each nursing home in Mecklenburg County four times a year. They talked about patients who waited hours for someone to come and help them when they needed help. They talked about activities that were planned and posted, but that just weren't happening, you'd show up and nobody would be there. They talked about never getting out of bed. Some of these committee members, they visited one nursing home where almost every single resident did not have access to a call bell to get help if they needed something. In many cases, the people working in these nursing homes are temporary workers. They don't wear name tags. They don't know residents' names. They don't know their preferences or what their needs are. There were residents who told these advisory committee members that they might go a whole day without a smile from anybody on the staff.
Terry: So what's going on with all this?
Crouch: The big issue is staffing shortages. The frontline workers in nursing homes are CNAs. These are the caregivers who are providing direct patient care. They're doing things like changing patients' adult diapers or taking them to the bathroom, bathing them, getting them dressed. They're the ones who are responsible for getting these residents out of their beds and into their wheelchairs and out to the activities. Sometimes they're feeding them. This is really hard work and they don't make any money. The caregivers in nursing homes now are making less than what they could make by going to Amazon or Walmart or Target. And so nursing homes are having a real struggle trying to keep and retain workers, especially in today's labor shortage.
Terry: Nursing homes got a lot of attention as centers for COVID outbreaks during the pandemic, but they've kind of fallen off a lot of people's radar, I think. How does what's happening now relate to COVID?
Crouch: COVID hit nursing homes really hard. They had very high rates of death. There were more than 3,900 residents of nursing homes and similar facilities who died of COVID through the pandemic in North Carolina alone. And because of those high infection rates, workers fled. So it really just exacerbated staffing shortages that had already been going on in nursing homes for years. The other thing that happened is a lot of family members, because they knew that nursing homes were shutting down during the pandemic, they pulled their family members out. And so nursing homes are also suffering from lower enrollment. They have fewer residents on the day before, and that's creating a price pinch as well.
Terry: Does this have the attention of state officials and are they doing anything about it?
Crouch: Yes, the Department of Health and Human Services is responsible for overseeing nursing homes. They have a team of inspectors that is responsible for going out and investigating complaints. And so when these advisory committee members in Mecklenburg file a complaint or any family member or resident files a complaint with the state, it's their responsibility to go out and find out what's really going on. But unfortunately, they're also dealing with their own staffing shortage. In fact, 15 of the 97 inspectors, 15 of those spots are vacant right now. As a result, it can take months and months and months for them to come out and investigate a complaint, which is leading to frustration among the residents and concerns that some of this negligence is not being investigated or taken care of.
Part of the reason for the shortage of state inspectors is pay. These inspectors are mostly registered nurses and their salary, right now, their average salary is about $68,000. What the Department of Health and Human Services tells me is that they can make $20,000 more working for a hospital or another health care related organization. And so it's really tough for them to compete. Right now, the turnover rate for these state inspectors is about 33%. What that means is after the state goes through all the trouble of training one of these people and teaches them what to look for when they go to a nursing home. About one out of every three is leaving within a year of starting on the job. So state health officials have asked for more funding to hire more inspectors, to increase their pay, to give them signup bonuses and even to give them some longevity pay. And Gov. Cooper did include a lot of that in his budget. The Senate and the House are working together to come up with their budget. And as of now, it's unclear how much of that is going to be in the final North Carolina budget.
Terry: So that's the state level. What about the federal level?
Crouch: Well, this is also a concern at the federal level. It's not just happening in North Carolina. The U.S. Senate Special Committee on Aging actually did a yearlong investigation and they published the results in May. And they found that across the country, nursing home complaints are not being investigated in a timely manner and that nursing homes are not getting their annual inspections and many of them are behind. So they are also looking at a funding boost to help solve this problem.
