MN confronts fatal falls in nursing homes

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I had to post this: Minnesota confronts fatal falls in nursing homes | StarTribune.com

State regulators might start issuing more citations when inspectors find mistakes that harm residents in Minnesota nursing homes, reversing a long-standing policy of ignoring previous errors if a home is in compliance with federal rules at the time of an inspection.

A top official with the Minnesota Health Department told state senators Thursday that her agency is considering changing practices after a Star Tribune investigation in November showed that regulators in neighboring states issue three times as many citations for substandard care as Minnesota regulators.

In a joint Senate committee hearing on fatal falls at nursing homes, chief regulator Darcy Miner acknowledged that the state was essentially "giving a bye" to nursing homes when it didn't cite deficiencies in cases of neglect. The Health Department enforces both federal and state nursing home regulations.

The newspaper also found that since 2002 more than 1,100 deaths were related to falls at Minnesota nursing homes. Less than 10 percent of those deaths were fully investigated by state regulators, leading some consumer advocates to question whether regulators were doing enough to reverse the trend, which has not shown signs of abating.

Viewcrest Nursing Home in Duluth is one home that escaped sanctions despite a series of falls that led to one death and serious injuries for other residents. In four separate incidents since 2005, inspectors found that the home failed to properly care for residents who fell. But the health department issued citations against Viewcrest in just one of the cases.

By not reporting all violations, consumers can get a distorted picture of the level of care at an individual nursing home. A popular federal website uses those reports to assign quality rankings.

Thursday's hearing also addressed concerns over low staffing levels at nursing homes, a frequent factor in the state's high rate of falls.

One nurses aide with 30 years of experience told senators that there aren't enough staff members on duty to safely care for nursing home residents.

"It is not unusual for alarms to be going off when both my co-worker and I are in the middle of helping a resident with something ... I am constantly hoping that whatever need is waiting at the end of the alarm can wait until I'm done with the task at hand," said Cheryl Dreyer, one of two night shift workers who care for 32 residents on the third floor of New Harmony Care Center in St. Paul.

In a statement, New Harmony administrator Trent Carlson said staffing ratios at his facility "are higher than state requirements."

By at least one federal measure, 75 percent of Minnesota nursing homes are understaffed, although both state and federal staffing standards are somewhat vague on staffing levels.

"We have a very high rate of falls in the state, but the bottom line is we do not have enough people doing the job and we have some lack of training," said Sen. John Marty, DFL-Roseville, chair of the Senate Health, Housing and Family Security Committee and a candidate for governor.

Marty said the state should invest more in nursing homes to bring staffing levels back up, but acknowledged that tight economic times would make it unlikely for the state to increase payment rates to nursing homes this legislative session.

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Also related: Shortage of nursing home staff blamed for falls in Minnesota | INFORUM | Fargo, ND

Some Minnesota nursing homes simply do not have enough employees to prevent residents from falling, two Minnesota Senate committees heard Thursday.

“I know we all hope to be independent until the day we die,” nursing assistant Cheryl Dryer said.

“There are not enough staff to make the dream a reality.”

Nursing homes report about 1,200 resident falls a year, Darcey Miner of the state Health Department said. But there are no state or federal guidelines on how large staffs need to be, she said.

The department recently increased the size of its investigative staff to 14 to better check on reports of falls and other problems, Miner said.

Senators took testimony on falls because of recent media reports emphasizing the problem. They took no action.

Dryer told of the 32-resident St. Paul facility where she works, explaining that she and a licensed practical nurse are the only two on the overnight shift. If they are helping someone, another resident who needs help must wait, she said.

Two people “do not have enough hands to provide care our residents deserve,” Dryer said.

Jane Ochrymonycz of the Alzheimer’s Association Minnesota-North Dakota chapter complained that nursing home workers “are forced to work at breakneck speed” and staffing already “is stretched to the limit.”

Limiting falls, she said, is important because they “often start the downward spiral.”

Denise Juday Barnett, however, said her nursing home and others have large enough staffs.

“Falls are one of the key issues we are working on,” said Barnett, a New Hope facility administrator.

Because of the type of people in nursing homes, older and frail, falls are to be expected, she said.

Restraints used to be a common way to prevent people from falling by preventing them from getting up by themselves. Now, it is more common not to restrain residents, asking them to call for staff assistance instead.

Patients always need to be involved in the decision to use restraints and other devices, Barnett said.

Sen. John Marty, DFL-Roseville, said the issue of falls is important because the population is aging quickly, and staff numbers are dropping because of government budget cuts.

“It is going to take more money, said Marty, a DFL governor candidate.