Nursing homes struggle with staff shortages. Here's how residents are affected

Erin Nolan
Times Herald-Record

GOSHEN — Robert McDonald, 80, proudly speaks about how his wife Constance, 78, had a successful career as a nuclear medicine technician in New York City. 

The couple married 53 years ago and lived in their native Brooklyn for several years before moving to Campbell Hall to raise a family. 

But since his arrival at Valley View Center for Nursing and Rehabilitation in early 2021, Robert said he's spent much of his time trying to care for Constance, who had been living there since the previous year. 

“I’ve had to feed her in bed because a nurse never came,” he said. “I get up every morning and make my own bed. I dress myself and take care of myself … but I mean I’m in a wheelchair. I can't pick her up and dress her. I get her dentures ready, I comb her hair. I do a lot by myself.”

Former Valley View Center resident Robert McDonald says a staffing shortage there meant his wife's needs were poorly attended. The couple moved out to another location in early April.

Valley View in Goshen is the Orange County-owned and run nursing and care facility.

McDonald doesn't have the qualifications or physical ability to fully care for Constance, he said. He did what he could and staff provided what he described as brief and apathetic care. Still his wife suffered multiple injuries which he said stemmed from inadequate care, including bed sores, a severely cut arm, congestive heart failure related to improper dispensing of her medication, and a severe urinary tract infection that progressed into sepsis and led Constance to a stay in the intensive care unit at a nearby hospital. 

But Valley View, according to its administrator Laurence LaDue, is doing everything it can to provide care for its residents as it faces an unprecedented shortage of workers. 

When asked about complaints of inadequate treatment, LaDue said he stands by his staff and cautions against basing assumptions about the quality of care at Valley View on one family's word. 

Nursing homes across the state have struggled with staff shortages for years. But the problem is exacerbated by what’s become a more than two-year pandemic. And this has often resulted in less frequent care for the tens of thousands of elderly residents of 614 long-term care facilities statewide.

“Valley View, like many other health facilities and specifically nursing homes, has struggled to hire new staff,” LaDue said. "As a result we have two and a half units closed, which results in about 75 less beds being utilized than normal. That's unfortunately 75 people in Orange County that aren't receiving services that they should be receiving because we don't want to take in more residents than we can care for.”

Valley View has approximately 360 beds, LaDue said, including the 75 currently not in use. The facility employs 232 direct care workers. 

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The pandemic and the problem

Stephen Hanse, president and CEO of the New York State Health Facilities Association, which represents hundreds of nursing homes, said these issues are not new. His organization had been working with the Department of Health and lobbying for nursing home-related legislation since 2018.

“But here we are in 2022 and we have so many folks who have left the industry for various reasons during COVID," he said. "Now we are in a situation where many nursing homes throughout this state are unable to accept new residents from hospitals in the community because they don't have the necessary staff. They have the beds to provide the care, but they don't have the staff.” 

That, Hanse said, leads to a backlog at hospitals, increased stress on healthcare workers, a mass exodus of burned-out healthcare workers and a ripple effect throughout the entire healthcare system. 

Staffers who remain, he said, often work overtime and double shifts.

“People can only do that for so long and it burns them out,” Hanse said. 

LaDue admitted that while he’s never considered leaving the industry, the pandemic has been a huge strain on him both emotionally and physically.

“This has been one of the worst experiences of my life. I've been an administrator for 20 years and the last few years have been the worst, obviously, without a doubt. It's maddening and completely frustrating that I can't help an additional 75 people in Orange County. That is not the reason why I got into this field. I got into the health care field because it was rewarding and I want to help people. To not be able to do that is extremely frustrating,” LaDue said. 

Valley View is trying to recruit more staff, and in the meantime, LaDue said, the facility tries not to accept any more residents than its staff can properly care for. He said they've been up front with families about the difficulties they are experiencing as a result of the worker shortage. 

“I don't think there's been an increase in complaints (since the start of the pandemic), and part of that is because I think we have good communication amongst our residents and family members,” he said.

Hanse said nursing homes in his organization aim not to allow the staff shortage to impact residents, but the McDonalds and State Sen. James Skoufis said residents and families are definitely feeling it.  

“At one end of the spectrum, basic daily needs of residents aren't met — eating, using the bathroom, taking scheduled medications, getting some sunlight,” Skoufis said in a statement. “At the other end of the spectrum, understaffing can lead undiagnosed illnesses to advance quickly, resulting in hospitalization or much worse. And of course, the toll on residents' mental health that comes with having your pleas and needs consistently ignored can't be understated.”

According to Skoufis, his "office fielded 16 nursing home-related cases in 2021, up from 12 the year before."

“While those numbers may seem modest in comparison to the hundreds of assorted cases we're handling throughout a given year, these (nursing home) cases have been wide-ranging and illuminate the ongoing need to better regulate nursing homes, as well as some of the gridlock families encounter when filing complaints with the Department of Health,” Skoufis said. 

And, Skoufis commented, just because his office didn’t receive more complaints doesn’t mean there aren’t more out there.

“It may also not be top-of-mind for a family in distress to think of contacting their state senator for assistance with care-related matters,” he said, “but we want folks to know that our office is here as a resource and an advocate.”

The final straw 

Connie Kowalewski, the McDonalds' daughter, said moving her parents to a new facility became urgent in February when the family said an aide left her mother on the bathroom floor after she fell out of her wheelchair.

Connie Kowalewski shows a photo on her phone of her mother, Constance McDonald, who she says was injured when she was dropped while a resident at Valley View Center Nursing Care in Goshen.

"My dad had seen the wheelchair roll out and then he goes, 'What's going on?'" Kowalewski said. "He's got a scooter so he goes over there. She's crying on the floor and there's no nurse supporting her. There's nobody by her side."

Robert McDonald said he heard his wife ring the bell signaling her need for assistance multiple times before a staff member agreed to help bring her to the bathroom. Inside the bathroom, Robert surmised, a staff member must have stopped short and launched his wife onto the bathroom floor. 

"I heard a scream and she was laying on the floor with blood all over the floor. The nurse wasn't there," Robert recalled. "I ran out screaming for a nurse. The nurse came and they rushed us to the hospital. But nobody ever apologized. Nobody."

Kowalewski said she was treated dismissively when she complained to Valley View administrators. Administration, she said, always stated they weren't neglecting her parents and any issues were related to the severe need for more workers.

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Efforts to address the staff shortage

In early December, Gov. Kathy Hochul sent National Guard members to work at understaffed nursing homes, including Valley View and the Sullivan County-owned home, Care Center at Sunset Lake.

"While this (the National Guard) is not a long term solution to staffing, it has been helpful in the short term," according to Megan Holton, administrator at the Care Center.  "They provide both medically trained and non-medically trained individuals who can help them arrange clerical tasks and provide hands-on care of the residents."

Five Guard members are currently stationed at Valley View to help care for residents and test workers for COVID. 

In January, a new law – supported by Skoufis – was slated to take effect requiring every facility to maintain daily staffing equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse or registered nurse. 

Gov. Hochul had delayed its enforcement, citing staffing shortages, but on March 31 she ended the delay.

But according to Hanse, it will be difficult for facilities to meet the requirements of this law. 

“We would love to meet that, but the workers are not there,” he said. “In an analysis of the 614 nursing homes, 97% can't comply. They want to. We would all love to. But for that law to be effective in New York, right now about 7,000 to 8,000 new direct care workers would have to show up at nursing homes throughout the state.” 

And if the law is strictly enforced, Hanse said multiple nursing homes across the state will shut down.

Valley View Center for Nursing Care and Rehabilitation in Goshen.

Hiring strategies

LaDue said his staff works hard to provide quality care for residents and that he is proud of everyone at Valley View, but the facility is desperately in need of more workers.

“We are always hiring, specifically nurses, RNs, LPNs, CNAs,” he said. “We're always hiring those positions for full-time, part-time and per diem roles. We've never stopped recruiting for those positions … I think the issue right now is there's not enough nurses out there to meet the demand. Valley View has received a total of three resumes in the last two months for nurses.” 

The facility, LaDue said, is trying anything and everything to recruit  staff, including reevaluating and increasing pay rates.

A new program at Valley View, created in 2021, promises new employees between $500 and $3,500 in sign-on bonuses depending on the position and how long they remain on the job. The program also offers up to $500 in referral incentive payments for various positions.

Elliot Weiss, marketing director at the Sullivan County-owned home, Care Center at Sunset Lake, said the Care Center also instituted a hiring incentive program. They offer $2,500 to $4,500 sign-on and referral bonuses depending on the position. In addition, the facility invested in software upgrades to ensure job openings are widely posted and advertised.

"But before we got into getting new hires, we focused a lot on our current staff to address their needs and make the environment the best it possibly can be," he said, noting that employee retention was the first priority. "In recent months we've added so many new programs that are special to each and every staff member, whether it's fun activities throughout the facility or within a department."

While the staff shortage did force the Care Center to temporarily close one unit of the facility, recruitment efforts have been successful enough that the 32-bed unit will reopen in the coming months.

Finding a solution to the nursing home worker shortage should be top of mind for everyone, said Hanse, president and CEO of the New York State Health Facilities Association – even if you don't currently know anyone in a long term care facility. 

The Care Center at Sunset Lake Rehab in Sullivan County, NY.

Families: More staff would improve conditions

After more than six months searching, Connie Kowalewski was able to move her parents into Ferncliff Nursing Home and Short Term Rehab in Rhinebeck – one of few area facilities able to take two new residents – in early April.

Kowalewski and her parents, the McDonalds, believe that at least some of the issues they had at Valley View would have been mitigated if the facility had a larger, well-rested staff. 

There were a few Valley View employees who Robert McDonald said genuinely cared for him and his wife. When those staff members worked with Constance, he said he saw a noticeable difference in her emotional and physical health.

In March, before his move to Ferncliff, Robert said, “When a nice aide comes in and talks to her, she smiles." 

Erin Nolan is an investigative reporter for the Times Herald-Record and USA Today Network. Reach her at enolan@gannett.com.