Families of nursing home residents strain for better care as staffing woes worsen

Chris McKenna Erin Nolan
Times Herald-Record

NEWBURGH – Joseph Suto's family has watched with anguish since he moved into a nursing home and suffered a series of serious health problems, including bladder cancer and two bouts of COVID-19.

But his daughter and grandson say his decline has been made more painful by the lack of attention and compassion the 88-year-old Suto has gotten since 2020 when he first arrived at Sapphire Nursing and Rehabilitation Center at Meadow Hill. Buzzes for help are ignored, even after he has fallen and hurt himself. Unchanged diapers led to urinary tract infections. He once was told he was merely dehydrated after suffering a stroke.

Sapphire Nursing at Meadow Hill in the town of Newburgh.

"It's so hard," said Connor Suto, who remembers his grandfather as a strong, active father figure to him. "We're always worried about Poppy and always afraid that something's going to happen at that place. It's terrible. It's very upsetting when I talk to him and he tells me about everything going on, how he screams and cries for help and nobody comes. It's heartbreaking to hear that."

Two more suits: Class-action cases filed against Sapphire's Dutchess County homes

Newburgh case: New class-action suit against Sapphire homes targets Meadow Hill

Goshen uproar: Maloney, Skoufis, state DOH press nursing home about complaints

Families across New York share the Sutos' frustration as nursing-home staffing shortages worsen under the strain of a pandemic that has lasted nearly two years. The result is often less care time and longer waits for help for their loved ones, the roughly 90,000 elderly and frail residents of 600 long-term care facilities statewide.

State officials are grasping for solutions. They sent National Guard members to work at understaffed nursing homes in early December and now have 120 deployed at 13 facilities, including the county-owned homes in Orange and Sullivan counties. Five Guard members are stationed at Orange County's Valley View Center for Nursing Care and Rehabilitation to care for residents and test workers for COVID.

To help stem the departures of health care workers in general, Gov. Kathy Hochul also has proposed offering $3,000 retention bonuses to workers at both hospitals and nursing homes who remain in their positions for at least another year.

State reforms took effect last month that aimed to boost staffing by requiring nursing homes to spend at least 70% of their income on resident care and limiting their owners' profits to 5%. The owners are fighting to undo those mandates with a lawsuit joined by around 240 homes across New York.

In the meantime, class-action lawsuits are pending against the Newburgh home where Joseph Suto lives and three affiliated homes in Orange and Dutchess counties owned by the same business group. Each case alleges dire understaffing and neglect since new owners bought the former Elant chain in 2017 and is seeking damages on behalf of all residents who have since lived there.

Class action cases

The Sapphire group that took over the nonprofit Elant homes runs them as for-profit operations with a total of 532 beds.

Within months of the sale, workers at Sapphire Nursing and Rehab at Goshen and their union began protesting impending layoffs that they said would reduce the nursing staff to dangerously low levels. Those warnings turned to an uproar with a flood of complaints from families and scrutiny from elected officials and the state Department of Health. State officials ordered the home to correct its understaffing and other problems.

Nurses and staff protest outside Sapphire in Goshen on January 8, 2018.

In 2018, two families brought a class-action lawsuit against the 120-bed Goshen home, which was followed the next year by similar cases against the other Sapphire facilities in Newburgh, Beacon and Wappingers Falls.  All four suits are still crawling through the court system with no trial dates in sight, and only the Goshen case approved so far by a judge to be tried as a class action.

In a court statement filed on behalf of the plaintiffs in September, a former administrator of the Sapphire-owned Fishkill Center for Rehabilitation and Nursing testified that Sapphire Care Group had tied his hands to cut costs, restricting how many people he could hire and how much he could pay them. The only staffing agency he could use was one owned by the son of one of the Fishkill Center's owners.

"There was constant pressure from Sapphire to keep the amount of money spent per day per resident as low as possible," Alec Shneider said in his sworn statement.

Beth Soto stands among the protesters outside Sapphire Nursing and Rehab in Goshen on January 8, 2018.

Because of those controls, the 160-bed home never had enough workers to properly bathe, feed and reposition residents, give them their medication and change their diapers, Shneider said. He said the owners abruptly fired him in 2018 after 10 months on the job, shortly before an annual inspection by the state Department of Health.

In a deposition for that case, one of the owners of the Sapphire homes said he didn't think any of his employees had ordered staffing cuts. Decisions about staff and other expenses were left to administrators of the facilities and other professionals, he said.

"I let my professionals make the decision and help me guide running the facility," co-owner Richard Aryeh Platschek testified in September. "And if we need more staff or they cost more money, they will tell me. And if they ask me or – we will go through it and we'll do whatever we need to do."

In just the last year, seven other lawsuits alleging neglect of past and current residents of Sapphire's four homes in Orange and Dutchess have been filed, state court records show.

One case was filed in December on behalf of a Fishkill Center resident who allegedly was hospitalized five times in two years after a series of falls and other incidents. She needed surgery after fracturing her hip in September. She suffered rib and arm fractures and cuts in previous falls and once was taken to the hospital after being given a narcotic overdose and becoming unresponsive, the suit alleges.

State Sen. James Skoufis, who regularly fields complaints regarding Sapphire locations in Goshen and Newburgh and has previously protested staffing shortages at the Goshen facility, said he believes these suits should conclude with aggrieved families getting compensation for the alleged lack of care their loved ones received.

Sapphire Nursing at Wappingers in the Village of Wappingers Falls

"In my opinion, there were dangerous levels of understaffing," he said about why he first got involved in the issue back in 2018. "We heard horrific stories about residents not getting basic hygiene services provided to them and sitting, well basically sitting in their own waste and filth for many, many hours before being addressed. There were complaints of inadequate nutrition and food, and when my team and I get complaints of not only that nature, but that scale, it's usually an indication that there's a fact pattern and there's a fundamental, very serious set of problems at a facility."

But even as Skoufis and other public officials voice their concerns regarding how Sapphire and other nursing homes care for residents, Connor Suto said he doesn't think the lawsuits have prompted Sapphire to improve their quality of care at all. 

A resident wing at Sapphire Nursing and Rehab at Goshen on February 15, 2018.

"It doesn't seem like they care," he said when asked about how the facility is responding to the lawsuits. "They don't seem to be afraid of any kind of action taken against them."

According to Connor and Kathy Suto, Sapphire has not provided Joseph Suto with adequate or compassionate care since his arrival in August 2020. 

When Joseph Suto arrived at Sapphire

In June 2020, Joseph Suto’s wife of 64 years died.

“My dad went rapidly downhill after she passed away,” Kathy Suto said. “He wasn't eating or drinking. He got depressed. I think it was July 29, 2020, when I had to call the ambulance. ... When the ambulance first came they thought that he had a heart attack or a stroke because he was just totally unresponsive. He was getting up to go to the bathroom and my son and I found him collapsed on the floor. We couldn't get him up.”

Joseph Suto was brought to St. Luke’s hospital in Newburgh when he experienced symptoms of extreme heat exhaustion, dehydration and a urinary tract infection, and later to Sapphire for rehabilitation.

“He was going to just get built up and he was only going to stay there for a couple of months,” Suto said. “But then he ended up getting COVID really bad. He had COVID for, my God, like a month and a half. He was really, really bad and they had to have him on the IV and the oxygen. Then from COVID he got heart and lung damage. They said that his lungs weren't the same.”

By the end of 2020, Suto’s father had recovered from COVID, but the lasting effects of the disease made his care too difficult for her to manage on her own.

“I just didn't think I'd be able to really take care of him,” she said, adding that she is also trying to manage her own breast cancer treatment.

Suto said she first started expressing her frustration in August 2021 to Sapphire staff, the Department of Health and Skoufis' office after an incident in which her father was suffering from diverticulitis and pneumonia but was left uncared for at the nursing home for hours.

“My dad was complaining. He had pain in his stomach and he wasn't eating. He just kept saying he wasn't feeling well. And he then started bleeding,” Suto said. “They said that it was just hemorrhoids. He wanted to go to the hospital and they wouldn't send him, but he wasn't feeling right ... it wasn't just hemorrhoids. It was a Sunday, and he had been asking all day to go, but he had to wait ... until it was nighttime.”

Despite medical documentation stating otherwise, Suto said Sapphire staff insisted Joseph Suto was simply dehydrated. 

In another instance, Kathy Suto said, nursing staff again insisted Joseph Suto was dehydrated, but hospital staff at St. Luke's later confirmed he had suffered a moderate stroke.

Despite numerous attempts to talk to Sapphire staff about these incidents, Kathy Suto said she has been dismissed and ignored.

Multiple calls from the Times Herald-Record to Sapphire in Newburgh for comment were unreturned. 

What happens to complaints filed against nursing homes

According to Skoufis, his office received three complaints against Sapphire facilities in 2021: one from the Goshen location and two from the Newburgh location where Joseph Suto lives.

Sapphire Nursing and Rehab at Goshen in Goshen, NY on Thursday, February 15th, 2018.

“Anyone who's had a family member in long-term care knows that you're entrusting basically strangers with the care of your loved one, so this is something that ought to be top of mind for everyone,” Skoufis said. He emphasized that three complaints are enough to potentially indicate a larger-scale problem. “The focus has only increased due to the pandemic.”

Since first getting involved in nursing home reform back in 2018, Skoufis said he and other lawmakers have authored and continue to write multiple nursing home reform bills focused on forcing long-term care facilities to staff up and provide adequate care.

“Every year we get a number of complaints, and no matter how many reforms we put in place, no matter how much accountability is in place, there are always going to be problems, but our motivation or goal is to just try and minimize that number to as close to zero as possible. It's never going to get to zero.”

Skoufis encouraged anyone concerned about how their loved one is being cared for to reach out to their local politicians and file an official complaint with the Department of Health.

Kathy Suto said she has done both of these things.

She said she's heard nothing in the six months since she first filed a complaint with the Department of Health back in August 2021.

"I think nothing of the Department of Health right now," she said. "It's been months. And now it's the beginning of February. My father could be dead by the time they find out anything important. If I file a second complaint, will it be another six months? Nothing happens and I don't know who to talk to."

Skoufis agreed that these Department of Health investigations often take an "unacceptable" amount of time.

"Especially when you're talking about final years and you're talking about the health and well-being of a senior citizen - oftentimes a vulnerable senior citizen. These types of delays are atrocious," he said.

In a statement from the Department of Health, its director of communications Jill Montag said the department can't comment on open investigations like the one looking into Suto's complaint, but the outcome of every investigation is shared with the original complainant. 

“Holding nursing homes accountable for the quality of care they provide is a top priority of the New York State Department of Health," Montag said. "The Department performs multiple types of surveillance activities on an ongoing basis on all New York State skilled nursing facilities, which includes unannounced onsite surveys.”

While her numerous complaints remain open and caught up in bureaucracy, Kathy Suto said she has tried unsuccessfully to find a new facility for her father.

“I feel really bad and I feel guilty,” Suto said. “I feel so bad for my dad to be in some hellhole like that ... My dad the other day was crying and said ‘I can't stay here much longer.’ I want him to come home, but there's no way I can take care of him. I just can't.”

Connor Suto said while he has countless pleasant memories of weekends spent hunting, fishing, swimming, golfing and sledding with his grandfather, those memories feel bittersweet when he compares the grandfather who helped raise him to the weak and neglected 88-year-old at Meadow Hill.

“He was always so active, and then to see him like this,” Connor Suto said, letting out a broken sigh. “You just don't end up like this. It's really not normal to be treated this way. That's what's the most depressing ... He was just telling me how he wanted to go to the bathroom this morning ... He's screaming and screaming for somebody to come and he has to wait and wait and wait and he wets himself and they still don't come. It's very upsetting when I talk to him and he tells me about all this, how he screams and cries for help and nobody comes."