The call came late one night in February, from the Kansas City-area nursing home where Georann Whitman’s 86-year old mom was living.
“They said that they had found her on the floor,” Whitman recalled. “She had gotten up in the middle of the night and had fallen.”
Whitman’s mom had dementia. She broke her left hip in the fall. Doctors said she shouldn’t walk while it healed. But, Whitman said, the nursing home didn’t have enough staff to make sure her mom stayed in bed. The next week, she fell again — breaking her right hip. A few weeks later, she fell a third time.
“Fall number four was on April 2, which was exactly a week later,” Whitman said. “And then the fifth one was on April 12, and she busted her head open and had to go to the ER.”
State investigators found the home put Whitman’s mom at risk for injury and pain. Whitman’s mom moved to hospice last May, where she soon died.
Advocates like Camille Russell, the former Kansas Long-Term Care Ombudsman, say it’s part of a concerning trend playing out at nursing homes across the country, where understaffing often leads neglect.
“People sit for hours. They get skin sores,” Russell said. “It’s hard on the people living there and it’s hard on the people working there — both — when there’s not enough staff.”
Regulators hope that’ll change once the Biden administration’s landmark new mandate takes effect that will set the country’s first-ever federal staffing minimums for nursing homes. Less than 19% of nursing homes in the U.S. would currently meet it, according to the health research group KFF — meaning that, by 2027, most will need to hire more staff.
It’s ignited fierce debate. Advocates say the new mandate — which isn’t as strict as many wanted — is the only way to begin to protect the country’s most vulnerable residents from neglect.
Nursing home owners say they can’t afford to increase their payrolls and warn the new rules will devastate an industry that’s plagued by workforce shortages. They’re suing to block the mandate in court.
“We do not have the people — and the money to pay people — in our system, currently, to meet the mandate,” said Rachel Monger, president and CEO of the nonprofit trade group LeadingAge Kansas.
She and other industry representatives say nursing homes already have razor-thin margins, and the mandate will force some to close.
Some economists say a lack of transparency around nursing home finances makes it hard to predict what will happen.
But even if homes with the worst staffing problems do shut down, Russell said maybe that’s not such a bad thing.
“This is not something where you’re making something on an assembly line,” she said. “These are human lives.”
Still, it’s increasingly unclear whether the staffing mandate will actually take effect as scheduled. Experts say those suing to block it may have better odds thanks to the Supreme Court overturning the Chevron doctrine, which means federal regulators now have less authority.
