For nursing home leaders, help is nowhere to be found

Ginger Andreoli Muscarella worries about the amount of care that her 80-year-old dad receives at his nursing home, Apple Rehab Chesterfields in Chester, Conn.

Fred Andreoli wears adult briefs that need to be checked every two hours, but his daughter says she regularly finds him soaking wet. A water pitcher in Fred’s room needs to be filled regularly, but the chronically understaffed nursing team has so many chores, there is rarely time to refill it.

“It infuriates me,” she said. “They’re just running through, trying to get things done.”

But Andreoli Muscarella doesn’t blame the nursing staff. Nursing homes across the country face what the American Health Care Association calls a “historic workforce crisis.” There aren’t enough nurses anywhere—not in Fred Andreoli’s facility, not in the state of Connecticut, not even in the United States.

According to a recent American Health Care Association report, nursing homes lost 15 percent of their nursing workforce between 2020 and 2022. Administrators say they have yet to recover the staff they lost during the pandemic.

Connecticut state legislators proposed several bills last month to address the problem, but they only succeeded in highlighting the difficulty of finding a solution.

One key piece of legislation failed. That bill would have increased the time each resident received from nurses per day, from 3 to 4.1 hours. Lawmakers thought the upped hours would compel nursing homes either to decrease the number of patients they admitted or hire more nurses. They pulled the 4.1 hours requirement from a 2001 Centers for Medicare and Medicaid Services study that concluded nurses needed to spend that much time with residents—at a minimum—to keep them safe.

The bill would have made Connecticut the first state to make the Medicare standard mandatory. Other states require fewer nursing hours. Only the District of Columbia says facilities must meet the 4.1-hour staffing standard.

But some Connecticut lawmakers argued the state couldn’t afford the increased care. If the bill passed, the state would have had to pay nearly $27 million to reimburse Medicaid in 2025 and $15 million more for the following two years. Legislators opted to study the issue before passing a bill, effectively tabling it.

Even if the state could afford the expense, it doesn’t have enough nurses to work those extra hours.

Jennifer Malone-Seixas, chief operating officer for two family-owned nursing facilities in Danbury, Conn., says the pandemic robbed nursing homes like hers of caregivers. Malone-Seixas said she has struggled to rebuild her teams at Filosa for Nursing and Rehabilitation and Hancock Hall. She considered recruiting nursing students from abroad and asked legislators to make it easier for nursing homes to hire immigrants.

That’s because, Malone-Seixas says, there simply aren’t any more nurses nearby. “You can’t create something that doesn’t exist,” she said.

Nursing homes have offered financial incentives to recruit more staff, and, as a result, nurses are compensated better than ever before. The American Health Care Association reports that wage increases doubled for nurses at all levels from 2020 to 2021. Nursing home operators say they have offered sign-on bonuses, extra pay for difficult shifts, and flexible scheduling. Yet they still have vacancies.

The day we spoke, Malone-Seixas said Filosa had 12 nursing aides and 6 nurses providing care for 89 residents during the day shift. She says she’s happy with the staff level during most day shifts. But nights and weekends get dicier. She said they were already down one nurse for the night, so one nurse would have to cover two units. It’s not ideal, but it adheres to minimum staffing requirements in Connecticut—and it’s all they can do.

Medicare, which regularly inspects the staffing conditions at nursing homes, rated Filosa 4 stars out of 5 for maintaining “above average” staff levels, but Malone-Seixas says it’s hard to keep up. If the state had implemented the 4.1-hour nursing mandate, she predicted every facility would fail, including hers.

“If nobody is compliant, what are you going to do? You fine us, and we’re going to end up on the front page of the newspaper, and for what?” she said.

Fred Andreoli’s nursing home received a rating of two stars from Medicare for “below average” staffing. This leaves Andreoli’s daughter frustrated and resigned to limited care from overworked nurses—it’s all she can afford for now.

Last year, an 87-year-old resident was attacked by another resident at another Apple nursing home, Apple Rehab in Old Saybrook, Conn. The state’s department of health said the nursing home staff failed to keep the residents safe, and authorities are investigating the death as a homicide. WORLD attempted to contact to Apple Rehab’s corporate headquarters for comment but did not receive a response.

Connecticut’s long-term care ombudsman, Mairead Painter, said a growing number of for-profit nursing facilities are run by private equity firms or individuals who are more focused on making money than providing quality care. Last week, state representatives unanimously passed a bill that requires all nursing homes in Connecticut to disclose their finances and involvement with private equity firms. In the bill that now heads to the Senate, facilities would also need to notify the state when residents are involuntarily transferred or discharged.

“When we look at owners, they’re making tons of money, but direct care staff are not,” she told me. “If the people who benefitted the most were the workers, we’d see a change in the industry.”

Since Fred Andreoli also lives in a for-profit facility, his daughter wants to move him elsewhere, but she feels bad about leaving the nurses.

“They are the ones holding everything together during this difficult time,” she said. “These are the ones who love my dad.”