Why advocates say upping staff at nursing homes could save lives

RICHMOND, Va. -- Born in a segregated hospital in the 1940s, Joseph Riley and his six siblings did not have an easy childhood in Richmond's Church Hill neighborhood.

"No plumbing, stove heat, and an outhouse," Joseph's brother, James Riley, said about the house they grew up in.

But, James said that Joseph always kept his family smiling.

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"Everybody liked him, he was very likeable, he liked to joke around, like to play pranks on people," James said.

Later in life, when Joseph was in need of constant care, his family put him in a government-subsidized
nursing home.

"He had difficulty moving around, and he had difficulty remembering things," James said.

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At Canterbury Rehabilitation and Healthcare Center, Joseph enjoyed chatting with the staff, but James remembers his brother complaining about slow response times.

"He said sometimes it would take up to a half hour before someone would respond. It's not that the staff were lazy, it's just that they were busy doing other things, you can't be in two places at once," James said.

Last March, Joseph became one of the Richmond region's first coronavirus victims.

"There was no visiting, there wasn't anything we could do," James said.

A total of 50 Canterbury residents would end up dying from COVID-19.

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The nursing home's former medical director, Dr. Jim Wright, said one thing became abundantly clear to him during that outbreak.

"Instead of simply being a frustration, we have now realized that staffing shortages are a death sentence for our elders in nursing homes," Wright said.

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Federal law does require Medicare and Medicaid certified nursing homes have a registered nurse on duty eight hours a day, seven days a week, a licensed nurse on duty 24 hours a day, and provide sufficient staff to maintain patient care.

But, Wright said "sufficient" is not specific enough.

"You can say we have appropriate staffing to take care of our patients if you only have one aid for 20 patients, there is nothing to prevent you from doing that," Wright said.

A state study completed last year, found that of the 286 nursing homes in Virginia certified by the federal government, 44 percent of them received a "below average" or "much below average" score on staffing levels.

Canterbury's staffing is rated "much below average."

"Staffing shortages are related to poor quality care, increasing bed sores, nutrition problems and things like that," Wright said.

Wright also points to two studies published last year that show nursing homes with poor staffing levels were more vulnerable to the spread of COVID-19.

"Let's institute those minimum requirements for staffing, let's just get the minimum so we can protect our elders from the next pandemic," Wright said.

Wright has an ally in Republican State Senator Jennifer Kiggans (7th district), who works as a geriatric nurse practitioner.

"We have four percent of our population that lives in a long term care facility, yet we have killed 40 percent of those people with the coronavirus pandemic, and a lot of that stemmed from just not having the proper staff in there," Kiggans said.

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Kiggans further clarified that 41 percent of COVID-19 deaths have occurred in long term care facilities.

For the second year in a row, she tried to get a bill passed that would impose minimum staffing requirements at Virginia's nursing homes.

In fact, this is the 17th year a legislator filed such a bill.

But, once again, it died in committee.

In the meantime, the Joint Commission on Healthcare will study whether Virginia's requirements are appropriately addressing quality of care in nursing homes.

"It is going to cost money to increase staffing ratios, we know that, so it's not a very popular choice sometimes, things that cost money," Kiggans said.

To that point, the group that advocates on behalf of Virginia's nursing homes, the Virginia Health Care Association, opposes minimum staffing requirements.

Their CEO, Keith Hare, declined to do an interview but a spokesperson said "the pipeline of available RNs, LPNs, and CNAs simply does not exist to support providers' ability to hire the numbers of staff that would be required."

Because of COVID, James Riley still has not been able to have a memorial service for his brother.

But, when it comes to staffing at places like Canterbury, he said the state cannot afford to wait.

"It's unfair to the people who are in the nursing home, the residents there, and it's unfair to the staff, the staff are overworked," Riley said.