Report: Federal staffing standards for nursing homes leaves Soldiers’ Home on shaky ground

  • An ambulance arrives at the Soldiers' Home in Holyoke on Tuesday, March 31, 2020. FILE PHOTO/KEVIN GUTTING

Staff Writer
Published: 5/20/2020 2:37:00 PM

HOLYOKE — Despite complaints about staffing issues from workers and families in years’ past at the Soldiers’ Home, inadequate federal staffing standards for long-term care facilities have created a shaky foundation on which the facility is dealing with a deadly coronavirus outbreak that has killed 74 veterans, according to a recent study.

Released on Monday by the Pioneer Institute, a public policy research organization based in Boston, the study takes previous reports of understaffing at the veteran’s home and examines federal staffing standards for long-term care facilities enforced at the state level that don’t meet the recommendations of health officials.

“State officials and leaders at the Soldiers’ Home seem to have applied the staffing standards correctly,” said researcher Andrew Mikula in a statement released by the Pioneer Institute, who co-authored the study with Greg Sullivan, the organization’s research director. “The problem is that the standards themselves are not sufficient to protect the frail and elderly during normal times, let alone in the midst of a pandemic.”

The Soldiers’ Home is the worst-hit long-term care facilities in the country, with 74 elderly veteran residents having died after becoming infected with COVID-19 as of Wednesday; 88 other residents and 84 employees have tested positive for the infectious disease. Almost 60% of COVID-19-related deaths in Massachusetts have occurred in the state’s long-term care facilities, according to the study.

The study cites a 2017 investigation by the Springfield Republican in which the newspaper reported that falls at the Soldiers’ Home left 600 veterans hurt over a 44-month period. The authors write that the newspaper had uncovered that families and staff had raised alarms about the lack of adequate staffing or protocols to prevent these falls, with the workers’ union going as far as declaring the facility was “chronically understaffed.”

The findings didn’t differ substantially from the average as reported by the Centers for Disease Control and Prevention, the study found. Subsequent investigations by the U.S. Department of Veteran Affairs and the Massachusetts State Auditor’s Office also did not cite staffing shortages — though the study argues these evaluations were based on federal benchmarks that are inadequate for providing high-quality care.

Aside from identifying “unnecessary payroll cuts for overtime hours,” the state’s audit found no issues with staffing at the Soldiers’ Home when citing federal standards and other criteria, the study states. A 2019 report on the Soldiers’ Home by Suffolk University said excessive overtime is “one of the primary indicators of possible problems with staffing,” but the study found the state’s audit never made that connection and warnings of union representatives “went unheeded."

“The above evidence constitutes a clear discrepancy between the on-the-ground reality as reported by union representatives, staff members, and residents’ families, and that reported in fall data and audits by administrative officials at multiple levels of government,” the study reads.

Current federal standards require that nursing homes provide direct care nurse staffing of no less than 2.5 hours per patient per day, despite a 2001 recommendation from the U.S. Centers for Medicaid and Medicare Services (USCMMS) that regulators require 4.1 hours of nursing staff on-hand, according to the study.

The Suffolk University report found that only one of the Soldiers’ Home’s six wards met USCMMS standards of total nursing hours per day, according to the study. Another study referenced by Mikula and Sullivan reports the mean amount of nursing hours across all U.S. nursing homes in 2014 as being above the USCMMS standard.

“In fact, the 2019 Suffolk University report attributes the difference of opinion between union representatives and HSH management regarding staffing concerns to the fact that ‘the required 2.5 benchmark...does not account for acuity or changing needs,’” Mikula and Sullivan wrote.

When it comes to the Holyoke Soldiers’ Home, the study notes that mismanagement may be a large reason why such a fatal outbreak of the coronavirus has occurred. The authors cite various news reports alleging that management had nine veterans sleep in the dining room at a time during the coronavirus outbreak, healthy residents using the same bathrooms as those infected and asymptomatic employees who had tested positive for COVID-19 being required to complete shifts, among other concerns.

And though multiple federal and state investigations announced in the past few months have begun to look more closely at the situation at the Soldiers’ Home, the study reported that it is “critical” that federal staffing standards “be investigated and, where appropriate, improved.”

“Unfortunately, regulators at multiple levels of government inadequately implemented the recommendations of this literature, leaving long-term care facilities like the Holyoke Soldiers’ Home fundamentally ill-equipped to provide maximum-quality care to elderly veterans, let alone handle the COVID–19 pandemic,” the report states.

Michael Connors can be reached at mconnors@gazettenet.com.


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