By Michelle Crouch
In April 2021, Tom Benoit was so upset about his wife’s care in a New Hanover County nursing home that he called the state to file a formal complaint.
His wife, who was unable to walk on her own, often waited more than an hour for someone to respond to her call light when she needed to use the bathroom. She was rarely bathed. Staff members failed to administer her medications on time, Benoit alleged.
Benoit, 66, also told the state that he had concerns about the way other residents were being treated.
He expected investigators to appear within weeks.
They didn’t show up until nine months later.
“It took forever,” said Benoit, who declined to name the facility because his wife is still there. “These delays are putting people in danger.”
Ombudsmen: Delays can lead to disillusion
Across North Carolina, the number of nursing home complaints has surged. In 2016, the state received 2,682 nursing home complaints, in 2022 that number was up to 3,405 complaints.
The larger number of complaints – coupled with a severe shortage of state inspectors – has led to longer wait times on some complaints, leaving residents and their family members in a limbo that can stretch for months.
Complaints are up 27 percent since 2016. Note: An individual can file a complaint against a facility that contains multiple allegations. Credit: N.C. Department of Health and Human Services
“Sometimes (the resident) might not even be there by the time the inspectors come, or they got so frustrated they moved to a different facility,” said Hillary Kaylor, Mecklenburg County’s nursing home ombudsman.
Victor Orija, the state long-term care ombudsman, wrote about the effect such delays have on residents and their family members in a May 1 letter to U.S. Sen. Bob Casey (D-Pennsylvania), chair of the Senate’s Special Committee on Aging:
“When state survey agencies do not have adequate staffing to visit and investigate the complaints, residents may be left at the mercy of non-caring facility staff and ownership who are not held accountable … This negatively impacts not only the physical well-being of residents, but their dignity and emotional health as well.”
In addition, Orija wrote, if too much time passes, it can be more difficult for an allegation to be substantiated. When that happens, “residents and their representatives become increasingly disillusioned with the process,” he said. “They do not see any reason to submit complaints.”
Many problems related to staff shortages
Nursing home observers said it’s not surprising that complaints are up. Many nursing homes were already struggling before the pandemic, and COVID-19 hit them hard. Workers, overworked and underpaid even before the pandemic, fled the nursing home sector in droves.
Although COVID-19 rates in nursing homes have markedly declined, this post-pandemic labor crunch has decimated staffing at many facilities, leading to overburdened caregivers with too many patients. Nursing homes are also dealing with declining occupancy rates and higher costs that were only partly allayed by the pandemic-era bump up in reimbursement.
In Mecklenburg County, the volunteer advisory committee that helps monitor nursing homes recently expressed public concerns about problems that could put residents at risk, including missed medications, untreated medical conditions, smaller meal portions, out-of-reach call bells and residents who wait hours for help.
Most of the problems, committee members said, are related to staffing shortages and a reliance on temporary agency workers.
In addition, the consolidation of the long-term care industry by large, for-profit corporations and private equity firms has made it more difficult for local ombudsmen to work with owners on improvements. As of May 2023, 83 percent of North Carolina’s nursing homes were owned by for-profit companies, federal data show.
“It’s not local people who own these buildings anymore,” Kaylor said. “Even the administrators of these facilities feel like they can’t make changes or make a difference because of the out-of-state ownership.”
A spokeswoman for the North Carolina Health Care Facilities Association, an advocacy group for the state’s nursing homes, said its president was not available for comment last week.
Serious complaints take priority
The state agency that regulates nursing homes said it doesn’t track how long it takes, on average, for it to investigate complaints.
“Complaints are promptly reviewed, prioritized based on severity, and investigated,” a spokeswoman for the N.C. Department of Health and Human Services (DHHS) said in an email. “Since complaints are triaged and the timeframe for investigation varies based on the nature of the allegations, there is not an average time to investigate complaints.”
States are required to start an on-site investigation within two business days if there is an immediate risk of serious injury, harm, impairment or death to a resident, and North Carolina meets that deadline, according to data DHHS submitted to the U.S. Senate Special Committee on Aging.
However, Mark Benton, chief deputy secretary for health at DHHS, acknowledged that the state doesn’t respond to other types of complaints as quickly as he would like.
“We take every one of those complaints seriously … and we want to be out there immediately,” Benton said. “But because of the number of cases, because of the growth in complaints, and also with our staffing challenges, we’re not able to do that.”
The department is also behind on doing federally required inspections that ensure nursing homes meet minimum standards for resident safety and well-being.
Federal law requires an inspection every 15 months for each facility. Of the 420 nursing homes in North Carolina that accept Medicare or Medicaid, 32 (7.6 percent) have not been surveyed in that time frame, according to DHHS.
Inspector jobs are hard to fill
The state relies on a team of 97 inspectors to inspect the state’s 420 nursing homes and investigate complaints. Most of the funding for those positions comes from the federal government.
Like other states, North Carolina has struggled to hire and keep inspectors, who are registered nurses.
As of last week, 15 of the 97 positions were open, and the job’s turnover rate was 35 percent – that means more than one out of three inspectors left the job within a year of starting.
“It is a very important job, but also it is a tough job,” Benton said. “They are picked off quite often by other settings who can pay a lot more and will also say, ‘You will no longer ever have to do any weekend work, you will not have to do any holiday work, and you won’t have to travel.’”
The average salary for N.C. nurse consultants is $68,317. That’s $20,000 or more below the pay offered by hospitals and other competitors to nurses with similar experience, according to DHHS.
More funding could be on the way
Gov. Roy Cooper’s budget proposal included 15 new nursing home inspector positions, along with salary increases, longevity payments and a signup bonus for new hires, Benton said. He hopes some of that will be included when the legislature finalizes the state budget.
But the budget from the House of Representatives lacked any funding for new nursing consultant positions, and the Senate budget had funding for only three new positions.
Congress is also considering a funding boost for nursing home oversight after a year-long investigation by the U.S. Senate Special Committee on Aging found that 32 states (including North Carolina) have inspector vacancy rates of 20 percent or higher, and that 28 percent of the nation’s nursing homes are behind schedule for standard inspections.
Benoit, whose wife is still in the same nursing home, said the North Carolina inspectors did a good job once they finally arrived. The facility was cited for 91 deficiencies.
“Once they got in, they were tenacious,” he said. “They brought in a bunch of people and had them there for at least two weeks. I just wish it could have been addressed quicker.”
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