It will be up to a court to decide the merits of a lawsuit against The Laurels of Salisbury, but two of the problems alleged in the complaint against the nursing home — chronic understaffing and inadequate monitoring of a patient — point to issues of broad concern among advocates for the elderly, professional care-givers and the industry in which they work.
Nursing homes and adult-care facilities around the nation cite problems in finding aides and other paraprofessionals. But the staffing issue is of particular concern here because North Carolina is among the top five states in the growth of its older-than-65 population. A task force studying the state’s longterm-care network concluded last year that nursing homes and assisted living facilities face a severe staffing shortage that is likely to get worse in the next decade. Over the next five years, the task force estimated, North Carolina will need an additional 21,000 nurse aides and other care assistants to meet the needs of a rapidly increasing elderly and disabled population.
Finding those workers can be difficult in a field where the pay and benefits are low, and the responsibilities and work-related stresses are often high. Although the lawsuit against The Laurels alleges that the facility willfully failed to maintain adequate staffing, operators of nursing homes and other care facilities say their goal is to keep stable, full staffs, but they’re thwarted by Medicaid reimbursement rates that prevent them from paying higher wages that would draw more workers into the field and help stabilize their workforce. The N.C. Association of Long Term Care Facilities last year filed suit against the state over the issue, contending North Carolina doesn’t pay enough money to care for the thousands of residents who rely on public assistance. The task force recommended increasing Medicaid appropriations to improve wages and benefits, but considering the Medicaid funding crunch, North Carolina and other states will be hard pressed to follow through without a substantial increase in federal appropriations.
Exacerbating the staffing problems are regulations that can make it difficult for patients and their families to gauge whether facilities are keeping enough people on duty at medical stations and in the halls. North Carolina has fairly specific rules for the number of staff who must be on duty during any given shift at assisted living facilities and other adult-care homes, based on the number of residents. But staffing regulations for nursing homes — whose residents require more medical care — are more general, based on hours of care available per patient per day, which can make it harder to evaluate the level of staffing and to enforce the guidelines. The monitoring issue becomes more complex at facilities such as The Laurels that are licensed as nursing homes but also include some “rest home” beds that fall under other regulations, separate from nursing-home supervision and outside the oversight of the Department of Social Services county adult-care specialists.
Regulators and the longterm care industry have made strides to provide facilities that offer good physical care, as well as a pleasant atmosphere for the elderly and others unable to live independently. As the elderly population increases, however, the industry and state officials face serious challenges in meeting the staffing needs that are vital to building on those improvements. The task force noted that some relief may lie in encouraging more in-home alternatives to institutional care.But any longterm solution to longterm-care needs must address wage and benefit issues for care-home personnel, as well as raising public regard for the work they do.
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