Nursing Homes in New York

According to Medicare.gov, New York has 608 nursing homes. While 357 (59%) of these skilled nursing facility rank at or above the national average for the care they provide, the remaining 251 (41%) are well below average or lower.

This substandard care is documented as an acceptable rating allowed by federal and state regulators at Medicare and Medicaid. Many families use this information before placing a beloved family member in a nursing home, independent living center, Memory Care Unit (MCU), or senior living facility.

Some nursing home residents with Alzheimer's, dementia, or other cognitive issues require memory care at the highest level. Other patients are mobility challenged due to aging, paralysis, or other medical conditions requiring assistance.

Sadly, mistreatment, abuse, and neglect of the disabled and elderly are common occurrences in New York. Many of these facilities lack quality care and fail to ensure that the residents receive all necessities, including hygiene assistance, medical care, shelter, food, and water.

State and federal agencies regulate nursing homes in New York by routinely inspecting skilled nursing facilities and assisted living centers in identifying any violations of established protocols, procedures, rules, and regulations. The intervention of a State Inspector will usually result in severe penalties by imposed monetary fines and enforced compliance.

Below is just a small sampling of some of the problems occurring in nursing homes in New York.

Failure to Protect Residents from Accident Hazards

If the New York nursing home employees fail to address safety issues, the residents might be at risk for severe injury or even death. Some common hazards include:

• Failure to ensure the environment was free from accident hazards when observations revealed sharp objects protruding from the door frame and resident areas. (Fulton Center for Rehabilitation Health Care)
• Failure to ensure that each resident receives adequate supervision to prevent elopement after one patient eloped from the facility through the back or exit in the lobby undetected by staff and was not detected as missing until 6.5 hours later when the local hospital notified them that the resident was in the emergency room. (Grand Manor Nursing and Rehabilitation)

Failure to Report and Investigate Any Act or Reports of Abuse, Neglect, or Mistreatment

Anyone who sees or hears anything suspicious at the facility must immediately tell the administrator and state agency. A serious concern involves not investigating allegations of mistreating residents.

• Failure to protect each resident's right to be free from abuse after a Licensed Practical Nurse did not report an allegation of abuse of the administrative per the facility's Abuse Policy and Procedure, involving a cognitively intact resident who was sexually abused by a CNA. (Fulton Center for Rehabilitation and Health Care)
• Failure to ensure all alleged violations are thoroughly investigated in response to allegations of abuse, neglect, and exploitation involving a resident who reported staff. (Fulton Center for Rehabilitation and Health Care)
• Failure to ensure that a resident was free from staff abuse after facility surveillance video recording revealed that a Certified Nursing Assistant (CNA) was abusing a resident and required other staff members to separate both people. (Grand Manor Nursing and Rehabilitation Center)
• Failure to ensure all alleged violations involving mistreatment, neglect, or abuse were thoroughly investigated after a resident had a fall because of a Nursing Care Plan violation. (MVHS Rehabilitation and Nursing Center)
• Failure to ensure residents were free from abuse when the nursing staff failed to prevent a resident from being sexually abused by a Certified Nursing Assistant resulted in actual harm. (MVHS Rehabilitation and Nursing Center)
• Failure to protect multiple residents from resident-to-resident altercations when one resident attacked the patient sustained lacerations to the sternum and abdomen, and another resident who sustained contusion and hematoma to the right side of the face and jawline. (Park Nursing Home)
• Failure to ensure residents were free from abuse involving resident-to-resident altercations when one resident verbally and physically abused another patient, and the facility never reported the incident to the New York State Department of Health. (Pontiac Nursing Home)
• Failure to ensure the resident was free from physical abuse after a confused patient experienced a physical altercation with another resident when hit with a belt buckle leaving scratches on the left forearm and forehead. (The Citadel Rehab and Nursing Center at Kingbridge)
• Failure to ensure that an alleged violation involving abuse and severe bodily injuries was reported to the New York State Department of Health within two hours as required by law. (The Citadel Rehab and Nursing Center at Kingbridge)

Failure to Implement and Follow Infection Protection Protocols

Infectious diseases can spread quickly through healthcare facilities if the nurses and nurse aides don't follow proper procedures. If they fail to clean their hands thoroughly before touching patients' skin they may pass germs onto them. They must wear gloves when handling patients' linen and wash their PPE regularly.

• Failure to ensure infection control practices were maintained to provide a safe and sanitary environment to help prevent the development and transmission of contagious diseases and infections. (Park Nursing Home)

Nursing Staff and Infection Prevention and Control

Nurses play a vital role in infection prevention and control (IPC). IPC is a set of actions taken to prevent or stop the spread of infections in health care settings. IPC covers everything from hand hygiene to environmental cleaning to using personal protective equipment (PPE).

Infection prevention and control protocols are a set of guidelines that aim to reduce the spread of infection. These guidelines are evidence-based and are continually updated as new information becomes available.

Some crucial protocols nurses must follow involve hand hygiene, using personal protective equipment, and proper cleaning and disinfection procedures.

Contributing factors that lead to the spread of infection and nursing homes in New York include:

• Failing to use Personal Protective Equipment: Not wearing gowns and gloves when providing long-stay or short-term care to patients in isolation due to infectious diseases or Covid-19 can spread the infection among patients, staff members, visitors, and employees.
• Failing to disinfect high-touch surfaces: Germs can live on surfaces for hours or days, so it's vital to disinfect frequently touched areas such as door knobs, light switches, bed rails, and call buttons.
• Allowing Unauthorized Visitors who are not authorized can bring in germs and increase the risk of infection spreading.
• Poor Hand Hygiene: Not washing hands often enough or adequately can lead to the spread of infection.
• Not Cleaning Patient Rooms Properly: Blood or other bodily fluids on the floor, furniture, or bedding can create a nursing care environment where bacteria can thrive and infect other patients.
• Staff shortages: Not having enough staff on duty in an independent living facility, nursing home, or rehabilitation center means that there may not be enough people to properly clean patient rooms and equipment, which can lead to the spread of infection.
• Poor Infection Control Practices: Failing to follow proper procedures for handling infectious materials can spread infection in a rehabilitation center.
• Allowing Pets in Patient Areas: Pets can carry germs; if allowed in a patient's private room or public areas, they can easily spread the infection to vulnerable patients.
• Allowing Food in Patient Areas: Bringing food into patient areas increases the risk of contamination and can spread infection, harming the resident's well-being.
• Not Disposing of Linen Properly: Dirty linen not disposed of properly can create an environment where bacteria can grow and infect other patients.
• Failing to Test Water Samples Regularly: If water isn't properly tested and treated in an independent living facility or rehabilitation center, it can become a breeding ground for bacteria that can cause infection outbreaks.
• Failing to Train Staff Members Appropriately: Staff members who aren't properly trained in handling infectious materials are more likely to cause an infection outbreak.

Every doctor and nurse can prevent the spread of infection by practicing proper hand hygiene, meaning washing hands with soap and water or using an alcohol-based hand sanitizer before and after each patient interaction.

Hand hygiene is paramount after contact with body fluids, after contact with patients who are on contact isolation precautions, and before eating or preparing food.

Protecting Patients in Skilled Nursing Facilities: Why Abuse and Neglect Still Occur

Unfortunately, nursing home abuse and neglect are still significant problems in the United States, despite having federal regulations to protect patients.

There is a high turnover rate among nursing care staff, meaning that there are constantly new employees who may not be adequately trained in handling patients with respect and dignity in a skilled nursing facility.

In addition, understaffing is a significant problem in many nursing homes, leading to staff members feeling overworked and stressed, which can lead to them taking out their frustration on the patients.

Contributing factors that lead to abuse and neglect at nursing homes in New York include:

• Substandard Hiring Practices: The New York skilled nursing facility Administrator and Department of Human Resources must follow established protocols when hiring any new employee by conducting background checks, reviewing recommendations, and checking references. These practices ensure that only qualified candidates are hired who will provide quality care for the residents.
• Poor Staff Training: Skilled nursing facility employees must be adequately trained to care for the residents. They should be given clear instructions on what is expected of them and what to do if they notice any signs of abuse or neglect.
• Staffing Ratios: There must be an appropriate number of staff members on duty to provide adequate care for the residents. If there are not enough staff members, residents may not get the care they need, leading to abuse or neglect.
• Lack of Supervision: Long-term care staff must be supervised closely so that they are aware of what is happening in the nursing home and can intervene if they see any signs of abuse or neglect.
• Poor Communication: Communication between nursing care staff, residents, and family members must be open and effective to make everyone aware of what is happening in the nursing home and report any concerns immediately.
• Inadequate Reporting Procedures: Senior care employees and family members must have a way to report any concerns about abuse or neglect without fear of retaliation. The reporting procedures should be clear and easy to understand.
• Resident-to-Resident Altercations: Nursing care residents may abuse or mistreat other residents due to age, mental health issues, aggressiveness, leading to physical injuries, emotional distress, and social isolation.
• Staff-to-Resident Altercations: Long-term care staff may harm or mistreat residents due to anger, frustration, or negligence, leading to physical injuries, emotional distress, and social isolation.
• Financial Exploitation: Family members, friends, or caregivers may steal money or personal belongings from residents or trick them into signing legal documents that give away their property, leading residents to feel helpless and vulnerable.
• Sexual Abuse: employees or other residents may sexually assault or harass residents against their will, leading to physical injuries, emotional distress, and social isolation.
• Neglect: Senior care employees may not provide necessary care for residents, such as bathing, dressing, grooming, eating, or drinking, which can lead to physical injuries or death.
• Poor Living Conditions: The New York nursing home may be in poor condition with inadequate heating/cooling systems, broken furniture, peeling paint, insect infestations, etc, which can lead to physical injuries or death

What You Can Do if You Suspect Nursing Home Abuse or Neglect

If you suspect that your loved one is a victim of nursing home abuse or neglect, there are several things that you can do.

• First, talking to your loved one about what is happening is vital. It's possible they are afraid to speak up or may not even be aware of the abuse or neglect.
• Next, you should contact the long-term care facility where your loved one resides and file a formal complaint. You should also contact the police if your beloved family member is in immediate danger.
• Finally, you should contact an attorney specializing in nursing home abuse and neglect cases. An attorney can help you investigate the situation and determine the legal options available to you and your loved one.

Why Facility-Acquired Bedsores Typically Indicate Nursing Home Negligence

Bedsores, also known as pressure ulcers and decubitus ulcers, are injuries to the skin and tissue that occur when a person is confined to a bed or wheelchair for a prolonged period. A newly formed bedsore usually indicates that the individual receives substandard care in nursing homes. Bedsores are commonly seen as a result of neglect or abuse.

Unfortunately, bedsores are all too common in nursing homes. In fact, according to a report from the National Pressure Ulcer Advisory Panel (NPUAP), anywhere from 11% to 37% of nursing home residents in nursing homes have at least one pressure ulcer. And of those residents with pressure ulcers, 4% will develop stage three or four ulcers.

What are Bedsores?

Bedsores are painful, unsightly, and can become infected if not treated properly. They typically form on areas of the body where the bone is close to the skin, such as the hips, tailbone, or heels. However, they can also form on the elbows, shoulders, or other bony areas.

Pressure wounds occur when the blood flow to an area of the body is cut off due to sustained pressure. The pressure could be from lying in one position for too long, wearing ill-fitting clothing or shoes, or having secretions from the skin that aren't being cleaned up properly.

Contributing factors that lead to facility-acquired bedsores in a skilled nursing facility in New York include:

• Failing to Perform Weekly/Daily Skin Assessment: Nursing home residents at high risk of developing pressure wounds must have a daily skin assessment to identify newly developed bedsores. If a wound is identified, the nursing staff must take immediate action to treat the wound.
• Not Changing Bed Sheets and Linens Frequently: Bed sheets and linens should be changed daily to prevent bacteria from building up and causing skin irritation.
• Not Turning Residents Frequently: Residents need to be turned frequently to prevent pressure sores from developing on their skin.
• Allowing Residents to Sit in Wet or Soiled Clothing: Nursing home staff should ensure that residents are changed out of wet or soiled clothing as soon as possible to prevent skin irritation.
• Allowing Residents to Lie in Urine or Feces: Staff should clean residents immediately if they are found lying in urine or feces to prevent skin irritation.
• Not Checking Water Temperature When Assisting with Bathing: The water temperature should be closely monitored when assisting residents with bathing to prevent burns.
• Allowing Residents to Remain in Bed for Too Long: Residents should not be allowed to remain in bed for more than two hours at a time, as this can lead to pressure sores.
• Using Incorrect Mattress Pressure Ulcer Prevention Protocols: Staff should use correct mattress pressure ulcer prevention protocols when checking patients for potential pressure sores.
• Not Administering Pain Medication as Prescribed: If a resident is in pain, they may not be able to move around, leading to the development of pressure sores.
• Ignoring Resident Complaints of Pain: If a resident complains of pain, nursing home staff should investigate the cause of the pain and take appropriate action.
• Failing to Properly Monitor Vacuum Sealed Dressings: Staff should properly monitor vacuum-sealed dressings on residents in nursing homes at high risk for developing pressure ulcers.
• Not Consulting a Physician When a Resident Develops a Pressure Ulcer: A physician should be consulted when a resident develops a pressure ulcer to determine the best course of treatment.

Categorizing Bedsores in a Skilled Nursing Facility

Medical professionals and wound care specialists categorize the stages of bed sores, where each stage is progressively worse than the last. The multiple stages of pressure ulcers include:

• Stage I Pressure Wounds: During the initial stage, the wound appears reddened or purplish that is warm to the touch. There is no breakage in the skin or damage to underlying tissue unless the injury is allowed to progress to Stage II.
• Stage II Pressure Sores: The skin breaks open and spills out yellow or green drainage. The wound may be 2-4 inches in diameter and hurt if touched. The surrounding tissue may become red, swollen, and warm to the touch.
• Stage III Pressure Ulcers: The wound becomes crater-like with a thickened border and can be up to 6 inches wide. The surrounding tissue will be very red, swollen, and tender. You may also see black spots on the skin around the wound called eschar.
• Stage IV Decubiltis Ulcers: These most severe wounds involve damage to muscle, bone, and other underlying structures. The skin will be necrotic (dead), and an odor may come from the wound.
• Unstageable: The build-up of necrotic (dead) tissue, debris, and dried blood can mask the extent of damage to the underlying tissue, muscle, bone, and tendons. Typically, a surgeon will debride the wound to expose the extent of damage to identify the stage of progressing bedsore.
• Deep Tissue Injury: Sometimes, bedsores appear different than a categorized Stage I through stage IV bed wound where the sore appears to be minimal at the top with significant deep tissue injury and the subdermal layers of the skin and muscle. A deep tissue injury can be deadly when infection develops before the skin ruptures at the surface.

All nursing homes must follow established protocols when providing skilled nursing care to eliminate the potential of developing bedsores. Usually, improving the patient's health by providing special diets, daily exercise, and assistance with activities of daily living can minimize the potential of a facility-acquired sore.

Resources:

• NCBI: Older People Abuse in Nursing Homes
• WHO-Information About Elder Abuse

Skilled nursing homes in New York that accept Medicare funding: