Mississippi Today

Falling short: 99% of Mississippi nursing homes don’t meet new staffing regs

Published

1 year ago

December 13, 2023

Viometrice Simmons remembers when she first fell in love with nursing. She was about 5 years old, sitting on the porch of her childhood home in Murfreesboro, Tennessee, as her aunt picked corn from the garden.

When she heard her great grandmother calling for her aunt from the bedroom, Simmons strode into the room, hopped up on the hospital bed and helped to turn and change the 84-year-old the way she had seen the women in her family do many times.

Forty-seven years later, that’s still the way she operates as a certified nursing assistant in the Mississippi nursing home she serves.

“When you walk in that door, every resident is your patient,” Simmons said.

Despite her dedication and more than 30 years of experience, she is only making $17 an hour at the nursing home where she currently works. In order to make ends meet, she works two jobs between 6 a.m. and 5 p.m., sometimes working overtime until 10 at night. She says some nights she gets out of work and sits in her car for an hour and a half because she’s too drained to move.

“I feel helpless. I feel exhausted,” she said. “But I know I got to keep going because who else is going to do it? If the people with the hearts give up, there’s going to be no one left for the people in there who are just forgotten about.”

Simmons never considered going back to school to become a registered nurse. What she loves about her job is being a familiar and reliable face for her residents. A CNA is responsible for providing the majority of hands-on resident care, and is often the person a nursing home resident sees the most on any given day.

“I don’t just want to be pushing pills,” Simmons said. “I want to let them talk to me. A lot of the residents tell me things that their families don’t even know about them.”

Poor pay and high turnover are among the reasons Simmons believes new federal staffing requirements in nursing homes will be, in effect, meaningless.

“Where are they going to get the staff from?” Simmons asked. “People are not doing it because they’re underpaid, and they can’t feed their families on that kind of money.”

In Mississippi, all but two of the 200 skilled nursing facilities – those licensed to provide medical care from registered nurses – would need to increase staffing levels under federal regulations the Biden administration proposed in September, according to data analyzed by Mississippi Today, USA TODAY and Big Local News at Stanford University.

That’s in line with the national trend: Over the first quarter of 2023 – from January to March – less than 1% of skilled nursing facilities in the U.S. met the draft rule’s two core standards of provider care.

After signing the executive order in September, Biden accepted public comment through Nov. 6. The Centers for Medicare and Medicaid Services is the agency responsible for reviewing the more than 40,000 comments and writing the final rule – which hasn’t happened yet and can take anywhere from months to years. Sixty days after the final rule is published in the Federal Registrar, the first phase in a staggered implementation process will begin.

Falling Short: Rebuilding elderly care in rural America

Rural nursing homes across the country, already understaffed, face significant new federal staffing requirements. With on-the-ground reporting from INN’s Rural News Network and data analysis assistance from USA TODAY and Big Local News at Stanford University, eight newsrooms explore what the rule change would look like for residents in communities across America. Support from The National Institute for Health Care Management (NIHCM) Foundation made the project possible.

The proposal, which comes at the heels of a years-long battle nursing home lobbyists waged against reform, outlines minimal standards. For example, the draft rule mandates 2.45 hours of CNA care and .55 hours of RN care per resident per day. That’s less than the 2.8 hours and .75 hours recommended by a CMS landmark 2001 study – even though residents’ needs have gotten more complex over the last two decades with more people living longer.

The proposal also mandates having an RN on duty 24-7. Current regulations mandate having 24-7 care, but allow the position to be filled by licensed practical nurses, who are used more frequently because their salaries are lower than those of RNs. The proposal does not have a requirement for LPN care, leaving experts worried nursing homes will simply replace LPNs with other staff.

“The 24-hour staffing requirement is good, as long as they make that in addition to the administrative nurses,” explained gerontologist and national nursing home expert Charlene Harrington. “But the other requirements they propose are just shockingly low. And that’s partly because the nursing homes have been lobbying against these standards for over a year and a half. So, all these advocates and the experts are very upset about it.”

The only two skilled nursing homes in Mississippi already meeting the not-yet imposed standards are Reginald P. White and James T. Champion nursing facilities – sister organizations of East Mississippi State Hospital, one of the state’s two psychiatric hospitals. The two Meridian nursing homes met the staffing minimums every day of the 91-day second quarter of 2023.

These homes receive about 20% of their funding from the state, according to Mississippi Department of Mental Health Planning and Communications Director Adam Moore. That’s in addition to the funding they receive from Medicaid and Medicare, as well as personal insurance and private pay.

Kevin Walker, administrator of Reginald P. White Facility, and Judd Nance, administrator of James T. Champion Facility, were surprised to learn they met the new requirements every day between April and June.

“We probably try to staff a little heavier than most nursing homes do, but we think we’re short all the time,” Nance said.

Having adequate staffing is one of the strongest predictors of whether nursing home residents will do well. And doing well doesn’t just mean the bare minimum of safety.

Any nursing facility participating in Medicaid or Medicare reimbursement is required by law to provide services that “attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident,” as dictated by the Nursing Home Reform Act of 1987.

Richard Mollot, the executive director of Long Term Care Community Coalition – a national nonprofit dedicated to advocating for residents of nursing homes and their families – says that when it comes to laws, the Nursing Home Reform Act is unique because it focuses on the customer – in this case, the resident.

“Most laws focus on the industry itself,” Mollot said. “For instance, all car manufacturers are expected to meet specific miles-per-gallon efficiency or have certain safety features. Nursing homes, on the other hand, are required to provide the staffing, supplies, and services to assure that every resident is able to attain and maintain their highest practicable well-being as an individual, based upon a comprehensive assessment of the person and a care plan that includes not only clinical needs, but the resident’s cultural background, goals, and personal preferences, too.”

Currently, states are in charge of regulating staffing in nursing homes. Some states have no staffing minimums, while the ones that do keep the requirements very low. In Mississippi, regulations require there to be at least a ratio of one CNA for every 15 residents during the day, and 25 residents at night – despite the fact that studies have shown one CNA for every six to eight residents during the day and 11 to 13 at night is optimal.

Even these suboptimal regulations are rarely enforced, according to Harrington, due in part to a national shortage of inspectors. States are required by the U.S. Department of Health and Human Services to conduct annual surveys and certifications of nursing homes receiving Medicaid and Medicare. In Mississippi, 54% of nursing home state surveyor positions were vacant in 2022, and 44% of the working surveyors had less than two years of experience.

“Enforcement is very weak, especially on staffing,” said Harrington. “We’d like to see CMS really crack down on the nursing homes that don’t have enough staff, and maybe put a hold on admissions until they have enough staff. If they’re not actually able to hire staff they shouldn’t be able to admit patients.”

Negligence that seems minor can compound into serious health issues and death – not to mention it often breaches basic expectations of dignity. Even in rehabilitation centers, where residents should be receiving support for mobility, low staffing can mean they are placed in diapers rather than assisted to bathrooms.

In previous nursing homes, Simmons says she witnessed bathroom requests going unanswered and continent residents being diapered out of convenience.

The results can be devastating. Residents who are confined to bed and unable to go to the bathroom not only suffer low morale, but can also develop concurrent urinary tract infections. In the elderly, these infections can cause delirium and exacerbate dementia. Those who try to get up on their own may suffer falls, broken bones and concussions as a result.

“You see residents with UTIs and falls and stuff because they’re crying out for help to go to the bathroom in the middle of the night and they fall because they have to go to the bathroom and they’re told to go to the bathroom in their briefs,” Simmons said. “Who wants to be sitting somewhere with a wet brief on? It’s humiliating. And it’s unacceptable.”

According to Mollot, it’s a violation of the Nursing Home Reform Act, and one that could be resolved with adequate staffing.

“Nursing homes claim that diapering residents is necessary because they don’t have enough staff to respond to call bells or implement resident-centered toileting practices,” Mollot said. “But if you think about it, that is pretty outrageous. In effect, facilities are admitting that they are taking in and retaining vulnerable human beings for whom they have neither the ability nor intention of providing decent care. Why do we accept the warehousing of millions of vulnerable Americans every year?”

Simmons says she has been let go twice, in two different states, shortly after filing incident reports to Occupational Safety and Health Administration and to the staffing agency she was contracted with.

But Simmons is resolved to continue advocating for the residents she serves and hopes that in time, higher pay and more stringent regulations will lead to better working environments for staff and quality of life for residents in nursing homes.

“I don’t care if they fire me from every job,” she said. “When I know something is not right, I’m going to stand up for it. And can’t nobody stop me from doing that.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Speaker White wants Christmas tree projects bill included in special legislative session

Published

8 hours ago

April 18, 2025

Staff Editor

Speaker White wants Christmas tree projects bill included in special legislative session

mississippitoday.org – @MSTODAYnews – 2025-04-18 10:38:00

by Taylor Vance, Mississippi Today
April 18, 2025

House Speaker Jason White sent a terse letter to Lt. Gov. Delbert Hosemann on Thursday, saying House leaders are frustrated with Senate leaders refusing to discuss a “Christmas tree” bill spending millions on special projects across the state.

The letter signals the two Republican leaders remain far apart on setting an overall $7 billion state budget. Bickering between the GOP leaders led to a stalemate and lawmakers ending their regular 2025 session without setting a budget. Gov. Tate Reeves plans to call them back into special session before the new budget year starts July 1 to avoid a shutdown, but wants them to have a budget mostly worked out before he does so.

White’s letter to Hosemann, which contains words in all capital letters that are underlined and italicized, said that the House wants to spend cash reserves on projects for state agencies, local communities, universities, colleges, and the Mississippi Department of Transportation.

“We believe the Senate position to NOT fund any local infrastructure projects is unreasonable,” White wrote.

The speaker in his letter noted that he and Hosemann had a meeting with the governor on Tuesday. Reeves, according to the letter, advised the two legislative leaders that if they couldn’t reach an agreement on how to disburse the surplus money, referred to as capital expense money, they should not spend any of it on infrastructure.

A spokesperson for Hosemann said the lieutenant governor has not yet reviewed the letter, and he was out of the office on Thursday working with a state agency.

“He is attending Good Friday services today, and will address any correspondence after the celebration of Easter,” the spokesperson said.

Hosemann has recently said the Legislature should set an austere budget in light of federal spending cuts coming from the Trump administration, and because state lawmakers this year passed a measure to eliminate the state income tax, the source of nearly a third of the state’s operating revenue.

Lawmakers spend capital expense money for multiple purposes, but the bulk of it — typically $200 million to $400 million a year — goes toward local projects, known as the Christmas Tree bill. Lawmakers jockey for a share of the spending for their home districts, in a process that has been called a political spoils system — areas with the most powerful lawmakers often get the largest share, not areas with the most needs. Legislative leaders often use the projects bill as either a carrot or stick to garner votes from rank and file legislators on other issues.

A Mississippi Today investigation last year revealed House Ways and Means Chairman Trey Lamar, a Republican from Sentobia, has steered tens of millions of dollars in Christmas tree spending to his district, including money to rebuild a road that runs by his north Mississippi home, renovate a nearby private country club golf course and to rebuild a tiny cul-de-sac that runs by a home he has in Jackson.

There is little oversight on how these funds are spent, and there is no requirement that lawmakers disburse the money in an equal manner or based on communities’ needs.

In the past, lawmakers borrowed money for Christmas tree bills. But state coffers have been full in recent years largely from federal pandemic aid spending, so the state has been spending its excess cash. White in his letter said the state has “ample funds” for a special projects bill.

“We, in the House, would like to sit down and have an agreement with our Senate counterparts on state agency Capital Expenditure spending AND local projects spending,” White wrote. “It is extremely important to our agencies and local governments. The ball is in your court, and the House awaits your response.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Mississippi Today

Advocate: Election is the chance for Jackson to finally launch in the spirit of Blue Origin

Published

8 hours ago

April 18, 2025

Staff Editor

Advocate: Election is the chance for Jackson to finally launch in the spirit of Blue Origin

mississippitoday.org – @BobbyHarrison9 – 2025-04-18 10:05:00

by Pauline Rogers, Mississippi Today
April 18, 2025

Editor’s note: This essay is part of Mississippi Today Ideas, a platform for thoughtful Mississippians to share fact-based ideas about our state’s past, present and future. You can read more about the section here.

As the world recently watched the successful return of Blue Origin’s historic all-women crew from space, Jackson stands grounded. The city is still grappling with problems that no rocket can solve.

But the spirit of that mission — unity, courage and collective effort — can be applied right here in our capital city. Instead of launching away, it is time to launch together toward a more just, functioning and thriving Jackson.

The upcoming mayoral runoff election on April 22 provides such an opportunity, not just for a new administration, but for a new mindset. This isn’t about endorsements. It’s about engagement.

It’s a moment for the people of Jackson and Hinds County to take a long, honest look at ourselves and ask if we have shown up for our city and worked with elected officials, instead of remaining at odds with them.

Pauline Rogers

It is time to vote again — this time with deeper understanding and shared responsibility. Jackson is in crisis — and crisis won’t wait.

According to the U.S. Census projections, Jackson is the fastest-shrinking city in the United States, losing nearly 4,000 residents in a single year. That kind of loss isn’t just about numbers. It’s about hope, resources, and people’s decision to give up rather than dig in.

Add to that the long-standing issues: a crippled water system, public safety concerns, economic decline and a sense of division that often pits neighbor against neighbor, party against party and race against race.

Mayor Chokwe Antar Lumumba has led through these storms, facing criticism for his handling of the water crisis, staffing issues and infrastructure delays. But did officials from the city, the county and the state truly collaborate with him or did they stand at a distance, waiting to assign blame?

On the flip side, his runoff opponent, state Sen. John Horhn, who has served for more than three decades, is now seeking to lead the very city he has represented from the Capitol. Voters should examine his legislative record and ask whether he used his influence to help stabilize the administration or only to position himself for this moment.

Blaming politicians is easy. Building cities is hard. And yet that is exactly what’s needed. Jackson’s future will not be secured by a mayor alone. It will take so many of Jackson’s residents — voters, business owners, faith leaders, students, retirees, parents and young people — to move this city forward. That’s the liftoff we need.

It is time to imagine Jackson as a capital city where clean, safe drinking water flows to every home — not just after lawsuits or emergencies, but through proactive maintenance and funding from city, state and federal partnerships. The involvement of the U.S. Environmental Protection Agency in the effort to improve the water system gives the city leverage.

Public safety must be a guarantee and includes prevention, not just response, with funding for community-based violence interruption programs, trauma services, youth job programs and reentry support. Other cities have done this and it’s working.

Education and workforce development are real priorities, preparing young people not just for diplomas but for meaningful careers. That means investing in public schools and in partnerships with HBCUs, trade programs and businesses rooted right here.

Additionally, city services — from trash collection to pothole repair — must be reliable, transparent and equitable, regardless of zip code or income. Seamless governance is possible when everyone is at the table.

Yes, democracy works because people show up. Not just to vote once, but to attend city council meetings, serve on boards, hold leaders accountable and help shape decisions about where resources go.

This election isn’t just about who gets the title of mayor. It’s about whether Jackson gets another chance at becoming the capital city Mississippi deserves — a place that leads by example and doesn’t lag behind.

The successful Blue Origin mission didn’t happen by chance. It took coordinated effort, diverse expertise and belief in what was possible. The same is true for this city.

We are not launching into space. But we can launch a new era marked by cooperation over conflict, and by sustained civic action over short-term outrage.

On April 22, go vote. Vote not just for a person, but for a path forward because Jackson deserves liftoff. It starts with us.

Pauline Rogers is a longtime advocate for criminal justice reform and the founder of the RECH Foundation, an organization dedicated to supporting formerly incarcerated individuals as they reintegrate into society. She is a Transformative Justice Fellow through The OpEd Project Public Voices Fellowship.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Mississippi Today

On this day in 1959, students marched for integrated schools

Published

11 hours ago

April 18, 2025

Staff Editor

On this day in 1959, students marched for integrated schools

mississippitoday.org – @MSTODAYnews – 2025-04-18 07:00:00

by Jerry Mitchell, Mississippi Today
April 18, 2025

April 18, 1959

About 26,000 students took part in the Youth March for Integrated Schools in Washington, D.C. They heard speeches by Martin Luther King Jr., A. Phillip Randolph and NAACP leader Roy Wilkins.

In advance of the march, false accusations were made that Communists had infiltrated the group. In response, the civil rights leaders put out a statement: “The sponsors of the March have not invited Communists or communist organizations. Nor have they invited members of the Ku Klux Klan or the White Citizens’ Council. We do not want the participation of these groups, nor of individuals or other organizations holding similar views.”

After the march, a delegation of students went to present their demands to President Eisenhower, only to be told by his deputy assistant that “the president is just as anxious as they are to see an America where discrimination does not exist, where equality of opportunity is available to all.”

King praised the students, saying, “In your great movement to organize a march for integrated schools, you have awakened on hundreds of campuses throughout the land a new spirit of social inquiry to the benefit of all Americans.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.