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

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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.

Mississippi Today

An ad supporting Jenifer Branning finds imaginary liberals on the Mississippi Supreme Court

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mississippitoday.org – Bobby Harrison – 2024-11-24 06:00:00

The Improve Mississippi PAC claims in advertising that the state Supreme Court “is in danger of being dominated by liberal justices” unless Jenifer Branning is elected in Tuesday’s runoff.

Improve Mississippi made the almost laughable claim in both radio commercials and mailers that were sent to homes in the court’s central district, where a runoff election will be held on Tuesday.

Improve Mississippi is an independent, third party political action committee created to aid state Sen. Jenifer Branning of Neshoba County in her efforts to defeat longtime Central District Supreme Court Justice Jim Kitchens of Copiah County.

The PAC should receive an award or at least be considered for an honor for best fiction writing.

At least seven current members of the nine-member Supreme Court would be shocked to know anyone considered them liberal.

It is telling that the ads do not offer any examples of “liberal” Supreme Court opinions issued by the current majority. It is even more telling that there have been no ads by Improve Mississippi or any other group citing the liberal dissenting opinions written or joined by Kitchens.

Granted, it is fair and likely accurate to point out that Branning is more conservative than Kitchens. After all, Branning is considered one of the more conservative members of a supermajority Republican Mississippi Senate.

As a member of the Senate, for example, she voted against removing the Confederate battle emblem from the Mississippi state flag, opposed Medicaid expansion and an equal pay bill for women.

And if she is elected to the state Supreme Court in Tuesday’s runoff election, she might be one of the panel’s more conservative members. But she will be surrounded by a Supreme Court bench full of conservatives.

A look at the history of the members of the Supreme Court might be helpful.

Chief Justice Michael Randolph originally was appointed to the court by Republican Gov. Haley Barbour, who is credited with leading the effort to make the Republican Party dominant in Mississippi. Before Randolph was appointed by Barbour, he served a stint on the National Coal Council — appointed to the post by President Ronald Reagan who is considered an icon in the conservative movement.

Justices James Maxwell, Dawn Beam, David Ishee and Kenneth Griffis were appointed by Republican Gov. Phil Bryant.

Only three members of the current court were not initially appointed to the Supreme Court by conservative Republican governors: Kitchens, Josiah Coleman and Robert Chamberlin. All three got their initial posts on the court by winning elections for full eight-year terms.

But Chamberlin, once a Republican state senator from Southaven, was appointed as a circuit court judge by Barbour before winning his Supreme Court post. And Coleman was endorsed in his election effort by both the Republican Party and by current Republican Gov. Tate Reeves, who also contributed to his campaign.

Only Kitchens earned a spot on the court without either being appointed by a Republican governor or being endorsed by the state Republican Party.

The ninth member of the court is Leslie King, who, like Kitchens, is viewed as not as conservative as the other seven justices. King, former chief judge on the Mississippi Court of Appeals, was originally appointed to the Supreme Court by Barbour, who to his credit made the appointment at least in part to ensure that a Black Mississippian remained on the nine-member court.

It should be noted that Beam was defeated on Nov. 5 by David Sullivan, a Gulf Coast municipal judge who has a local reputation for leaning conservative. Even if Sullivan is less conservative when he takes his new post in January, there still be six justices on the Supreme Court with strong conservative bonafides, not counting what happens in the Branning-Kitchens runoff.

Granted, Kitchens is next in line to serve as chief justice should Randolph, who has been on the court since 2004, step down. The longest tenured justice serves as the chief justice.

But to think that Kitchens as chief justice would be able to exert enough influence to force the other longtime conservative members of the court to start voting as liberals is even more fiction.

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

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Mississippi Today

On this day in 1968

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mississippitoday.org – Jerry Mitchell – 2024-11-24 07:00:00

Nov. 24, 1968

Credit: Wikipedia

Black Panther leader Eldridge Cleaver fled the U.S. to avoid imprisonment on a parole violation. He wrote in “Soul on Ice”: “If a man like Malcolm X could change and repudiate racism, if I myself and other former Muslims can change, if young whites can change, then there is hope for America.” 

The Arkansas native began to be incarcerated when he was still in junior high and soon read about Malcolm X. He began writing his own essays, drawing the praise of Norman Mailer and others. That work helped him win parole in 1966. His “Soul on Ice” memoir, written from Folsom state prison, described his journey from selling marijuana to following Malcolm X. The book he wrote became a seminal work in Black literature, and he became a national figure. 

Cleaver soon joined the Black Panther Party, serving as the minister of information. After a Panther shootout with police that left him injured, one Panther dead and two officers wounded, he jumped bail and fled the U.S. In 1977, after an unsuccessful suicide attempt, he returned to the U.S. pleaded guilty to a reduced charge of assault and served 1,200 hours of community service. 

From that point forward, “Mr. Cleaver metamorphosed into variously a born-again Christian, a follower of the Rev. Sun Myung Moon, a Mormon, a crack cocaine addict, a designer of men’s trousers featuring a codpiece and even, finally, a Republican,” The New York Times wrote in his 1998 obituary. His wife said he was suffering from mental illness and never recovered.

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

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Mississippi Today

On this day in 1867

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mississippitoday.org – Jerry Mitchell – 2024-11-23 07:00:00

Nov. 23, 1867

Extract from the Reconstructed Constitution of the State of Louisiana, 1868. Credit: Library of Congress

The Louisiana Constitutional Convention, composed of 49 White delegates and 49 Black delegates, met in New Orleans. The new constitution became the first in the state’s history to include a bill of rights. 

The document gave property rights to married women, funded public education without segregated schools, provided full citizenship for Black Americans, and eliminated the Black Codes of 1865 and property qualifications for officeholders. 

The voters ratified the constitution months later. Despite the document, prejudice and corruption continued to reign in Louisiana, and when Reconstruction ended, the constitution was replaced with one that helped restore the rule of white supremacy.

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

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