Lindsay-Heckler Portrait

NY State Nursing Homes Staffing Study

On September 20th, 2019, NY State Department of Health is having the first of two meetings to examine how staffing enhancements, and other initiatives, can be used to improve patient safety and the quality of healthcare service delivery, in hospitals and nursing homes. Supervising Attorney Lindsay Heckler will be there to give brief testimony on how staffing shortages are impacting our most vulnerable community members and in some cases, resulting in abuse and neglect.

The meeting will be live here:

You can submit your comments to the NY State DOH by emailing

Lindsay’s Testimony:

Thank you for the opportunity to provide the Department with testimony regarding the Staffing Study. I am a Supervising Attorney with the Center for Elder Law & Justice. We provide free civil legal services to seniors, people with disabilities, and low-income populations in the 8 Western New York Counties. Our mission is to improve the quality of life for our clients and the communities we serve. Our goal is to protect the essentials of life such as access to quality healthcare and protection from abuse. Sadly, due to inadequate staffing, our most vulnerable community members, are being abused and neglected in our nursing homes.

Our written testimony will provide more details about the horrors of inadequate staffing in WNY, the need for set minimum standards, and proposals aimed to increase the workforce to meet resident needs/standards. Today I wanted to take my 5 minutes to paint you a picture of how short staffing directly impacts nursing home residents, their families, and the staff tasked with providing care. Inadequate staffing is a problem and nursing homes must be held accountable, this means requiring minimum and specific staffing standards.

A WNY Nursing Home, Safire Rehabilitation of Southtowns, LLC (Safire South) has been cited 5 times in a row for insufficient staffing over the past 5 inspections: August 22, 2019, June 5, 2019, July 26, 2018, April 24, 2018, and December 28, 2017.While our written testimony will also highlight other nursing homes, we discuss Safire Rehab here due to its repeat deficiencies for insufficient staffing.  This 120 bed facility averages 109 residents per day but only 1.8 total staffing hours per resident per day. This information is from a recent report issued by the Long Term Care Community Coalition.[1] Safire Rehab’s staffing levels are the lowest in Erie County and well below the 2001 study that recommended hours of 4.1 total staffing hours per resident per day.  

The lack of staffing directly impacts resident care and safety and we will include literature on related studies in our written testimony. Safire South is an example of the correlation of insufficient staffing to poor quality care. Compared to state-wide averages, this nursing home has 4x the average health citations (75 compared to 19) over a three year period.[2] This nursing home has also been on the CMS Special Focus Facility Candidate List for 36 months.

Safire South has been cited 5 times in a row, for insufficient staffing. The following comes from the Department’s publically available Statements of Deficiencies. As you listen, keep in mind I am only referencing sections of the Statements of Deficiencies that pertain to F Tag 725 (Sufficient Staffing):

On December 24, 2017 (complaint), surveyors determined:

  • Residents did not receive medications and treatments as ordered by the physician due to the lack of adequate staffing
  • For 40/41 residents reviewed, the facility did not notify the physician that the medications or treatments were not provided.
  • For 22/22 residents reviewed, the facility did not provide treatment for skin ulcers and wounds per physician order.

On April 24, 2018 (complaint), surveyors determined:

  • The facility was not staffed per its own assessment resulting in the delay of an assessment of an acute resident and the subsequent transfer to a higher level of care due to the lack of staffing.
  • The RN on duty that night told surveyors the following “Everything looked ok but the pulse was elevated. I don’t remember exactly what it was but I do remember it was elevated. I was so busy that day I don’t think I even wrote a note. It’s busy at the change of shift. I was getting staff call-ins, I was trying to figure out staffing and print out Closet Care Plans. When LPN #1 came in (for the day shift) I told him there was a change in condition, he should asses her and send her out. I was so busy that day I didn’t do an assessment of the resident, just got vitals. I didn’t call the MD. I laid it on LPN#1’s hands. If I didn’t have the dual responsibility it would’ve been a different scenario. I would’ve been able to concentrate on that one resident.”
  • LPN #1, was scheduled as the day shift supervisor, due to major staffing issues, LPN#1 had to work as the Charge Nurse on the Subacute Rehab Unit. The LPN could not recall what time he got to the floor to begin the Charge Nurse duties on the unit, as he was making phone calls attempting to get staff into the building.

The resident was found curled up in a fetal position, moaning, and her pupils fixed. Short staffing resulted in delay for a resident being transported to the hospital.

On July 26, 2018 (annual) surveyors determined:

  • The facility did not have sufficient nursing staff to get residents up in the morning.
  • This impacted a resident who did not want to eat breakfast in his room,
  • LPN # 2 stated there was only one CNA for 40 residents when she came in Saturday morning. They did not get another CNA until 8:30am. We couldn’t get residents out of bed with that kind of staffing.

The impacted resident is a two person assist. It is hard for a CNA to provide proper care/services when there is only one CNA and a resident is a two person assist.

On June 5, 2019 (complaint), surveyors determined:

  • The short staff directly impacted a resident who is incontinent of ladder and bowel and is care planned to receive incontinent care every two to four hours; and instructions to “Please check resident frequently for incontinence.”
  • Review of a nurse’s note dated 5/20 stated “unable to do well checks on 5/19/19 due to one aide on unit and no aide this shift 5/20. Only visual. Family in to visit and upset with circumstances.”

On August 22, 2019, Safire Rehab, during its annual inspection, was cited for insufficient staffing.

These examples were only from F Tag 725. Throughout the complete Statements of Deficiencies, we see residents who just want to receive decent care and be treated with some humanity. We also see staff trying their best but to no success.

I know the nursing home industry is against minimum staffing standards because they claim it is too costly. I respectfully disagree and will detail so in our written testimony. I ask the Department, and the industry the following: How would you feel if you or a loved one, was forced to lay in your waste for hours?  To not be able to eat a meal at a table? Or not be able to participate in skilled therapy (which is needed to return to the community) because you were not provided your pain medications? How would you feel if you were the staffer trying to do their best to provide care to their residents?

Our written testimony will offer proposed solutions to address this issue. One such proposal is that nursing homes, who have insufficient staffing levels, cease admitting new residents. People are being harmed because facilities are continuing to admit those they do not have the staff to provide care. We also encourage the Department to assess State fines for citations issued at the Greater Than Minimal Harm Level (D-F) rating, as allowed by Public Health Law and CMS.

Thank you for your time.

[1] Data from LTCCC Staffing Report, accessed 9/18 at

[2] Data from NY Health Profiles,

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