TAMPA, Fla. — The COVID pandemic has taken a toll on Florida’s long-term care facilities, not only with patient deaths but also because nursing homes and assisted living facilities can’t find and keep workers.
Short-staffing and high employee turnover rates are causing problems throughout the long-term care industry, leading Florida lawmakers and Gov. Ron DeSantis to take action.
When we visited Dr. Adewale Troutman at the Sodalis Tampa assisted living facility in July at the invitation of his wife Denise, nobody asked us who we were or where we were going.
“You just walked right up,” Denise Troutman said. “On the weekend, it’s just like a ghost town… pizza delivery people just walking around.”
A sign near the front door said the assisted living facility is secured “for the safety and security of residents,” but that wasn’t the case on a recent weekday.
“The residents here are unprotected”
“I literally can be anybody off the street. I walk in from the parking lot; I open the door,” Denise said as she walked through the unlocked door.
Nobody was at the front desk or in the lobby.
“The residents here are unprotected, and the staff. You never know who’s coming in,” Denise said.
She said she and other families took their concerns to ALF employees, but the situation didn’t get better.
Denise said earlier this summer, her husband was given a whistle to summon nurses because the call button system was down for weeks.
“Nobody would come,” Dr. Adewale Troutman said.
“I would prefer to see the system be improved without relying on blowing a whistle,” Dr. Troutman said.
Eric Hansum, an attorney for Sodalis, denied the system was down for weeks.
“Sodalis did have a brief time where nurse call buttons needed to be repaired in a facility. The system was down for a few days, and hourly checks were performed when that occurred to ensure patient safety. Whistles were also provided during this short time frame to ensure patient safety. Sodalis took steps to address the situation quickly. The company apologizes for any inconvenience caused to residents,” Hansum said in an email.
The frustrating transition from President of the American Public Health Association to patient
Dr. Troutman’s voice was faded, and he sometimes struggled to find words when we met with him in July.
Late-stage Parkinson’s disease left him prone to falls, but Troutman was once a giant in public health.
“He came down here to be the Associate Dean of Public Health at the University of South Florida,” Denise Troutman said.
Troutman, who served as President of the American Public Health Association, was a family doctor, an emergency room physician and Health Director for Metro Louisville.
While in Louisville, Troutman implemented one of America’s first indoor smoking bans, served on President Obama’s Infant Mortality Task Force and oversaw the region’s response to the swine flu epidemic.
But inside Sodalis Tampa on busy Bearrs Avenue, Denise said the fallout from the pandemic has driven away staff that he and others depend on.
“I don’t want there to be a time when I hear that there’s been a resident who’s walked out to Bearrs Avenue, or even that my husband has fallen down and there was nobody that heard a whistle,” Denise Troutman said at the time.
Dr. Troutman passed away last week, but his wife Denise thought it was important to share his story to help other families.
She described him doing this interview as his final act in his lifelong commitment to promoting public health.
Attorney Hansum responded to the Troutmans’ allegations with the following statement:
"Sodalis treats its residents and employees with compassion and respect and makes efforts to ensure the safety and security within its facility. Such steps include having locked facility doors during weekends and evening hours on weekdays, screening visitors, and requiring visitors wear masks. Sodalis is proud of its position within the Tampa community and elsewhere and continues to provide compassionate care to its residents every day."
“Feces went onto my side”
Twenty miles away in Pinellas County, 35-year-old Jack Knox is receiving care at Peninsula Health and Rehab following a severe injury in a car crash.
“I have a colostomy bag on my stomach from the accident,” Knox said.
He said overworked nurses at the facility ignored his calls.
“They were supposed to be checking it frequently and burping it,” Knox said. “The feces went onto my side. And they left the feces soiling on my side for two or three hours.”
“There is no knowledge or record of Mr. Knox’s colostomy bag bursting or leaking at our facility,” said a statement provided by Ann Bowdan Wilder, spokesperson for Signature Health Care which operates Peninsula Health and Rehab
“We were saddened to hear that Mr. Knox faulted us for events we have no knowledge of and/or did not occur here or occur as he has described,” the statement said.
Peninsula was on the Florida Nursing Home Watch List after being cited for an infection control issue.
Medicare.gov gives Peninsula a “below average” rating with two out of five possible stars.
The site said residents receive an average of 21 minutes of registered nursing care a day, which is about half the national and state average.
Medicare.gov also said 68.8% of registered nurses leave each year, and the turnover rate for all nursing staff is more than 50%.
“Residents are at a greater risk”
“When you have to replace every other staff member each year, you’re gonna have a crisis,” said Sam Brooks, who is Director of Public Policy for The Consumer Voice, a nonprofit that lobbies for better patient care in nursing homes and ALFs.
“The impact that COVID has had on nursing homes, particularly nursing home staffing… residents are at greater risk now,” Brooks said.
Kristen Knapp is a spokesperson for the Florida Healthcare Association, which represents nursing homes.
“We had nurses who were burnt out who made the decision to retire early; people just left or chose not to enter that field. So we’re really seeing that impact now,” Knapp said. “We’re seeing a 50% decline in CNAs who renew their license, and those are the people on the front lines. “
Knapp said that means empty beds in some facilities since companies can’t hire enough staff to meet minimum staffing requirements.
Knapp also said low federal and state reimbursements have kept wages low.
In an effort to address the crisis, Florida lawmakers approved $120 million for nurse education programs in this year’s budget and approved higher reimbursement rates which will allow member companies to raise salaries for nursing home employees to at least $15 an hour.
“That will allow us to be a little bit more competitive in our communities in helping to recruit new folks,” Knapp said.
Her organization is operating a job board to help fill some of the vacancies.
But Brooks said many facility operators are more focused on profits than providing ample resources to frontline workers.
“They’re put in just impossible positions. They’re put in positions where residents are dying; they don’t have enough training, they’re not making enough money,” Brooks said.
Knox and the Troutmans reported their concerns to the state and are sharing their stories so others might get better care.
“I just hope that they become more aware of what they’re doing with their patients, you know. Be more mindful and care about your patients more. That’s all I want, you know,” Knox said.
“It was important that somebody knew and somebody gave the voice to the voiceless that are here,” Denise Troutman said.
Dr. Troutman’s memorial service will take place Saturday morning.
Signature Healthcare answered a series of questions regarding Knox’s claims, staffing levels and Medicare ratings.
Below are excerpts from the company’s responses:
Inclusion on the Nursing Home Watch List:
States survey nursing homes on behalf of the federal government, routinely and at minimum once every year. While fines related to those surveys, even for the most minor violations, are meant for accountability, which is important, it is also an avenue for a state to increase its own funding. The $1,000 dollar fine you mention, and related citation were not only minor in nature and by definition, but also from 1 year ago and concerning a matter that was corrected and closed by the state. Our facility has been operating, and currently operates, under the Normal Standard licensure status. Regarding the watch list, unfortunately, state legislation does not always keep up with current times, or current information. The Florida Health Finder format was developed 21 years ago in 2001, when no other comparative data was available, and the State of Florida added it to Florida law at that time. Today, there are more updated and balanced platforms. Unfortunately, and unfairly, this antiquated platform can lead persons, who are not informed or educated on this site or the outdated format behind it, to consider or portray various nursing homes in a bad light, suggesting that a center may have unfavorable outcomes. This information can be misleading because the watch list does not capture current care being delivered by a given center, but rather reflects on PAST care, and in many cases, care that took place months or even years prior. Once on the watch list, a facility remains on it for a full 30 months, regardless of current compliance, correction or care and does not reflect follow-up survey outcomes. Stated another way, a listing on the watch list can last for three years, even if the original citation was corrected as early as the first month, and this can lead to misguided public scrutiny.
Medicare.gov Two-Star (“Below Average”) rating:
This interpretation of the data is unbalanced and inaccurate. First, this same data on Medicare.gov shows our staffing rating is 3 stars and our quality measures at 4 stars. Furthermore, since January 2022, the center has worked at or above the 3.6 Patient Per Day (PPD) requirement. This is overseen by Peninsula Care & Rehab’s administration daily, to ensure that hours are met. The current RN turnover rate at the center is 24.6%. As readily public, and available information makes clear, staffing turnover numbers have been significant during and due to the pandemic, and not just for the long-term care industry, but in industries across the nation. It has been devastating that our industry has been maligned for this issue, as other industries have not. We care for some of our community’s most vulnerable people, and we proudly accept that calling. This is exactly why more attention should be put on the healthcare heroes in long-term care who have risen to this call, despite the overwhelming negative media and national attention, and kept this absolutely essential industry of long-term care and skilled nursing going during this continuing pandemic.
Our nursing turnover rate is based on a TTM (Trailing Twelve Months) system and calculated with payroll data. That data is constantly changing, yet most public monitoring systems, like the one you mention, do not break down that data as we do, to show the basis of that change, therefore leading to a turnover percentage that can be misleading. Most public platforms show a percentage that does not account for healthy turnover such as an RN promotion to a higher leadership role within the organization. As that RN moves into a higher role (a DON, Director of Nursing, or ADON, Assistant Director of Nursing), it can negatively affect the RN turnover percentage. Also, healthy retirement, or new hires can affect that turnover percentage rate. Not all turnover is a negative, as new hires and promotions are crucial, but can affect the RN turnover percentage rate and make it appear negatively high. Additionally, there may be a smaller ratio of RNs related to LPNs, or CNAs in our facilities. For example, if a facility has 5 RN’s and there is a turnover of 2 RN’s, it would register as a 40% RN turnover percentage. But the basis for the “turnover” is not mentioned or understood. Peninsula’s current 24.6 RN percentage rate covers the last twelve months. Peninsula Care and Rehabilitation Center has worked hard to continue to support and value its long-time stakeholders (our employees) and our new hires. We focus on supportive orientation and onboarding, have implemented a retention plan for all new hires with training and an opportunity to complete education, and we have a mentoring system for our staff. We work diligently to prioritize the needs of our residents, their families, and our staff with a listening ear, meeting them where they are, and showing compassion.
Staffing:
During Mr. Knox’s stay at our facility, Peninsula Care & Rehab worked at or above the state’s minimum staffing requirement
Knox’s Care:
We were saddened to hear that Mr. Knox faulted us for events we have no knowledge of and/or did not occur here or occur as he has described. We empathize with Mr. Knox and his disabling medical condition following an unexpected and tragic motorcycle accident. We understand that a life-changing situation like this would be extremely difficult for any person to accept or handle, and we consider this in our care delivery. Our staff has been here for Mr. Knox, and still are, despite times our staff had been met with unkind words and his repeated refusals of care. At first, Mr. Knox also refused to allow staff to help him apply for needed state aid that would pay for his care. But with time, empathy, and continued conversation with our staff, he has since decided to apply. For our residents, we understand in these difficult situations, that is what it takes; time, patience, and compassion. In Mr. Knox’s case, our staff strives to manage his care, and his needs as best as possible, under the circumstances of his situation.
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