Nursing homes need more oversight. This may include your loved one’s facility

Two years ago, a Rego Park neighbor, Anisia Ayon, had a knee replacement and went to a nursing home for rehabilitation. Apart from the post-operative care team (“I give them a five [out of five],” she said), the rest of the staff failed her on even basic tasks like administering her diabetes medication on time, Ayon told Epicenter NYC, adding that a staffer who was supposed to bathe her didn’t do so for 20 days. So she was forced to bathe herself in the bathroom despite her operated knee.  

“My experience with nursing homes is they need to be more checked,” she said. “[Staff] … don’t care, they just go for work. They need to have more humanity because these people are sick, and especially the ones that don’t realize what’s going on, it’s very sad.”

Ayon is only one of the many patients who have recently reported mistreatment or neglect while in long-term care facilities in New York. In March, the attorney general’s office settled a $8.6 million lawsuit with a nursing home in Long Island for fraud and residential mistreatment.  

Last year, Attorney General Letitia James sued the owners and operators of four nursing homes for fraud and resident neglect. The suit alleged that patients suffered from dehydration and malnutrition, were forced to sit in their own urine and feces, sustained severe injuries from falls, and developed infections and sepsis as a direct result of improper care, even resulting in death. 

Months after the last federal report highlighted a series of pandemic lessons learned in order to improve care in nursing homes, better care is still a far-off goal, local officials and advocates say.  

A need for more oversight at nursing homes

Understaffing and lack of oversight are to blame, according to advocates and elected officials who spoke at community meetings in Queens and Harlem before community boards broke for summer recess. They say the needle hasn’t moved much since the reckoning of conditions at nursing homes during the Covid-19 pandemic.

“I can’t tell you over the years how many people call and [say], ‘my person’s in a nursing home,’ [and] don’t know what’s going on … are they getting their meals? Are they getting bathed? Are they getting their medication?” said Senator Cordell Cleare, who represents Harlem and other parts of Uptown Manhattan, during a Manhattan Community Board 10 meeting in May. “Their quality of life deteriorates because no one is really checking up.”

Cleare says she saw this firsthand during a visit to a nursing home, where she checked on a patient on behalf of a constituent. Staff told her a patient wasn’t eating, she says. Cleare learned the patient was getting their lunch around the time they left the room for their medication. By the time they returned, she says, staff had unwittingly taken away the patient’s lunch before they had had a chance to eat.   

This need for proactive checks at nursing homes is why the senator says she pushed for a $2 million investment in the Long Term Care Ombudsman Program, a statewide advocacy program for older adults and people with disabilities in assisted living facilities.  

Other local leaders, like Richard Mollot, executive director of the Long Term Care Community Coalition, are also hopeful more people will report concerns through the resource program. While ombudsmen can’t penalize a facility for poor quality of care, it can help residents air and resolve their concerns. The increased mainstream media attention to care issues at nursing homes during the Covid-19 pandemic hasn’t led to real change, he says. 

“Things have gotten worse for nursing home residents [since the pandemic],” Mollot told Epicenter NYC. “The inspections have been less frequent … so that means that nursing home operators know that they can get away with poor care, with mistreating residents, with discharging residents inappropriately with impunity, because there’s generally little, if any, repercussions for illegal or inappropriate care.”

Mollot has highlighted challenges in the nursing home industry, such as owners allocating enough funding for staff and misusing public funds that pay for most nursing home care. New York State actually has strong nursing care standards, he says, but they require oversight. A vast shortage of inspectors has delayed most inspections in New York City past the legal timeframe, THE CITY reports.  

The state agencies do a poor job of identifying when residents have suffered, when there’s adequate care, or when staff over-uses antipsychotic drugs as chemical restraints, Mollot says. This lack of supervision and enforcement makes New York and New Jersey some of the weakest states in the country when it comes to protecting residents in nursing homes, he says.  

“I think it’s a real culture of complacency,” he said. “And a culture in which the nursing home industry is seen as the customer, rather than the residents and families and the public, who depend upon nursing homes.”

How Central Queens community leaders are pushing the agenda

The Queens Community Board 6’s committee on aging, social services, and disabilities has hosted recent webinars and meetings as part of the group’s ongoing efforts to push beyond the informal powers of the ombudsman program and advocate for policies with teeth. 

In April, CB6 put forth a resolution to elected state officials calling for more oversight for long-term care facilities. Rehab centers and nursing homes had been asking for increased Medicaid funding, which was approved as part of the 2024-2025 state budget. 

The goal for the next state budget cycle is to encourage legislators to refrain from increasing funding for nursing homes unless they do a better job with areas like allocating money for sufficient staffing.

“What ends up happening, to me, is that [staff] are taking the blame for something they have no control — they need a job, they’re working really hard, and they have a [high patient-to-staff] ratio,” said Mark Laster, a longtime clinical social worker with a decade of experience in nursing homes. “Especially a night aide, when usually there’s less staff around, they’re going to be held accountable for something that goes wrong, when the reality is … there’s just not enough staff.”

Practical advice for checking in on your loved ones

Meanwhile, here are some practical suggestions Laster shared on how to keep your loved ones safe in long-term care facilities: 

• Encourage as many family members and friends that can visit to check in on patients in person. That way you’re not overburdening one person with frequent visits. make multiple visits.

• It’s best to visit at different times of the day. If a patient has a visitor at, for instance, 10 a.m., the staff starts to realize that and make sure the patient looks great at that time. We don’t know how that person is gonna look at, for instance, 2 p.m. Given staffing shortages, this kind of variation helps you get a better sense of the care your loved one is getting.

(If you need help finding an ombudsman, call the Long Term Care Ombudsman program at 1 (855) 582-6769. Find out more information, including the state complaint hotline for long-term care, here.) 

• If you’re concerned about your loved one facing improper care at a long term care facility, discuss with their social worker or director of nursing services. 

• To prevent a single individual from getting blamed and ensure the whole team is on the same page about your concerns, request for the care plan team coordinator to set up a meeting with staff. Nursing home staff might even pay more attention when they know you are educated on the process and, for instance, know what a care plan team coordinator is. 

• Don’t go into these conversations or meetings yelling. Staff are people too. If you start screaming at people, they’ll shut down and won’t listen. 

• The squeaky wheel still gets the grease, especially with patient advocacy. If you’re seeing the same pattern, then the next step would probably be to bring in an ombudsman. If you need help finding an ombudsman, call the Long Term Care Ombudsman program at 1 (855) 582-6769. 

• If the situation doesn’t resolve, you can take your complaint to the state. (Find out more information, including the state complaint hotline for long-term care, here.) You can also discuss a transfer of your loved one to another facility through the social worker or discharge planner.

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Richard Mollot also recommends joining resident and family councils and seeing a grievance officer at the nursing home. You can find more resources from the Long Term Care Community Coalition and the Centers for Medicare and Medicaid Services. 

For more stories geared towards helping you, check out the rest of our reporting.