Apparent declining staffing levels at Laughlin Healthcare Center are causing concern among loved ones who help care for relatives at the skilled nursing facility.
Their concerns were brought into sharp focus by a July 3 incident involving a resident who walked outside through the main entrance, fell over in the parking lot and then continued into woods on the property before being brought back inside.
The incident was witnessed by several people visiting the nursing facility at 801 E. McKee St. now operated by Ballad Health. A Ballad Health administrator acknowledged this week the incident took place and said corrective measures are being taken.
The Tennessee Department of Health would not confirm an active investigation is taking place in relation to the July 3 incident. A DOH staff member was reportedly at the nursing home on July 13 talking with relatives of residents and health care center employees.
Observations by some frequent visitors to Laughlin Healthcare Center indicate decreased staffing levels. A question about staffing was not addressed in a statement issued this week by Chuck Whitfield, CEO of Laughlin Memorial Hospital.
The merger of Wellmont Health System and Mountain States Health Alliance was finalized in February. In April, Ballad Health, the new name for the nonprofit health care system, announced about 150 filled positions were being eliminated, and 50 vacant positions would be phased out.
The merger brought together 21 hospitals, assisted care facilities and other health care facilities in 29 counties of Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky. Ballad Health has about 15,000 employees, including those at the 90-bed Laughlin Healthcare Center.
Gary Cutshall’s 87-year-old mother has been a Laughlin Healthcare Center resident since April 2017. He and his sister alternate visits to ensure their mother is fed, cleaned and receives the appropriate level of care every day.
She has Alzheimer’s disease and is bedridden, dependent on others for basic care. Cutshall said many residents do not have relatives or friends visit on a regular basis and rely entirely on staff for their well-being.
Cutshall has noticed a number of resignations and other staff departures this year at Laughlin Healthcare Center.
“It’s getting to the point where there are not enough employees who can adequately take care of their patients,” he said. “They have cut (Laughlin Healthcare) staff down tremendously.”
On a recent visit accompanied by a relative of a resident, the facility appeared clean and relatives of residents said the the food served to residents is on a standard with similar facilities in the area.
The staffing issue is what troubles frequent visitors like Cutshall, who said he recently observed two CNAs who were responsible for feeding 19 residents on one shift.
He believes there are simply not enough employees to attend to the basic needs of many residents.
“We got people over there suffering,” Cutshall said. “I know (my mother) wouldn’t be fed properly if I wasn’t there.”
Polly Denning, who lives near Raleigh, North Carolina, spends much of her time in Greeneville helping to care for her 96-year-old mother, a Laughlin Healthcare Center resident since September 2017.
“I think they need more staff and lot of them complain they’re being overworked,” Denning said.
Both Cutshall and Denning said staffing levels on weekends pose a particular problem in ensuring residents get the care they need.
“You pay the facility the same amount for the care you have all week and you expect to have the same amount of care every day,” Denning said.
Denning said her mother occasionally has long waits to be accompanied to the bathroom and decides to act on her own.
“She’s not supposed to do anything by herself but she does,” Denning said.
Denning said she has noticed a slight improvement in staffing levels at the facility recently, but still feels obligated to spend more than half her time in Greeneville, commuting about 300 miles each way from North Carolina to help care for her mother.
“There are some (staff) there who are pretty dedicated and go above and beyond,” Denning said. “I just want to make sure mom stays pretty well satisfied.”
The rate for residents is set by the state. Cutshall said it costs $5,600 a month, or $190 a day, for his mother to live at Laughlin Healthcare Center.
“The majority of the nursing home staff are hard-working, dedicated employees. The problem is, there’s not enough sufficient numbers of staff to provide needed services in a timely fashion,” Cutshall said. “They are simply overwhelmed with so much responsibility and so little help.”
REPRESENTATIVE HEARS CONCERNS
State Rep. David Hawk was asked to serve as a member of a Local Advisory Council created by the state DOH in connection with the Certificate of Public Advantage granted to Mountain States Health Alliance and Wellmont Health systems during the merger that created Ballad Health. The Certificate of Public Advantage, commonly referred to as a COPA, is the document that gave permission for the health systems to merge.
Hawk has listened to the same concerns voiced by relatives of assisted care living facilities.
“Unfortunately, I have no role in any merger transition, and am on the outside looking in as business decisions are being made by Ballad Health,” Hawk said in an email response to questions.
At the June 6 inaugural meeting of the advisory council, Hawk said he shared his concerns “about low nurse staffing levels, as well as other stated concerns, at our Greene County health care facilities, which are now part of Ballad Health.”
He spoke with Cutshall, along with “numerous health care professionals in Greene County.”
During the organization of the advisory council, Hawk said information was given to him and other council members that “the purpose of the LAC is to facilitate input from residents of the COPA Geographic Service Area.”
“I expanded this purpose during my subsequent comments (and) I intend to share public concerns about operations of Ballad Health with our Tennessee Department of Health,” Hawk said.
His comments of concern were then directed to the new COPA monitor, Larry Fitzgerald, who “was specifically hired by the state DOH to field public comments about the creation of Ballad Health through merger.”
“I will continue to share any concerns that I hear about Ballad Health with our Tennessee Department of Health,” Hawk said. “My encouragement to constituents in Northeast Tennessee is to contact myself or other LAC members about any concerns related to Ballad Health, with the understanding that these concerns will be relayed to the COPA Monitor, Larry Fitzgerald, and the Tennessee Deptartment of Health.”
In recent months, Cutshall has observed the resignation of more than 15 CNAs “that have quit because of the situation,” he said.
CNAs are responsible for clothing, bathing and providing other basic care services for residents with conditions like severe dementia.
In speaking with some Ballad Health employees, Cutshall said they agree “something has got to be done.”
Cutshall said that at least nine licensed practical nurses have also left since December 2017, and has observed only one replacement hired to replace the departed LPNs as of last week.
Questions to Ballad Health about the July 3 incident involving the resident and staffing issues were initially posed to Laughlin Health Care Center administration, and then moved up the chain of command to Whitfield.
At least two visitors to Laughlin Healthcare Center on July 3 said they saw the resident walk out the front entrance door, go through the parking lot down an incline with stones and falling before getting up. They said the man then walked into woods on the property at the edge of the parking lot before being brought back inside.
Whitfield issued a statement this week.
“The safety of our patients and long-term care residents is our number one priority. Staffing decisions at Laughlin Healthcare Center are determined by local facility leadership based on patient need,” Whitfield wrote.
The most recent report from the U.S. Centers for Medicare and Medicaid Services “awarded the facility four out of five stars for its staffing practices,” Whitfield wrote.
“A patient did leave the dedicated patient care area on July 3 for a period of a few minutes, but did not leave the facility property. We have identified factors that led to the event, and Laughlin Healthcare Center is updating security practices, which should mitigate the opportunity for any similar event to occur in the future,” Whitfield wrote.
Elizabeth Hart, a state DOH spokeswoman, confirmed this week that Laughlin Healthcare Center last had formal complaints about operations filed on May 18, 2017, before the merger and creation of Ballad Health was approved.
An investigation by the DOH Division of Health Care Facilities was completed and “no health deficiencies were cited” in regard to either complaint, according to DOH documents.
Laughlin Healthcare Center is inspected annually by the state DOH.
Hart would not confirm that a DOH official was at the skilled nursing facility last week. She would not detail the reason for the 2017 complaints or confirm any additional ones have had been filed since then.
General information is available by going to https://apps.health.tn.gov/FacilityInspections/ and searching alphabetically for Laughlin Healthcare Center.
“We do not post nor do we share actual complaints,” Hart said. “Additionally, we do not comment on any long term care facilities until after an investigation, if warranted, is completed.”
According to a U.S. News & World Report best nursing homes survey, the Greeneville facility has an overall average rating. It is rated above average in the categories of health inspection and complaints, staffing and medical care safety measures.
The staffing rating includes the “average number of hours per day received per resident from registered nurses, licensed practical nurses, licensed vocational nurses and certified nurse assistants.”
It is unclear when the most recent ratings were posted online.
Cutshall and other visitors can only relate personal observations of what they have seen at Laughlin Healthcare during daily visits in recent months.
“They’ve lost cafeteria help, housekeeping help and most importantly, health care staff,” he said. “Everybody has noticed the difference.”
Cutshall took notice when Ballad Health placed a television ad during the Super Bowl in February. He thinks the money could have been better spent at Ballad Health facilities like Laughlin Healthcare Center.
“They say this used to be the best nursing home to work at in Greene County,” Cutshall said. “When Laughlin had it before all this Ballad Health stuff took place, it was a good one.”
Cutshall said his intent is not to disparage Ballad Health or its employees.
“We just want people in here to take care of these residents,” he said. “Something needs to be done. Something’s got to give.”