A Culture of Throw-Away People Or My God, Florida Nursing Homes Suck
“We all know how hard it is to age and where that road ends, but we’ll bend over backwards to shut seniors away because it’s easier on our collective patience and pocketbooks. ” —Anna McGann, Hedgerow Court
What do I mean when I say Florida nursing homes suck? Here are a handful of the many awful things I personally witnessed during my time as a CNA and nurse:
A resident with dementia was accused of lying about/misremembering abuse at the hands of his roommate. The facility was aware of abuse and covered it up so they wouldn’t have to switch rooms and lose a private pay bed (private pay patients and Medicare patients are usually housed separately). The abused resident became depressed and was put on medication.
A resident put on her call light overnight. Her aide was asleep in another room. The resident fell trying to put herself on the toilet and died. The call light is still on in the morning when day shift arrives. The resident was a DNR with no family, there were no consequences for aide.
A resident with dementia tried to bludgeon his roommate with a blood pressure pole because he makes too many sounds, the facility denied workman’s comp to the nurse injured getting between them because she “should have run”.
A facility covered up sexual assaults against employees by another employee related to head of HR by firing staff members who report it. Told a victim “I don’t know why you girls keep lying about him like this, he’s a good boy.” (This facility is eventually closed, lawsuits include sexual assault of a resident)
A facility’s air conditioning in their locked unit broke in late June and wasn’t fully fixed until mid August. Windows in the unit could not be opened for safety reasons, so the staff tried to cool residents by putting wrapped bags of ice in their wheelchairs. Six residents suffered heat related injuries.
A resident’s ulcerated bed sore was allowed to regularly fill with feces because the nursing team had too much trouble rolling her for wound care.
A veteran and frequent rehab patient lost his leg and half of a buttcheek to diabetic neuropathy because he couldn’t afford insulin and rent. Social services wouldn’t even attempt to help because “it’s the V.A.’s problem”.
A facility physician regularly denied pain medication to female patients, especially patients of color, because they were “faking it”.
Like I said, just a short list. Most nurses who have worked in nursing homes down here will have similar stories…if they’re honest.
Despite Florida’s reputation as the retirement capital of the country, the AARP ranks Florida nursing homes 43rd out of 51 (all states and DC). The AARP also reports that almost 40% of Florida nursing homes are on the state’s Nursing Home Watchlist. As someone who observed how cozy some state inspectors can be with nursing home administrators, I don’t believe this number reflects reality. If a facility is found wanting, it’s usually given a warning as opposed to a fine, and the fines are a drop in the bucket compared to the thousands of dollars they collect per resident every month. Despite the egregious care offenses I’ve seen, only one facility I’ve worked at was ever closed—and that was after years of misconduct and almost $400,000 in fines. The facility, owned by a “non profit”, reported $121 million dollars in revenue on its 2011 taxes (less than two years before its closure), but ended up with $11.9 million dollars in deficit. Its chairman made $370,058 that year.
Because facilities focus on generating revenue, nursing home pay is low, and conditions are often sub par: my first facility often ran out of janitorial supplies; on one memorable occasion, leaving us to clean a feces-smeared locked unit with nothing but baby wipes. This same facility often had staffing shortages so severe the unit, which normally had a nurse and 3 CNAs, would sometimes have only myself and another CNA overnight. This facility was not the one shut down by the state.
Rampant corruption aside, even before Covid, Florida nursing homes were struggling with staffing. 95% of Florida nursing homes are reported as understaffed. Now, the majority of my local nursing homes rely on staffing agencies, and the lack of familiar care adds to an already stressed system. A nurse who doesn’t know their long term patients is a nurse who misses subtle changes, and in geriatrics those changes can be our only clue a patient is on the verge of a problem.
Staffing isn’t the only issue. With insurance companies dictating the length of hospital stays, nursing homes are often expected to care for near-acute level patients in a rest-home style setting. Facilities don’t have the tools they need to succeed, and the system is perpetually rigged against them. If it is in a patient’s best interest to run blood work every 24 hours at a hospital, why discharge them into an environment that will check their levels only when requested by a physician—especially when one physician usually oversees the entire facility (often more than one) in addition to maintaining an outside practice? Pair the lack of physician oversight with nursing staff who don’t know their patients, and you have a dangerous situation for elderly residents who often aren’t able to advocate for their own needs.
Many good people work in nursing homes. They manage to care for their residents without being dragged down by the depressing reality around them. Many, many more hang on because it’s a steady paycheck in an industry that always needs people. People with more empathy than backbone are typically driven out of nursing homes, and I was among them. I still miss nursing, but I still bear the physical and emotional scars it left on me as well.
People ask how nursing homes got this bad, but the truth of the matter is they’ve always been awful—and they’ve typically been worse. Modern American nursing homes evolved out of the dissolution of poorhouses, springing into existence as convenient places to store inconvenient people and bolstered by government funding in the 1950s. Honestly, we’ve never cared about senior citizens who aged out of society in this country, and Florida leads that charge. In 2022, the Florida Legislature reduced the number of mandated CNA care hours, allowing non-skilled staff to make up the difference. This move was widely panned by the AARP and other elder advocacy groups, but lauded by the nursing home industry. The number of short-stay hospitalizations for nursing home residents rose 12% that year. In 2023, Florida Republicans introduced bills in both chambers to limit wrongful death suits against nursing homes, citing a desire to prevent facility resources from being diverted away from patient care. The move would eliminate an estimated 90% of wrongful death suits by limiting potential claimants to surviving spouses and children under 25—because most of us have kids when we’re in our 50s, apparently.
So what do I expect readers to take from this infodumpy rant? Honestly, I don’t know. I’m just spreading the word; maybe I’ll inspire families to look for other solutions for their aging loved ones (move, don’t let them retire here). I’d love to see things change, but I’m at a loss. Reporting issues to the state typically ends in employee backlash versus action—especially when “random” inspections usually come with a warning. Where I’m at, contacting my local officials puts me in touch with the sort of men who only care when it's in their best interest financially or it will help them get votes. They’re either aware of the issues or can’t be bothered to listen. Voting them out seems unlikely. If you’ve got solutions, I’m all ears.
https://www.tampabay.com/news/health/feds-shut-off-aid-for-tampa-alf-to-close-in-august/2130551/
https://www.nursinghomeabusecenter.com/nursing-home-neglect/understaffing/
https://www.aarp.org/caregiving/health/info-2023/caregiver-support-scorecard.html
