CNAs try to mandate minimum staffing levels in Washington State

When reading one of my favorite sites for local updates, the Public News Service, I was reminded about the sad state of affairs for Washington caregivers in the nursing home industry. Washington doesn’t have a state law that spells out minimum staffing levels in nursing homes.  In the 2015 legislative session, nursing home caregivers will continue their battle to implement some basic staffing minimums.

Nursing home workers cite three reasons to mandate minimum staff-to-resident ratios: 1) Better care for nursing home residents, 2) Less turnover for weary staff members, and 3) Greater safety for both groups.

Shelly Hughes has been a Certified Nursing Assistant (CNA) in Washington facilities for five years. She explained that rarely is there enough time or enough staff in place to give residents the care they need. “One of the most heartbreaking things about my job is that I see great, kindhearted, hard-working people leaving,” she says. “Not only my facility, but the industry entirely because they’re so frustrated with the level of care we’re able to give our residents.”

Ms. Hughes says under current conditions, a CNA could be on duty for 15 or 20 residents.  Can you imagine? That ratio is not at all conducive to quality care for nursing home patients. However, Hughes points out that the facilities know in advance when state surveyors are coming to inspect. This is when managers pitch in and there are plenty of people scheduled.

AARP research indicates an annual turnover rate of 52% among nursing home workers in the state. Hughes says SEIU’s proposal would implement staffing rules over a three-year period, and nursing homes would submit monthly staffing reports with payroll records to the state, to confirm that they’re in compliance. She and other caregivers with SEIU Local 775 have been sharing their stories with Washington lawmakers, and she believes a new state law is a matter of time. “It will take a while, but I haven’t met a legislator yet that disagrees with anything I have to say,” says Hughes. “I think the will is there, we just have to find a way.” She adds, Oregon and California both have direct-care staff requirements for nursing homes. Washington caregivers will make their case at a lobby day in Olympia later this month, January 29. 

Graceful aging after a catastrophic accident: Lan Remme persists

My parents are in their early 70’s. They hike up mountains, golf daily, walk for hours, garden, and travel constantly. Sometimes, I get tired just hearing what they’re up to. But I’m pleased that they’re healthy and so physically capable. But it is more difficult to age in a healthful manner for some over 65 years old–particularly those who have sustained catastrophic injuries.

Remme Photo by Ruby

Lan Remme with wife Laura working on a yoga pose. (Photo credit: KUOW/Ruby De Luna)

A local NPR reporter for KUOW, Ruby De Luna, examines the aging population with disabilities in “Aging With Grace For Boomers With Disabilities.”  Ms. De Luna’s story centers on Lan Remme, a recent bicycle injury client that Stritmatter Kessler Whelan attorneys represented.  Keith Kessler, one of the SKW lawyers on Remme’s team comments, “Lan is one of those who has handled such adversity with grace and wisdom.”

His grace and wisdom will help and so will his optimism. Ms. De Luna  reveals how people with physical disabilities, such as 67 year old Lan, face greater obstacles in aging gracefully.

A University of Washington study takes a closer look at this segment of our population with the goal of assisting them to lead healthy lifestyles. After SKW bike injury client Lan Remme hit his bicycle wheel against a defective sidewalk on the Montlake Bridge, he lost use of his legs and must now use a wheelchair to get around.

In Ms. De Luna’s interview, Lan explains that he would love to maintain his independence, despite his physical limitations. He tells Ruby,“Anytime that I can head out someplace or do something on my own without relying on someone, it’s a huge boost of independence.  But, he explains, “The thing about being in a wheelchair is that it makes you a person 50 times more dependent on others than you would be normally.”

Remme is not going to let his disability get in the way of aging gracefully. He was physically active (cycled in many events in the years and months before his tragic accident) before he was wheelchair bound. Now, he will just work that much harder to stay physically fit. Laura Remme, Lan’s wife, is a model partner in helping him navigate the rough waters. He’s starting yoga and who knows what else he will tackle in the coming years.  We salute Lan Remme for his fortitude and determination.

Listen to Ruby De Luna’s story and interview of Lan Remme.

NOTE: This blog post was originally posted at

Who is “vulnerable” to nursing home abuse?

As I mentioned previously, nursing home abuse isn’t necessarily exclusive to those 65 years old and older.

In states such as Washington and Minnesota, “vulnerable adult” is used to refer to those who are alleged victims of nursing home abuse. Vulnerable adult is a broader category of individuals than the elderly and they are also frequent victims of nursing home abuse. The term is used in various states laws, including Washington and Minnesota. In Washington, “vulnerable adult” includes a person

a)     Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself; or

b)     Found incapacitated under chapter 11.88 RCW; or

c)      Who has a developmental disability as defined under RCW 71A.10.020; or

d)     Admitted to any facility; or

e)     Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or

f)       Receiving services from an individual provider; or

g)     Who self-directs his or her own care and receives services from a personal aide under chapter 74.39 RCW.

At the federal level, the Omnibus Reconciliation Act (OBRA) of 1987 was an important turning point in showing a serious commitment to ensuring better care for vulnerable adults. Included in the OBRA of 1987 was the Federal Nursing Home Reform Act (NHRA) with a Residents’ Bill of Rights. The goal of NHRA: To ensure that nursing home residents receive quality care that will result in their achieving/maintain their “highest practicable” physical, mental psychosocial well-being. While the NHRA was passed in 1987, the law did not truly become effective until the United States Department of Health and Human Services implemented regulations on September 26, 1991.

The NHRA specifies the services a nursing home must provide to its residents. The Act also lays out the standards for these services.  Among the required services: individualized comprehensive care plan, periodic assessments for each resident, nursing services, rehabilitation services, pharmaceutical services, dietary services. For nursing homes with more than 120 beds, a full-time social worker is required.

Over 90% of all nursing homes have Deficiencies

The vast majority of nursing homes in this country accept Medicare/Medicaid payment. When accepting reimbursement from the Center of Medicare and Medicaid Services (CMS), a nursing home is bound to CMS rules along with federal and relevant state regulations. According to federal regulations, a deficiency is a nursing home facility’s failure to meet participation requirements in the Act or in 42 CFR 483.

But guess what? A 2008 federal report that came out of the Department of Health and Human Services revealed that no less than 91% of 15,000 nursing homes that were included in the survey had seven deficiencies on average. Sadly, Washington State has one of the highest numbers for reported deficiencies in the country.  In 2010, a whopping 97.8% of Washington nursing homes were reported with deficiencies.  No wonder lawyers for nursing home abuse are sought after.

There are many reasons why the number is so high, despite the fact that  CMS and state health care agencies impose layers of rules and standards on nursing homes. One reason is that enforcement is difficult. The burden of enforcement is on the state. These days, most states cannot audit and investigate all the complaints. Even when a facility is found noncompliant, the penalties are relatively low and difficult to collect.  Only in the most egregious cases does does a nursing home get shut down.

This information and future posts that appear in this blog is intended to inform those who are concerned about the quality of care at a specific facility. Stay alert to signs of abuse because they are not always obvious. We will discuss much more about the different types of elder abuse.

Nursing Home Victims Are Not All Elderly


Jeffrey Sanderson was a 36 year old nursing home victim that our firm represented.

Jeffrey Sanderson was a 36 year old nursing home victim that our firm represented.


“Nursing home abuse” usually conjures up images of a frail senior citizen as a victim. However, there are many victims who are much younger. There are those who require around the clock assistance because of profound disability. Take, for instance, Stritmatter Kessler client Jeffrey Sanderson.

Jeffrey was in his 30s when his family came to our firm to represent them in a lawsuit against a local skilled nursing facility in Bremerton, Washington. Severely brain injured, Jeffrey’s family had though that the facility was the best place for him. But things didn’t look right when Jeffrey put on 80 pounds within several months of moving in. The facility characterized its abuse of Jeffrey as minimal, refusing to take any responsibility for his injuries and large weight gain.

Upon discovery, what our nursing home abuse attorneys found was that the Evergreen staff had patently disregarded Jeffrey’s condition of polyphagia, endangering him to eat large quantities too fast. The skilled facility’s staff also had failed to bathe him and provide proper hygienic care. When confronted with their neglect/abuse, they admitted that they lacked adequate staffing.

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