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Years Of Understaffing Created ‘Perfect Storm’ At San Diego Nursing Homes During COVID-19

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Our partners at inewsource scoured state and federal inspection reports, databases and lawsuits to examine the histories of the 12 San Diego nursing homes with the most coronavirus cases. All have faced lawsuits or citations in the past three years accusing leadership of insufficient staffing practices

Speaker 1: 00:00 In San Diego County, at least 60 nursing homes have reported COVID-19 infections and 14 have reported deaths from the virus. I knew source investigative reporter. Jill Castellano explores the histories of staffing shortages at nursing homes, which have left them especially vulnerable to the pandemic.

Speaker 2: 00:19 Esther Hernandez was a 94 year old resident at the Windsor gardens nursing home. When the pandemic hit, her family used to be there with her every day, making sure she had enough food and was taken care of properly. When she was at the facility, she was never by herself. That's Hernandez, his granddaughter, Rebecca Nibla. She said when her grandmother's national city nursing home went on lockdown, her family worried about what would happen to Hernandez without them there. It was very hard and very difficult for us to not physically, you know, be there because we, we knew that the care was going to be way different. So we were afraid of something like this, you know, what happened to her. And unfortunately he did in may Hernandez, tested positive for COVID-19 the next time her family video chatted with her. She looked sick, but has said during the six hour call, nobody from the nursing home, checked on her grandmother, they put the computer and they left it there from two to eight and she was organizing Hernandez died two days later, none of her family members were with her. Something very, very hard to process, you know, after so many years and the relationship that we had for her to go alone. And I knew source investigation found that the San Diego County nursing homes with the most COVID-19 cases, including Windsor gardens have long histories of staffing, shortages all have faced lawsuits or government citations in the past three years in response to understaffing their facilities.

Speaker 1: 01:57 There's not the staff that it really takes to do the job they need to do.

Speaker 2: 02:01 Phillip Lindsley is a senior attorney at the San Diego elder law center. He says nursing homes have been cutting their workforces for years to increase profits,

Speaker 1: 02:10 Family that can and is willing to come back. It can be an important difference dress for keeping our weather eye out. Have to make sure that what should be happening is

Speaker 2: 02:19 Advocates believe banning visitors during the pandemic has made nursing homes more vulnerable to COVID-19 rather than less, they say families would be the ones to sound the alarm. If staff are not following infection control plans or providing proper care, Rosa Montiel does this for her sister Lilly who lives at San Diego post acute, where she's treated for down syndrome and epilepsy.

Speaker 1: 02:42 Normally I would ask her, do you need this? Do you need that? And I could get an answer. And then I could just ask the staff to come in and, and provide the care that she needed. And now it's much more difficult because I can't be inside. And it's difficult to tell from, from outside to determine what needs I can't do that anymore. It's it's horrible.

Speaker 2: 03:03 Montiel spends nine to 10 hours a day sitting outside the window to her sister's room, making sure she's fed changed and given her medication on time,

Speaker 1: 03:12 I come here and as you can see, you know, I have this little stool and I sit here and I observe, you know what? She's going.

Speaker 2: 03:20 Montiel became her sister's caregiver in 1992, after their mom had a brain aneurysm on the same day their dad died.

Speaker 1: 03:27 I did promise her. I'd take care of her always. So I'm here to fulfill that problem. Yeah.

Speaker 2: 03:32 Montiel is concerned that the staff are too busy and are not taking enough precautions. She fears someone might accidentally bring the virus into the building and get her sister's sick.

Speaker 1: 03:42 I mean, one staff person bringing it in would be, it would be devastating. I mean, it would be the end. It would be the end of her life. And of, of many of them,

Speaker 2: 03:51 Mary Camarie, the administrator of San Diego post acute said that Lily Montiel is receiving round the clock care. And the staff's top priority is the wellbeing of its residents. Windsor gardens would not comment for this story for KPBS. I knew source investigative reporter, Joel, Castillano

Speaker 1: 04:09 Joining me as I knew source reporter, Jill Castellano and shell. Welcome to the program.

Speaker 2: 04:14 Thanks for having me on what are the requirements for a staffing

Speaker 1: 04:18 To resident ratio at these facilities and how badly are some of the homes in violation?

Speaker 2: 04:25 So state law requires nursing homes to provide 3.5 hours of care to each resident every day. But researchers say that's way too low, that if you drop the number below 4.1 hours of care, you start to see the quality of that care decline. So I use that number of 4.1 and I analyzed federal data and found that 84% of San Diego's nursing homes don't meet that recommendation. They don't have enough certified nursing assistants who are like AIDS and 63% don't have enough registered nurses to meet these kinds of recommendations provided by researchers. One of the researchers I talked to said nursing homes, without enough RNs, registered nurses were twice as likely to have COVID-19 cases. So that is quite a big risk. And we see a lot of nursing homes not meeting those levels in San Diego County.

Speaker 1: 05:18 And if they didn't meet those levels before COVID, why were they

Speaker 2: 05:23 Still allow to operate? Well, it's a variety of factors. Um, nursing homes aren't generally shut down. They're often told by state regulators do this to improve the situation at your nursing home. We'll monitor you. We'll keep an eye on what you're doing sometimes. And like what's happening right now. There are certain waivers provided. So when the pandemic began, the state decided to lift certain requirements. So technically none of these nursing homes right now are in noncompliance. They are allowed to have facilities that are understaffed without, in trouble because these regulators know how hard it is to keep the facilities staffed to the appropriate levels right now.

Speaker 3: 06:04 So have even more staff left because of the pandemic.

Speaker 2: 06:08 Yes, everyone that I've spoken to with agrees that the pandemic has made staffing shortages at nursing homes works for one thing. If you have COVID-19, you're required to self isolate for at least 10 days after developing symptoms. And there are other requirements like if you're exposed to someone, you might have to self isolate if you're a healthcare worker. So there are a lot of stipulations that make it difficult right now to keep staffing levels at the appropriate level, to provide the level of care necessary to keep these residents safe.

Speaker 3: 06:42 Well, how closely is the state monitoring nursing homes during the pandemic to see if proper COVID safeguards are observed and proper care is being given

Speaker 2: 06:53 The federal government suspended most onsite inspections in March to try to slow the spread of the virus, trying to keep too many people coming in and out of these facilities, but they are allowing onsite inspections for visits related to infection control or immediate threats to patients safety advocates say, that's not enough. We need more focus right now on what's going on in these nursing homes. But the people who represent these nursing homes say they're doing the very best they can and they are getting a lot of scrutiny right now. So it definitely depends on who you ask,

Speaker 3: 07:27 Do residents of the counties, nursing facilities account for many of the COVID deaths in San Diego.

Speaker 2: 07:33 It's hard to get an answer to that question. Unfortunately, the numbers are not very clear. The County refuses to release information about how many nursing homes and which nursing homes have residents with COVID-19. And at the state level, you can only see nursing homes that have had 11 or more cases. So the numbers that we do have are low estimates. We do know that outbreaks at San Diego nursing homes are responsible for somewhere around at least 89 deaths, but that's likely a very low estimate.

Speaker 3: 08:09 The family members of nursing home residents observed proper precautions is social distance masks. Maybe even those plastic face masks that a hospital workers use, why aren't they being allowed to see their loved ones in person?

Speaker 2: 08:26 That's the exact question that they're asking and they feel like they're not getting a satisfying answer to the people who run nursing homes. They're trying to be as careful as possible. And we do know that there are instances where it appears to be the case that people coming in and out of nursing homes like staff seem to be bringing in the Corona virus. So it stands to reason that the more people come in there is a chance that the risk could go up up. But these family members say we don't have to be inside the facility. We could be arranging visits out in the courtyard or through some other means. And they want these facilities to work with them because they think it's very important for their loved ones in these nursing homes, to be able to spend time with them.

Speaker 3: 09:09 Finally, just talk to us a little bit more about the family members you spoke with the family of Esther Hernandez and Rosa. Monteya looking after her sister Lilly, the dedication of these family members is remarkable. How has the pandemic changed their lives?

Speaker 2: 09:27 It's changed them a lot for Esther's family. They didn't expect her to die to go so soon. They expected her to come home. But when she went into that nursing home, she never came back. So they're still struggling with this loss and trying to understand what happened and if it's possible, it could have been prevented. And it's an open question. That's really affected them. As for Rosa. She is terrified. She's doesn't know what's going on with her sister Lily every day. She thinks that her sister's not getting the care she needs. And so it's really torn these families apart and created a lot of anguish among people in San Diego who know and have loved ones in nursing homes.

Speaker 3: 10:07 I've been speaking with our news source reporter, Jill Castellano and Jill. Thanks.

Speaker 2: 10:12 Thanks so much

Speaker 3: 10:14 For more on this nursing home story, go to, I knew I knew source is an independently funded nonprofit partner of KPBS.

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Maureen Cavanaugh and Jade Hindmon host KPBS Midday Edition, a daily radio news magazine keeping San Diego in the know on everything from politics to the arts.