These 10 Monmouth, Ocean nursing homes pounded by $676K in fines for staffing shortages

Samuel McCurdy had been living at Complete Care at Laurelton, a nursing home in Brick, for less than two years in July 2022 when, according to a lawsuit, he was found to have pressure injuries on his backside and multiple maggot-infested wounds.

The Toms River resident was taken to Ocean University Medical Center in Brick and treated, but the incident left him with severe physical and mental anguish, according to the lawsuit, filed against the nursing home and its owner in February.

The lawsuit said the injury could have been avoided if the nursing home had enough nurses. Instead, it said, Complete Care "knowingly established staffing levels that created recklessly high resident-to-staff ratios."

Complete Care at Laurelton is one of 10 Shore-area nursing homes that have been fined by the New Jersey Department of Health in recent months for failing to meet staffing requirements that were enacted four years ago in a bid to keep patients safe.

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The penalties total $676,000 and represent hundreds of days over at least three years that regulators found shortages, an Asbury Park Press analysis found . And the fines have been rolling in as the facilities sift through federal staffing rules that were introduced last week by the Biden administration.

Industry officials are conceding defeat, saying they have raised wages and offered hiring bonuses, but the labor pool for certified nursing assistants at the center of the mandate simply doesn't exist.

'Staffing is everything'

But patient advocates are skeptical, noting nonprofit and independent, family-owned nursing homes are having more success. They are renewing their call on state lawmakers to require operators to be more transparent with how much of their Medicaid reimbursements are going towards patient care.

"Staffing is everything in long-term care," said Laurie Brewer, long-term care ombudsman with the state Department of Health. "You need staff that are well-paid, dedicated and treated fairly in the workplace. That's not always the case in, primarily, for-profit nursing homes."

Complete Care said in an email it couldn't discuss the specifics of McCurdy's lawsuit due to privacy rules. "We are contesting these allegations vigorously," a spokesperson said. "Each Complete Care resident is provided with high quality care and is treated with dignity."

But patient advocates say understaffing puts residents at risk and opens nursing homes to lawsuits.

Crystal Lake Healthcare and Rehabilitation in Berkeley in February was assessed a penalty of $177,000 for staffing deficiencies dating to 2021, the Health Department said.

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The 235-bed facility and PBV Herman Holdings LLC, which has owned the business since 2021, were named in a lawsuit filed last week in state Superior Court, Ocean County, on behalf of Frank Lattore, a patient there in 2022 and 2023.

During his stay, the lawsuit said, Lattore was assaulted, developed pressure wounds and suffered a fall that resulted in a fractured right leg.

The nursing home failed to meet required applicable regulations and allocate sufficient resources to care for Lattore, the lawsuit said.

Crystal Lake officials didn't respond to a request for comment.

Crystal Lake on its website is advertising for a certified nursing assistant with wages ranging from $16 to $25 an hour, along with a $1,500 signing bonus. Among the qualification and requirements: knowledge of relevant nursing care; friendly and professional bedside manner; current CPR certification; multitasking skills; effective oral, written and reading communication skills; and an understanding of legal implications of patient care.

New Jersey set minimum staffing ratios in October 2020 as the COVID-19 pandemic swept through nursing homes, eventually killing more than 9,000 residents, accounting for a quarter of the state's COVID deaths.

The rules call for long-term care facilities to provide: one certified nurse assistant for every eight residents during the day; one direct care staff member for every 10 residents during the evening; and one direct care staff member for ever 14 residents at night.

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Ramped-up enforcement

The New Jersey Health Department tracks staffing levels when it is recertifying nursing homes or investigating complaints. It can fine facilities $1,000 per day when it finds multiple deficiencies that are direct risks to a patient's physical or mental health or a violation of residents' rights.

The department appears to have ramped up its enforcement. The Asbury Park Press identified 63 nursing homes in Monmouth and Ocean counites. Of those, nearly 16% have been assessed penalties by the state for understaffing.

Among them is Complete Care, a privately owned company based in Toms River that operates 43 nursing homes statewide, including 13 in Monmouth and Ocean counties. Its footprint grew two years ago after it acquired eight nursing homes from nonprofit Hackensack Meridian Health .

The past two years, Complete Care has been assessed a total of $193,000 in penalties at four facilities in Monmouth and Ocean counties for staffing shortages, according to the New Jersey Department of Health.

In at least four of the five Monmouth and Ocean County facilities formerly operated by Hackensack Meridian, Complete Care's nursing staff has rapidly left, pushing the turnover rate higher than the statewide average of 47.7%.

In Wall, the total nursing staff turnover rate during the past year has been 82.9%. In Shrewsbury, the turnover rate has been 81.5%. In Holmdel, 75.5%. In Ocean Grove, 69.2%, according to the Centers for Medicare & Medicaid Services. The turnover rate for Complete Care at Brick wasn't publicly available.

Complete Care said the state's staffing requirements are unreasonable. In a statement to the Asbury Park Press, it noted New Jersey's senior population is the fastest-growing demographic, while the population of caregivers ages 45 to 64 is shrinking.

It said its turnover rate was high at its new facilities because Hackensack Meridian relied heavily on temporary nurses from employment agencies, which detracts from patient care. Since taking over, Complete Care has been working to transition to permanent, in-house staffing and has seen the turnover rate improve, the company said.

Complete Care said it has been working with schools to recruit employees. And a wage increase took effect throughout its southern New Jersey region on May 1.

“Patient care and safety is paramount to Complete Care, and we ensure that all our nursing homes are well staffed," the company said in an email. "Fines have been levied against nursing homes throughout the state, which Complete Care along with others are contesting.”

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'They can't find enough people'

New Jersey is trying to incentivize nursing homes to hire more staff. Gov. Phil Murphy's budget proposal would provide bonuses to nursing homes treating residents covered by the state's Medicaid program, NJ FamilyCare, based on metrics that include total nurse staffing hours and nurse staffing retention, the Department of Human Services said Tuesday.

The proposal would need to be approved by the Legislature.

More staffing requirements, however, are on the way. The Biden administration last week finalized new rules in part requiring nursing homes to provide at least 3.48 hours of nursing care per resident day. An Asbury Park Press review of federal data found just 20% Monmouth and Ocean County nursing homes meet that standard.

Industry officials said they are studying the impact of the latest staffing requirements. But they say the standards are virtually impossible to satisfy.

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Almost every nursing home is hiring. About 90% of nursing homes have increased wages in the past six months. Some 78% offer signing bonuses. But they can't find enough candidates who are either qualified or interested, according to a recent survey by the American Health Care Association, a trade group.

Meanwhile, 45% of nursing homes said they are operating at a financial loss, the survey found.

"Nursing homes can't comply with the ratios," said Andrew Aronson, president and chief executive officer of the Health Care Association of New Jersey, a trade group. "No matter what efforts the homes are making to hire — they're offering hiring bonuses, they've raised wages significantly, offered different benefit packages — they can't find enough people to fill the slots."

Being a certified nurse's aide isn't for the faint of heart. The job has an average wage ranging from $19.83 an hour in southern New Jersey to $22.81 an hour in northern New Jersey, according to the Bureau of Labor Statistics, for work that can involve caring for patients who are coping with dementia or are susceptible to falls.

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Nonprofits doing better

But advocates and researchers say staffing levels have suffered as New Jersey has seen a shift from nonprofit operators to for-profit operators.

The Centers for Medicare and Medicaid Services tracks nursing home staffing levels and turnover and rates them on a scale of one star (much below average) to five stars (much above average).

In Monmouth and Ocean counties, 87.5% of its eight nonprofit operators had a staffing level that received at least four stars from Medicare. By comparison, 10.9% of its 55 for-profit operators received a similar score, an Asbury Park Press analysis found.

" The nonprofit nursing homes do tend to have higher staffing levels than the for-profit nursing homes, and they also tend to have higher quality of care," said Dr. Rachel Werner, executive director of the Leonard Davis Institute of Health Economics and the University of Pennsylvania. "Some of that is simply because they have higher staffing levels."

Not that privately owned nursing homes can't meet the standards.

Sunnyside Manor, a for-profit long-term care facility in Wall, has five stars from Medicare. Its nursing staff spends 4½ hours per resident a day, well above the new federal requirements. And its turnover rate is 21.4%, far below the statewide average, data shows.

MaryEllen Keane, the second-generation owner, said she has tried to combat the tight labor market by ensuring annual raises for her staff and fostering a collegial workplace with the help of a core group that has been with the company for decades.

If Keane sees that the facility won't meet the state's regulations, she said, she will turn away patients to make sure residents have appropriate care. Last week, for example, Sunnyside had 48 patients, even though it had 60 long-term-care beds.

"It is very hard to attract new talent; that's 100% true," Keane said. "Where I'm fortunate is I've kept my base staff. They're a real family. Every person that works for me, I know, they've had challenges over the years. But I say, 'All right, you're having a challenge, how do we get through this?' We've all learned to support each other."

The persistent staffing shortage has caused advocates to urge the state to require nursing home operators to disclose more financial information to ensure a fair share of revenue is going for patient care.

A bill introduced last year in Trenton requiring operators to provide audited financial statements failed to pass. Aronson said nursing home operators already provide financial reports to regulators and noted the proposal to require audited statements would be another expensive burden.

Advocates disagree and wonder how much nursing homes spend on related-party transactions, or other companies that the operators also own.

“We don’t know if they are losing money," Ernest Tosh, an attorney specializing in nursing homes, said during a webcast with the New Jersey Long-Term Care Ombudsman's Office. "We keep as a society throwing money at nursing homes expecting the care to get better, and it does not. We expect staffing ratios to go up. They do not. Where’s the money going? We don’t know.”

Understaffed nursing homes face fines

Ten nursing homes in Monmouth and Ocean counties were assessed penalties by the state for understaffing. They are:

AristaCare at Whiting in Manchester was fined $70,000 in April 2024.

Excel Care at Manalapan was fined $94,000 in March 2024.

Complete Care at Laurelton in Brick was fined $64,000 in March 2024.

Crystal Lake Healthcare and Rehabilitation in Berkeley was fined $177,000 in February 2024.

Complete Care at Green Acres in Toms River was fined $96,000 in February 2024.

CareOne at Wall was fined $96,000 in January 2024.

Coral Harbor Rehabilitation and Healthcare Center in Neptune was fined $28,000 in December 2023. Coral Harbor officials said they disputed the findings and are working with the state Health Department to clear up the situation. "The well-documented, industry-wide skilled nursing staffing shortage has made it increasingly difficult to hire talent — despite the allocation of ample financial resources and persistent, elevated recruiting efforts. To that end, our efforts are bearing fruit," Carolyn Zeh, Coral Harbor's administrator, said, noting that Medicare has recently raised its rating on the nursing home's staffing levels.

Complete Care at Bayshore in Holmdel was fined $18,000 in November 2023.

Complete Care at Bey Lea in Toms River was fined $14,000 in September 2023 for staffing violations found in April and May 2023.

Complete Care at Brick was fined $19,000 in September 2023 for staffing violations found in June and August 2023.

The operators can challenge the survey's findings and request a hearing with the Office of Administrative Law. Crest Haven paid the fine, while CareOne at Wall paid the fine but is requesting a hearing, the Health Department said.

Coral Harbor officials said they disputed the findings and are working with the state Health Department to clear up the situation.

"The well-documented, industry-wide skilled nursing staffing shortage has made it increasingly difficult to hire talent – despite the allocation of ample financial resources and persistent, elevated recruiting efforts. To that end, our efforts are bearing fruit," Carolyn Zeh, Coral Harbor's administrator, said, noting that Medicare has recently raised its rating on the nursing home's staffing levels.

Michael L. Diamond is a business reporter who has been writing about the New Jersey economy and health care industry for more than 20 years. He can be reached at mdiamond@gannettnj.com.

This article originally appeared on Asbury Park Press: These 10 Monmouth, Ocean nursing homes pounded by $676K in fines for staffing shortages