A surveyor’s testimony took the spotlight recently in a criminal fraud trial involving leaders of two nursing homes.
Susan Williamson, director of nursing care facilities for the Pennsylvania Department of Health, outlined an alleged pattern of cost-cutting by evading state staffing regulations at two skilled nursing facilities — Mt. Lebanon Rehabilitation and Wellness and Brighton Rehabilitation and Wellness Center.
Both facilities repeatedly failed to meet the state’s staffing requirements, according to Williamson. They were cited multiple times in 2018 and 2019, Williamson testified just before the court recessed for Thanksgiving.
Williamson admitted that nursing homes face serious staffing troubles in today’s environment — including difficulties finding staff and maintaining reliable schedules, especially around holidays.
But an indictment accused CEO Sam Halper, co-owner of Comprehensive Healthcare, of directing management staff at Brighton Rehab to keep staffing levels low to reduce costs, even though he and others knew that it led to poor health outcomes for residents. That’s a crux of the ongoing federal prosecution case, which is expected to run through December.
Other providers may find themselves facing similar temptations when it comes to staffing documentation, given the White House push for a federal staffing minimum and states that continue to layer on their own minimums.
Pennsylvania nursing homes were required to provide 2.7 hours of care per resident, per day at the time of the infractions. Consistent failure to meet this state threshold can result in facilities being placed on a provisional license or even being shut down.
“Staffing is really the backbone of taking care of residents,” Wiliamson said. “Without being honest about staffing, your residents aren’t going to get the care they require.”
Each time they were cited, Mt. Lebanon and Brighton Rehabilitation submitted plans to address the staffing shortages.
Shortages continued, however, and the government accused the facility’s leadership of intentionally falsifying staffing records to cut costs.
Pennsylvania’s 2.7 hours requirement is set to increase to 3.2 by July of 2024. Meanwhile, a proposed Centers for Medicare & Medicaid Services staffing mandate would increase the requirement to 3.0 nationally.
These increases threaten to add even more pressure on SNFs to find the workers and the funding necessary to raise their staffing levels.
Williamson reminded the jury, however, that no matter how understandable their staffing troubles are, facilities are “never permitted to lie.”
The government’s key assertion is that the facilities had recorded “ghost employees” clocking in to work and then leaving the facility without their absence being noted. This would have inflated the facilities’ hours per resident per day without actually providing that care.
“If they aren’t in the building, they wouldn’t be able to provide direct care to a resident,” Williamson said. “If they’re not willing to provide truthful information to us, doing our job is nearly impossible.”
Ashley Ifft, former human resources employee at Brighton Rehabilitation, also testified last week that it was common for employees to leave work in the middle of the day, TribLive reported.
Attorneys for the facilities and leaders there, including a co-owner and CEO of Comprehensive Healthcare, argued that gaps in record keeping were the result of mistakes, not willful criminal behavior.
But the facilities’ staffing woes should have been addressed regardless, according to the state.
“We expect you don’t just try, but you actually do it,” Williamson said.