Some say more staffing, better training would help reduce falls.
Jim Grant, a 73-year-old stroke victim in the room he once lived in at Rose of Sharon Manor. Grant said he gave up calling for help because it took too long to get a response. Grant said when he needed to go to the bathroom he couldn't wait so he moved from his bed to wheelchair and bathroom by himself. In January, he fell and broke bones in his right leg. Here, he moves from the bed he sat and talked on to his wheelchair. Grant has since moved from the Rose of Sharon Manor to a different facility.
Every night, after pulling on her scrubs and heading to work for the night shift, the nursing home aide would start to feel tense.
Frail people's lives would soon be in her hands. Call lights would blink. Alarms would beep. Sometimes she felt too rushed to care for everyone properly.
"If there's one alarm going off in one hall and there's another one going off in the other hall in the other direction, which one do you go to first?" she said. "One of them you're going to save from falling. The other one is going to fall."
Inadequate staffing is a common complaint from nursing home workers, industry watchers and families with loved ones in nursing homes. More than 1,000 Minnesotans suffered fall-related deaths in nursing homes from 2002 through 2008, according to a Star Tribune analysis of death certificates. But would more staffing -- costly as that would be -- actually reduce falls and save lives?
"I think it's really related to the inadequate staffing. Totally related. And, you know, the damage is untold," said Charlene Harrington, a professor emeritus of sociology and nursing at the University of California, San Francisco. She has done numerous studies on nursing home staffing.
Though state and federal staffing standards are not precisely defined, 75 percent of Minnesota nursing homes reporting data are understaffed by one federal measure.
In interviews with the Star Tribune, 16 nurses aides at some homes with more than 10 fall-related deaths from 2002 through 2008 frequently complained of insufficient staffing. They requested anonymity, fearing for their ability to get jobs in the industry.
The former night shift aide, who once worked at two metro area nursing homes, said it sometimes felt like chaos, even at 2 a.m.
"Residents don't sleep. They're up," she said. "They take their naps during the afternoon and they're up. Or there's a resident screaming ... all night long and they're going to wake up everyone."
Working in the homes, the aide said, was nerve-racking because the consequences were life-threatening.
"I get really nervous about that," she said. "I've seen, you know, a lot of, 'oh she fell, so' and then two weeks later, she's gone."
Nurses aides help nursing home residents do the routine things others take for granted: Get out of bed, go to the bathroom, walk, eat.
The residents in their care have dementia, incontinence and all sorts of medical problems. Some try to get up on their own when they shouldn't. Some try to wander away.
The state's 397 nursing homes, which care for more than 30,800 Minnesotans, have struggled to find good workers in the past, although the recession has widened the pool of candidates recently, said Darrell Shreve, vice president of health policy for Aging Services of Minnesota, an industry group representing mostly nonprofit nursing homes.
"You deal with people's, you know, feces and, you know, vomit," said state Rep. Patti Fritz, DFL-Faribault, who was a licensed practical nurse at nursing homes. "Every sort of nasty substance that comes from the body, you deal with it ... you have to clean it up."
The average hourly wage for a nurses aide in Minnesota is $12.86, according to the state Department of Employment and Economic Development.
"The pay is so low because the state sets our [reimbursement] rates," Shreve said.