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Continued: Last of 3 parts: No easy solutions

Sister Theresa Robertson, the nursing home's administrator, said she believes there is a correlation between staffing and falls. Higher staffing means residents can be watched more closely, she said.

That may help the staff figure out when residents are acting differently and understand ways to help them and prevent falls, she and other administrators said.

"We try to really focus on continuity of care," Robertson said. "If there is the same caregiver ... they will notice subtle changes."

The wait for help

Nursing home resident Jim Grant, who once lived at Rose of Sharon Manor in Roseville, said it took too long to get a response when he turned on his call light.

Grant, a 73-year-old stroke victim, said that once when he needed to go to the bathroom, he got up by himself and fell and cracked bones in his right leg about a year ago.

"I shouldn't have went to the bathroom by myself, but I did," he said this summer.

There are no uniform regulations for timeliness in answering call lights. Anxious residents often think it takes longer to get help than it does, nursing home administrators point out.

As Grant sat in his cramped room at Rose of Sharon, his bed surrounded by family photos and knickknacks, a woman down the hall bellowed in a hoarse voice, "I have to go to the bathroom! ... I've got to go. I've got to go ... I've got to go now."

"She's got to go bad," Grant said. He noted that yelling to get a staff member's attention wasn't uncommon.

Administrator Kay Schumacher said privacy laws prevented her from talking about Grant. To her knowledge, she said, he had never complained about call lights. "Call lights typically aren't an issue in the facility," she said.

Grant moved to a different nursing home in August and has retained an attorney to consider legal action.

When is staffing short?

State health investigators and regulators rarely issue citations for staffing levels, data shows.

"There isn't an exact science to determining short-staffed," said Darcy Miner, director of the compliance monitoring division at the Minnesota Department of Health. "That's actually a real challenging area because there are nursing homes that do a fabulous job with fewer people."

But nurses aides know that, even if they're working short-staffed, they're often the ones who take the blame for falls.

Cases show homes have avoided citations if they've fired an aide involved in a fall and taken other steps to correct a problem before investigators arrive.

"The home is just reacting because they know the state is going to expect to see some immediate action," said Steve Hunt, internal organizer with the Service Employees International Union Healthcare Minnesota, which represents aides at several homes.

  • about this series

  • More than 100 Minnesotans die each year after suffering falls in nursing homes. Few deaths are fully investigated by the state, and serious penalties for violations are rare.
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