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More than 1 million people live in nursing homes in the U.S., but in many states, the agencies that regulate those facilities are understaffed. Advocates for the elderly say that can put residents at greater risk of abuse and neglect. Rose Conlon of member station KMUW reports on how that's playing out in one Midwestern state.
ROSE CONLON, BYLINE: By late last year, Jennifer Hernandez was waking up throughout the night to check on her great aunt through a Ring camera. Joan Cody was 94 and had dementia, and Hernandez notified staff and set up the camera because she suspected neglect at her aunt's memory care home in a suburb near Kansas City, Kansas. But nothing prepared her for what she would see one night last December.
JENNIFER HERNANDEZ: I got an alert and looked and saw that she had fallen out of bed. I went back and watched the video, and she laid there for longer than an hour-and-a-half.
CONLON: It's one of more than a dozen incidents that Hernandez says she reported to regulators at the Kansas Department for Aging and Disability Services, also known as KDADS. But she says the state agency didn't respond to her complaints for six months. It and the facility declined to comment for this story, citing privacy rules.
A few weeks after the December fall, Cody fell again, breaking her pelvis. Although an ombudsman - a state-employed patient advocate - urged regulators to investigate the falls, no response came. Fifteen days later, Cody died. A coroner attributed her death to complications from a fall.
HERNANDEZ: I get it's a busy system and people are busy, but, like, these are human beings that are loved. And my aunt didn't even get a dignified death.
CONLON: State ombudsman and other elder care advocates say Cody's case reflects chronic failures by Kansas regulators to investigate complaints of nursing home neglect and abuse in a timely manner. In part, that's because of critical staffing shortages. Half of the state's 61 investigator positions are currently vacant, and Nina Kohn, a law professor at Syracuse University, says the problem is not unique to Kansas.
NINA KOHN: Certainly as demand for nurses has gone up and nursing salaries have gone up, states have found it hard to hire the number of inspectors they need at the rates they want to pay.
CONLON: A 2023 report from the U.S. Senate Special Committee on Aging said, across the country, state agencies responsible for oversight are in crisis due to severe staffing shortages, high turnover rates and stagnant federal funding. Kansas was 1 of 9 states with inspector vacancy rates of 50% or more.
Kansas regulators say they support increasing wages to attract more investigators. Currently, investigators must be registered nurses. Their starting pay is around $60,000 - nearly 20,000 less than the average salary that a Kansas RN makes. And Haely Ordoyne, the state's lead long-term care ombudsman, says there can be fatal consequences when there are not enough investigators.
HAELY ORDOYNE: Our office has seen times where a resident has passed before KDADS is able to go out and investigate that. And we have seen people become more depressed about situations and kind of feel almost a sense of, you know, loss of the will to live because they feel like they don't matter.
CONLON: States have a federal mandate to regulate federally licensed nursing homes, but they rarely face consequences for lax oversight. A class-action lawsuit in Maryland, filed by the legal nonprofit Justice in Aging and others, could help change that. Thousands of disabled nursing home residents say alleged oversight failures there violate their rights under the Americans with Disabilities Act. An outcome in their favor could pressure other states to make oversight a higher priority.
For NPR News, I'm Rose Conlon in Wichita, Kansas.
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