CLAYTON — A group of nursing home workers have been on strike for days to protest unfair labor practices and what they say are dangerous violations and deficiencies at three understaffed St. Louis-area facilities.
On Monday, Blue Circle Rehab and Nursing workers and union members protested outside their employer’s corporate office, calling on St. Louis and St. Louis County to investigate.
At Blue Circle, which workers and federal regulators agree is understaffed, a 146-page inspection report from 2020 details numerous failures at the facility. A resident was left sitting in their own waste for hours. Others have developed bedsores. Staff reported they rarely have time to bathe the residents in their care. A resident who was at risk of choking and required a feeding tube was able to sneak food from vending machines.
Lenny Jones, state director for SEIU healthcare Missouri and Kansas, said many of the facilities’ problems stemmed from their reliance on temporary agency workers rather than unionized staff. The agency workers move from facility to facility, making more than union workers.
“They come in temporarily, they don’t have relationships with the staff, they don’t have relationships with the workers,” he said. That understaffing leads to stories such as “residents being left in the dining room for a long time, soiling themselves, unable to move.”
The three homes — Blue Circle, Chestnut Rehab and Nursing, and Big Bend Woods Healthcare Center — are all owned, at least in part, by Mendel Brecher, Chana Lichtman and Jacob Zimmerman.
The facilities show a history of severe deficiencies and citations by the Centers for Medicare and Medicaid Services. Each has only a single star on CMS’ website comparing nursing home quality.
They’re lagging the rest of Missouri, already last in the nation, in the number of their health care personnel who have received a COVID-19 vaccine.
Combined, they’ve been issued fines — or had Medicare reimbursements withheld — to the tune of nearly $180,000 in the last three years. Now, about 70% of Blue Circle’s unionized workforce of about 20 are on strike.
“There are residents wandering around and getting out, which wouldn’t happen if the place was fully staffed,” Jones said. Family members of facility residents have been coming up to workers on the picket line, “encouraging them to keep going, because they’re seeing many of the same problems.”
Administrators at the three facilities have not returned messages from The Independent seeking comment. Representatives for St. Louis Mayor Tishaura Jones and St. Louis County Executive Sam Page did not immediately return messages seeking comment.
Working at Blue Circle
It’d be easy for Lemarr Young to simply quit. In his 20 years working at Blue Circle Rehab and Nursing, he says, he’s seen demoralized staff struggle to keep up with the increasing demands of their jobs.
The number of residents in the facility was only 40 before the current owners took over in 2019.
“When they took over, they did increase on residents,” Young said, “but they cut down on staff.”
There’s no longer a dedicated staffer constantly handling the front desk, Young said. He said residents were more prone to leaving the facility unsupervised as a result. It happened again just this past Saturday.
Another time, Young said a resident with back pain told him he’d been slammed on the floor. The resident’s sister took him to the doctor and discovered his back was broken, Jones said.
During a weekend shift, Young said, he saw a resident sit in their own urine as a temporary agency nurse failed to take care of them.
“As long as that monthly bill is getting paid from these residents, that’s all it seems they’re concerned about,” Young said of the facility’s owners.
A long list of similar incidents are documented in Centers for Medicare and Medicaid Services inspection reports for the facility. Last year, an October 2020 inspection resulted in 31 deficiencies being identified, a $23,595 fine and Medicare payments for new residents being withheld until issues were addressed.
The average for citations during such an inspection in Missouri is 9. Nationwide it’s 8.3.
If problems with a facility aren’t addressed, they can lose their certification to be paid and care for Medicare or Medicaid patients.
History of deficiencies
An October 2020 inspection report said Blue Circle failed to ensure adequate staffing numbers to provide residents with consistent care. Two certified nursing assistants told investigators they felt the facility was always short-staffed.
At the time, usually four certified nursing assistants would be scheduled per day shift, meaning they were responsible for 15 to 16 residents each. The number of staff they could schedule was set by corporate officials, the director of nursing said, according to the inspection report.
“It is difficult to do everything that is needed to be done when you have that many residents,” the report read. “Another problem is they have too many agency staff, which creates communication problems.”
In that same inspection report, agency nurses said they were never given an orientation about the facility and its policies.
Residents went days — or even weeks — without help taking showers or shaving. One resident had long nails with dirt under them.
A resident was found having to put a towel under a bag of feces on their bed because it had not been changed and was leaking. A bag full of feces-covered towels lay on the floor near the resident’s bed.
Staff failed to prevent residents from developing pressure ulcers, or bedsores, and failed to treat them.
Inspection reports at Big Bend Woods demonstrated recounted troubling failures. In January, staff failed to perform CPR on a resident who was choking nor called 911. A resident also died in early 2020 when staff failed to perform CPR.
Inspectors found in May that staff at Big Bend Woods failed to investigate allegations of abuse reported by family members of residents. That inspection resulted in 28 citations but no fines.
During Chestnut Rehab’s most recent regular health inspection, in September 2020, officials found 38 health violations and denied the facility its Medicare payment.
In the last three years, the facility has had 35 complaints that resulted in at least one citation.
Early this year, a resident died at Chestnut because the staff failed to perform CPR, thinking the resident had a “do not resuscitate” order. And late last year, the facility had a COVID outbreak but continued to house residents who did not have COVID in the same wing it had designated as its COVID ward.
Workers at Blue Circle have been unionized through SEIU Healthcare for over a decade, but they have yet to finalize their first contract with Blue Circle Holdings, LLC since negotiations began over a year ago.
Workers are demanding higher wages, better health insurance and for the company to institute a health and safety committee so employees can advocate for things like more personal protective equipment or additional shift bonuses to help address understaffing.
Union officials want regular meetings with management about worker safety. They believe it could help with the facility’s low rate of COVID-19 vaccinations among staff. Only 55% of Blue Circle’s healthcare personnel are vaccinated. At Chestnut and Big Bend Woods, those rates are below 30%.
“We’re able to talk with the owners about…this is what it’s going to take to help make workers comfortable with getting vaccinated, like…additional paid time off in case someone gets sick after getting vaccinated, having vaccine stewards help convince those who are holding out on getting vaccinated, to let them know the safety of it,” Jones said. Blue Circle held one vaccination clinic, and after there was low staff turnout for that clinic, made no further effort towards staff education on vaccines.
The union has filed a complaint with the National Labor Relations Board alleging that ownership has bargained in bad faith and made coercive statements. At Monday’s press conference, Jones announced that the board would be ruling in their favor.
During negotiations, ownership has refused to use video on Zoom, resorting to calling in.
“If they were serious about bargaining, they could have flown down and sat at the table with us instead of being on the phone in New York,” Jones said.
Afterward, Young said some of his coworkers were scared and feared being replaced if they went on strike. According to the National Labor Relations Act, employees who strike in protest of an unfair labor practice cannot be discharged or permanently replaced.
“That was totally disrespectful,” Young said.
At a recent bargaining session, management said they would raise wages for housekeeping and dietary staff from $10.30 an hour — Missouri’s current minimum wage — to $11.30 an hour, Jones said.
“And the joke of that is that minimum wage is going up to $11.15 an hour in January,” Jones said, referring to scheduled increases Missouri voters approved in 2018. “So for them to think like that is some big movement on their part was just pretty atrocious.”
The union is pushing for St. Louis City and County to create worker safety offices, where workers can directly report their complaints with management. In the county, Jones said, Councilwoman Shalonda Webb has been a major supporter. In the city, Mayor Jones has been moving towards the establishment of such an office — and has attended a recent strike to support SEIU workers.
“We’re really looking forward to the things our government officials can do to hold ownership groups like Blue Circle accountable,” Lenny Jones said.
Young’s mom, who worked in laundry at Blue Circle and quit at the start of the pandemic in part due to the staffing issues, often pleads with him to get another job.
But Young wants a strong foundation for the facility’s workforce to be able to adequately take care of its residents. And he knows the impact the nursing home has in an area that is marked by many vacant buildings. He grew up nearby, and to him, the facility is a cornerstone of the community.
“It’s not the pay,” Young said. “It’s really trying to get a change in there.”
This article by Sophie Hurwitz, Tessa Weinberg and Allison Kite is published from The Missouri Independent via a Creative Commons license.