Joan Lorenzo has some memories of her mother’s stay at a local nursing home that she wishes she could forget.

The smell of urine in her mother’s room, and on Lorenzo’s clothes once she left, is one of them.

Lorenzo said her mother, Carmella Valenti, who died last week, would on some days be “sitting in saturated urine.”

Her mother’s stay at Niagara Rehabilitation and Nursing Center started off strong. But Lorenzo said in an interview with News 4 Investigates that things began to go downhill this summer.

Her conclusion about the challenges nursing homes face?

“Not enough staff, first of all,” Lorenzo said. “Don’t get me wrong, they do have some good caring people. I did let the administrator know that you do got some good people in here but you got some people who are not taking care of the seniors.”

The administrator at Niagara Rehabilitation and Nursing Center declined to answer questions or be interviewed for this story. But the industry cannot deny the staffing crisis it is in, and it’s not getting better.

“Staffing is the most expensive component of expenses that go toward residents and it’s also the easiest to frankly cheap out on,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that focuses on improving quality of care in the state’s more than 600 nursing homes.

A News 4 Investigates analysis of federal data shows that nursing homes in the state have historically ranked in the lower 10% to 20% in the nation for staffing some of the most critical positions.

And the first quarter of this year was not any brighter for the industry.

Consider that nursing homes in the state ranked 35th in the nation for registered nurses total hours per day per resident. This category includes registered nurses (RNs), the RN administrators and the RN director of nursing.

The ranking is even worse for total nursing staff hours.

Nursing homes in the state ranked 46th in the nation for total nursing staff hours per day per resident. This includes registered nurses and their direct administrators, the RN director of nursing, licensed practical nurses, certified nursing assistants, and three other positions.

“I think because there are not enough workers, the patients are not getting the proper care and that’s what’s very sad,” Lorenzo said.

A survey this year by The American Health Care Association and National Center for Assisted Living found that nearly every nursing home is facing a workforce crisis.

And 59% of nursing homes are experiencing high levels of staffing shortages, the survey found.

The industry groups said more than 70% of the nursing homes said a lack of qualified candidates and unemployment benefits have been the two biggest obstacles in hiring new workers.

As a result, many nursing home employees are working double shifts and overtime to fill the gaps.

“The survey demonstrates the severe workforce challenges long-term care providers are facing due to the COVID-19 pandemic,” said Mark Parkinson, president, and CEO of AHCA/NCAL.

“Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents. Lawmakers across the country must prioritize long-term care and that begins with providing resources to address workforce challenges. When facilities have the means to offer competitive wages and training programs, workers will follow.”

The organizations have provided both state and federal lawmakers with their own proposals to increase staffing, but they have not been acted on. The proposals include increasing federal Medicaid funds to states so that they equal the cost of care, loan forgiveness for new graduates who want to work in the long-term care industry and childcare assistance.

Christopher Laxton, executive director of American Medical Directors Association – The Society for Post-Acute and Long-Term Care Medicine which represents medical directors, doctors, and some front-line workers in long-term care, said the industry’s staffing problem predates the Covid-19 pandemic.

“Truthfully, nursing home staff are exhausted and demoralized,” Laxton said. “They’re demonized, the finger gets pointed at them, they’re not well trained, they’re not well compensated, they don’t really have opportunities for advancement, and they’re not well supervised.  

“If you want to start talking about solutions, you have to start making this workplace a safe one and make the work meaningful for these folks,” Laxton said.

Mollot said throwing more money at the industry isn’t the answer. Rather, nursing homes need to step it up and provide better wages and benefits and stop paying administrators and nursing-home owners outsized salaries.

“People come in, but they don’t stay,” Mollot said. “If you improve the working conditions, if you improve the amount of staffing where it’s not like you know what is hitting the fan all the time, I think you’ll have a better situation for maintaining staff.”

The staffing crisis comes at a challenging time, with the Covid-19 pandemic and new state minimum staffing ratios for nursing homes going into effect next year.

In addition, the state will soon require nursing homes to spend at least 70% of their revenue toward direct resident care, with 40% of it toward staffing that care for residents.

“I think they’ll solve it because they’re mostly for profit, and if the rules are enforced and they want to stay in business, then they’ll solve it,” Mollot said.