Gene Timmons\u2019 brief stint in an Albuquerque nursing home was supposed to make him stronger.<\/p>\n
His family hoped he would live there for a few weeks, getting the physical therapy he needed to return home stronger and avoid repeat falls, said his son, Matthew Timmons, an Albuquerque resident.<\/p>\n
Instead, Gene Timmons got sicker. When he went to the hospital after just a few days in the nursing home, doctors determined he was suffering from severe dehydration, pressure ulcers, sepsis and respiratory failure, said Caela Baker, an attorney representing the family.<\/p>\n
Gene Timmons died in December at age 83 \u2014 seven days after leaving the nursing home.<\/p>\n
\u201cHe was only there for a week before he was taken out and basically put on his deathbed,\u201d his son said.<\/p>\n
Stories like Timmons\u2019 aren\u2019t as unusual as you might hope, according to the latest safety and quality ratings from the U.S. Centers for Medicare and Medicaid Services. Inspectors hand out, on average, 9.3 health citations per nursing home across the U.S. In New Mexico, that figure nearly doubles to 17.8 health citations \u2014 the highest of any state in the country.<\/p>\n
The New Mexican reviewed ratings for all 68 facilities in the state considered nursing homes by the Centers for Medicare and Medicaid Services. Nearly a quarter received one star out of a possible five from the agency\u2019s rating system.<\/p>\n
Eleven facilities were recently cited for abuse. And Casa Real \u2014 one of just two nursing homes currently in operation in Santa Fe \u2014 is unrated \u201cdue to a history of serious quality issues,\u201d according to the federal agency\u2019s website. The facility\u2019s latest inspection yielded 29 health citations, well over New Mexico\u2019s average of 17.8 and the national average of 9.3.<\/p>\n
Several factors contribute to the poor quality of care available in the state, including profit-driven corporate structures and low reimbursement rates for care, said Angelina Flores-Montoya, deputy Cabinet secretary of the New Mexico Aging and Long-Term Services Department. Chief among those, though, is trouble recruiting and retaining staff.<\/p>\n
\u201cWe have a nursing shortage in this country. That\u2019s not specific to New Mexico; that\u2019s across the U.S.,\u201d Flores-Montoya said. \u201cBut New Mexico certainly faces that in more challenging ways in rural communities.\u201d<\/p>\n
To fix those problems, policymakers will have to strike a \u201cbalance of resident safety and quality of care with the realities of the long-term care workforce and Medicaid reimbursement,\u201d department spokesperson Joey Long wrote in an email.<\/p>\n
The state\u2019s poor quality and safety ratings have led attorneys who represent plaintiffs in nursing home abuse and neglect cases to call on the Legislature to increase minimum staffing standards for nursing homes.<\/p>\n
\u201cWhat we need is some kind of state legislative mandate that makes staffing better at these places,\u201d said Tyler Atkins, founding partner of an Albuquerque-based law firm that takes on nursing home abuse cases. \u201cAnd yeah, it may affect the bottom line of the corporations operating them, but \u2026 they\u2019re going to be in business. They just won\u2019t make as much money by safely staffing these places.\u201d<\/p>\n
<\/p>\n
Gene Timmons, left, with his son, Matthew Timmons, in 2004.\u00a0<\/p>\n
Courtesy Matthew Timmons<\/p>\n
However, minimum staffing standards aren\u2019t a \u201csilver bullet\u201d for better care as facilities struggle to recruit and retain qualified staff, especially in rural communities, argued Vicente Vargas, executive director of the New Mexico Health Care Association and New Mexico Center for Assisted Living, trade groups that represent long-term care and assisted living facility operators.<\/p>\n
\u201cCould it move the needle? Sure \u2014 at what cost? Is it less availability of beds? Is it closing down a facility?\u201d he said.<\/p>\n
Vargas added, \u201cIf we\u2019re going to have that discussion, we need to have a more robust discussion about how we can find the workforce, how we can pay the workers, how we can ensure that they have a safe working environment.\u201d<\/p>\n
What are nursing homes?<\/p>\n
Nursing homes are one step on a ladder of care options available to older adults, Flores-Montoya said. These include:<\/p>\n
Independent living, in which residents manage their own affairs but may use facility amenities for things like meals and entertainment.Assisted living, in which residents need help with daily, nonmedical tasks like bathing or preparing meals.Skilled nursing facilities, which are staffed with professionals 24\/7 to provide medical care \u2014 like administering IV antibiotics or providing physical and occupational therapy \u2014 directly after a hospital stay.Nursing homes and long-term care facilities, which provide skilled nursing care for extended periods of time.Memory care, a type of specialized care for people with some form of dementia that can take the form of either assisted living or skilled nursing care.<\/p>\n
Nursing home care is \u201cappropriate when a person requires that 24-hour care\u201d plus assistance with daily activities like feeding, bathing and toileting, Flores-Montoya said.<\/p>\n
All of those types of care are becoming increasingly important as New Mexico baby boomers age. The state\u2019s over-65 population grew nearly 40% between 2010 and 2019, outpacing the rest of the nation. That the trend is poised to continue: By 2030, New Mexico is projected<\/a> to have the fourth-highest percentage of people over age 65 of any state in the nation, a demographic shift expected to have wide-reaching implications for the state\u2019s healthcare system.<\/p>\n \u201cIn the next five years, 1 in 4 New Mexicans will be over the age of 65,\u201d state Aging and Long-Term Services Cabinet Secretary Emily Kaltenbach said. \u201cThat\u2019s quite alarming, and we still have a long way to go to build the infrastructure and to support the providers to care for those individuals.<\/p>\n One critical caveat to long-term nursing home care, Flores-Montoya said: It\u2019s not typically covered by Medicare. The insurance program for older adults covers short stays in skilled nursing facilities, usually in the aftermath of an injury or illness. But long-term care is primarily paid for by Medicaid, the public insurance program for low-income people.<\/p>\n Nursing home operators have long argued Medicaid reimbursement rates aren\u2019t sufficient to cover the cost of care. A 2024 report from the U.S. Department of Health and Human Services\u2019 Assistant Secretary for Planning and Evaluation found Medicaid reimbursement rates covered about 82 cents of every dollar of costs nursing homes incurred by caring for Medicaid patients.<\/p>\n Those tight resources limit the revenue available for nursing homes to increase pay for workers or provide training, Vargas said. His organization, he said, would \u201cstrongly support\u201d specialized behavioral health training for nursing staff, as they care for an increasing number<\/a> of patients struggling with dementia or behavioral health conditions.<\/p>\n \u201cMedicaid rates just don\u2019t cover it,\u201d he said.<\/p>\n Insurance doesn\u2019t cover independent or assisted living<\/a> for older adults at all, leaving families to pay for those facilities \u2014 where rent can cost $10,000 per month or more \u2014 from their savings, if they have any.<\/p>\n \u201cMost people are shocked to learn that Medicare does not provide long-term care services in nursing facilities,\u201d Kaltenbach said. \u201cAnd so, unfortunately, many of our older New Mexicans get to a certain age and realize that they don\u2019t have the funds to support a very expensive service.\u201d<\/p>\n Staffing standards<\/p>\n Providing a skilled nursing level of care is demanding work, Vargas said. It\u2019s a high-stakes environment in which staff \u2014 particularly certified nursing assistants and certified medication aides, who Vargas called the \u201cbackbone\u201d of nursing facilities \u2014 are responsible for residents\u2019 health and safety.<\/p>\n Nursing homes are highly regulated. The state Health Care Authority Division of Health Improvement is responsible for determining compliance with state licensure regulations and for conducting certification and compliance surveys at nursing homes on behalf of the U.S. Centers for Medicare and Medicaid Services.<\/p>\n The federal agency tracks and publishes nursing homes\u2019 performance on a series of safety, quality and staffing measures, ranging from rates of pressure ulcers and urinary tract infections to resident emergency room visits. When facilities don\u2019t meet those standards, they can be written up for health and safety violations.<\/p>\n \u201cThese measures are stringent,\u201d Vargas said. \u201cThey\u2019re not easy to achieve, nor should they be easy to achieve. This is high-stakes care.\u201d<\/p>\n Safe staffing is one part of nursing home regulations. The Centers for Medicare and Medicaid Services monitors several staffing measures, including the care available to each resident per day and turnover rates among staff, nurses and administrators.<\/p>\n Yolanda Saenz, social services and activities manager for the Miners\u2019 Colfax long-term care facility, visits with resident and Raton native Ralph Leal during lunch at the Miners Colfax Medical Center in Raton on July 15.<\/p>\n Gabriela Campos\/The New Mexican<\/a><\/p>\n But state \u2014 rather than federal \u2014 standards guide nursing home staffing levels. Though federal law requires all facilities provide enough staff to safely care for residents, there aren\u2019t any nationwide standards dictating safe staffing.<\/p>\n The Biden administration in April 2024 considered minimum staffing requirements for long-term care facilities, with the goal of reducing the number of residents receiving unsafe and low-quality care. The rule would have mandated at least 3.48 hours of nursing care per patient per day, including at least 0.55 hours of registered nurse care and 2.45 hours of direct nurse aide care.<\/p>\n The Trump administration scrapped the minimum staffing proposal in December 2025. New Mexico Attorney General Ra\u00fal Torrez and fellow Democratic attorneys general from 17 other states decried<\/a> the move as likely to worsen the quality of care available in nursing homes, while nursing home operators largely welcomed the change.<\/p>\n New Mexico has its own standards for appropriate staffing in long-term care facilities, though they\u2019re lower than the ones considered under the Biden administration. State regulations require each facility have a member of nursing staff on-site at all times and set a minimum staffing level of 2\u00bd hours per patient per day. For a facility with 100 patients, that\u2019s roughly equivalent to one nursing department employee for every nine to 10 patients.<\/p>\n \u201cThere shall be sufficient nursing service personnel assigned to care for the specific needs of each resident on each tour of duty,\u201d state regulations note. \u201cThose personnel shall be briefed on the condition and appropriate care of each resident prior to beginning hands-on care of residents.\u201d<\/p>\n Increasing staffing<\/p>\n Without sufficient staff \u2014 or with overburdened and unqualified staff \u2014 nursing home residents can get hurt, said Jennifer Foote, a partner at an Albuquerque-based law firm that specializes in nursing home abuse litigation.<\/p>\n Citations from the Centers for Medicare and Medicaid Services are replete with examples of staffing issues.<\/p>\n Beverly Latham leads card game for residents in the room room before lunch at the Miners’ Colfax\u00a0Medical Center in Raton on July 15.<\/p>\n<\/p>\n
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