Our family member has been a resident for more than four years.  Following the transition from INOVA to Green Tree Health in 2023 resident care has definitely deteriorated.

Ongoing concerns:

• Turn-over is continuous including positions of Administrator, DON, and LTC Floor Manager, and direct care.
• Improvements are promised each time, but never materialize.
• There is no continuity or enforcement of standard practices and policies.
• Emails to administration go unanswered, and it is next to impossible to reach anyone by phone (typically no answer or voice mailbox full) or schedule a meeting making it very difficult to coordinate doctor appointments, outings, or simply obtain medical status updates.
• Recently, two doctor appointments had to be cancelled and miss-appointment fees were incurred due to my inability to speak to anyone in the facility to assist with coordinating transportation pick-up, although I had sent two e-mails advising and reminding of the appointment date and time of pick-up. 
• LRNC advised that staff is not available to bring a resident to the lobby to facilitate transportation at a specific time.  Transportation advised that, due to strict insurance regulations, staff is not permitted to go past the lobby to retrieve or return a resident from their room.  How is this to be solved??? 
• LTC 2nd Floor unit secretary left several months ago and has not been replaced.  This was absolutely the only way to communicate with the floor.  This position was eliminated to be absorbed by the 1st Floor admin who has since left as well.
• Staffing at a ratio of 1-10 does not allow for sufficient attention to each resident as needed.  Consider no shows or call-ins and this ratio quickly increases.
• Staffing should be based on a Patient Classification/Acuity System matching number of skilled staff directly to patient needs, not head count.
• It is often obvious that new or contract temporary staff are not comprehensively briefed on each resident's specific medical conditions and needs including risk factors, such as fall or aspiration, or level of cognitive ability.   
• Frequent resident check-ins is communicated as standard practice, but is frequently not happening.  I personally observed a nearly four-hour time span between a CNA check-in for our family member.  
• Sometimes a result of low staffing, and sometimes untrained, uncaring, or neglectful staff.   
• Supplies are limited to the extent that staff "stash" items to be sure they have what is needed.  Low incontinence supplies forces less changes resulting in more infections and skin wounds.
• Administration refuses to discuss or respond to concerns with the Family Council either in person or via e-mail.  This is seen as a strategy to avoid acknowledgment, accountability, and action.  There is no indication that there is a desire to work together with a common goal.

Individuals residing in Long-term Care facilities, who are typically elderly, disabled, and/or suffering from chronic illnesses, deserve and should be guaranteed a much higher level of respect and care than they are receiving. 

The rules and regulations for operating a LTC facility need review and strengthening to ensure these individuals at risk are respected, cared for, and protected against neglect and abuse.  Violations are occurring daily.

Oversight agencies need to conduct more frequent unscheduled visits; not only citing violations, but forcing accountability and consequences to owners who are reaping profits.