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Thousands of elderly patients across New York City are warehoused in understaffed nursing homes where they suffer from neglect, malnutrition, dehydration, abuse and — in some cases — premature death, a Daily News investigation has found.

Many homes for the elderly, beset by cutbacks, a tight labor market and pressure to squeeze out profits, do not hire enough aides to pay attention to the needs of their patients, a three-month News probe found.

Patients needs are not always top priority in some nursing homes. 
Staffing levels at the city's 176 nursing homes are 19% below the national average, a News analysis of state Health Department data shows.

On average, city nursing homes reported staffing levels that are 10% lower than those in the rest of the state. Yet department inspectors last year cited only one city nursing home for a staffing deficiency.

Some 25 years ago, New York's for-profit nursing homes became the focus of a national scandal after a state commission and news organizations documented how millions of Medicaid dollars earmarked for the care of the elderly were lining the pockets of politically influential home owners instead.
Once again, woefully inadequate conditions have become the standard at many of the city's nursing homes, where more than 42,000 of the city's most vulnerable and infirm seniors live.

In a dozen nursing homes The News visited, elderly wheelchair-bound residents — mostly women — were often left unattended in hallways, staring off into space like lost souls.

The chief findings of The News' probe: 

· Widespread staff shortages contribute directly to patient neglect. Aides, especially during evening shifts, repeatedly told The News they were put in charge of as many as 40 elderly patients at a time, forcing the aides to choose between them — sometimes with disastrous results. 

· Nurse's aides in New York are not subjected to mandatory criminal background checks. As a result, aides with criminal histories continue to land jobs caring for the elderly. 

· In the past decade, fully 25% of workers prosecuted for abuse or violence had criminal records that included drug dealing, sexual abuse and assault. 

· Nursing home residents also are facing a new and unexpected threat to their safety: fellow residents. Homes are poorly prepared to deal with increasing numbers of dementia patients who are prone to violence. 

· Patients and their loved ones who complain about nursing home abuse or other problems are too often met with silence from the State Health Department. 

The News reviewed hundreds of pages of state and federal nursing home inspection reports and government audits, talked to dozens of patient advocates and experts, examined scores of court cases filed against nursing homes and spoke with union officials, nursing home workers and nursing home residents and their relatives.

Patients left unattended in hallways were just one of the troubling sights Daily News investigators found on their surprise visist to area homes. 

Under the Freedom of Information law, The News obtained access to records of patient abuse complaints referred to the state attorney general's office.

"We continue to see a pattern of both abuse and neglect that is unacceptable," said Jose Maldonado, deputy attorney general in charge of the Medicaid Fraud Control Unit, which prosecutes nursing home corruption and patient abuse.

"There's a direct correlation between staffing and quality of care.

Understaffing, which is widespread throughout the industry, directly results in substandard quality of care," he said.

Industry officials acknowledge they are having trouble adequately staffing their facilities.

"Are we suffering from personnel issues? Absolutely. That is the single biggest problem," said Robert Murphy, spokesman for the New York State Health Facilities Association, which represents 308 nursing homes. "Are aides working longer? Absolutely. We are having trouble finding people."
Lola Anderson, a staffer at Hillside Manor Nursing Home in Queens and a union activist, said the shortages cause serious problems. "If the 3-to-11 shift is short, some of these patients get no food," she said.

The findings of The News' investigation mirror those of a landmark federal government study that recently found nursing home staffing levels below minimum standards across the nation.

Nursing home operators insist they are doing their best to cope with the staff shortages, sometimes by pressing aides into mandatory overtime.

"Patients are not in danger or risk," Murphy said.

Nursing home officials say New York's robust economy has made it harder than usual for homes to attract reliable workers for backbreaking jobs that pay little more than minimum wage.

Critics say newly hired aides often do not have enough experience dealing with the frail elderly.

Nursing aides must undergo at least 100 hours of training, including at least 30 hours working in a home.

A resident left unattended at Kingsbridge Heights center in the Bronx. 
Still, certified nurse's aides are required by the state to undergo less training than cosmetologists (1,000 hours) and nail specialists (250 hours).
"They are hiring people right off the boat who have no training," said Larry Krasin, an attorney who handles patient abuse cases. "It's absolutely ridiculous."

It also can be harmful — and sometimes deadly:

· Two nursing home workers in the city were arrested last month for allegedly abusing elderly patients. Vincent Paone, a 43-year-old registered nurse at the Eger Nursing Home on Staten Island, was charged with physical abuse after he allegedly placed tape over the mouth of an elderly patient suffering from dementia. 

In Queens, nurse's aide Charmaine Ray, 45, of Hollis was charged with endangering the welfare of an incompetent person and assault after a 94-year-old at Elmhurst Care Center in his care suffered traumatic skin tears. Paone and Ray have denied the charges.

A 90-year-old resident of the Greater Harlem Nursing Home received second-degree burns after a nurse's aide put her in a bathtub and filled it with scalding water. The victim was mute and suffering from dementia.
Aide Gloria Felder was charged with endangering the welfare of an incompetent person and was fired immediately n A worker at St. Patrick's Home for the Aged in the Bronx found a resident lying restrained on her bed after an aide tied her nightgown in a knot around her thighs.

The aide said she was trying to prevent the woman from tearing off her diaper. She had filled the woman's diapers with towels, she said, to keep them dry — a violation of patient care standards.

At the time, she and one other aide were caring for 44 patients.

The aide was suspended soon after the incident and retired in April 1999. A St. Patrick's spokeswoman had no comment. n Manuel Roman developed gangrene and had to have his testicles and a leg amputated in 1997 after workers at the Augustana Lutheran Medical Center in Brooklyn failed to spot sores developing on his body, his family's lawyers allege.

The home's staff also allowed the 76-year-old to become malnourished and develop hypoglycemia, the lawsuit charges. David Rose, an Augustana administrator, declined comment.

· Nurse's aide Valerie Freeman was arrested in 1998 for allegedly punching an 85-year-old patient of Manhattan's Kateri Residence in the face after the woman called her names.

Freeman was charged with violating health laws and endangering the welfare of an incompetent person. She was fired after the incident, according to Kateri administrator Lascelles Bond.

"That was an isolated incident," Bond said.

· Shortly after his 87-year-old mother arrived at the St. Barnabas Nursing Home in the Bronx five years ago, Tony Felidi began to notice nasty bruises on her arms. It appeared to him as if someone had squeezed her arm.
But no one — neither the nurse's aides nor their supervisors — could explain why. And his mother, who suffered from Alzheimer's disease, was little help.

One day, Felidi found his mother with a serious cut above her right eye. He was told she fell out of bed. Another day, he found her finger broken.
Her colostomy bag would overflow and soil her dress.

In September, he arrived on a Monday and found his mother's right leg bruised and swollen. Doctors told him they thought it was a blood clot. Three days later, it was discovered that her right leg was broken. She had not walked on her own for two years.

Maria Felidi died Oct. 20 at age 92 of unrelated causes. The family has filed a complaint against St. Barnabas with the Health Department.

St. Barnabas spokesman Gerald McKelvey said officials have been unable to determine how Maria Felidi was injured. "My question to them is, ‘What happened?'" Felidi said.