Feces in the shower. Pressure sores. Dead worms in the corner of one building.
"Be careful who you trust with nursing home care," shout four billboards placed recently around Indianapolis by a union that wants to warn people about problems like chronic understaffing at Harborside Healthcare nursing homes.
Nonsense, counter Boston-based Harborside managers. They claim the union is using isolated events to "extort" more pay and benefits from Harborside and expand union membership.
Either way, Indianapolis appears to be the starting point for a nasty public relations tussle that could spread across the East Coast.
The Washington, D.C.-based Service Employees International Union has taken to the airwaves, highways and Internet to spread its message. A Web site shows a picture of a forlorn elderly woman and tells visitors about problems found over the past few years at Harborside's Indiana locations.
Government inspectors found the feces and worms during two separate visits to the Indianapolis site. They reported the pressure sores on patients at the Decatur location, according to the Web site.
These problems crop up when proper staffing levels are not "part of the core mission of the company," according to Dave Regan, president of the union's District 1199, which covers Ohio, West Virginia and Kentucky.
"We've made the decision that we're going to launch a comprehensive effort within Harborside to demand that homes be appropriately staffed to avoid the kinds of problems that are being publicized in Indiana," Regan said.
Regan said the main goals of the union's publicity campaign are to improve staffing levels and conditions for the workers.
He said Harborside pays its certified, skilled care givers $8 or $9 an hour. He said these nursing aides and assistants cannot afford health care and have no retirement plans.
Improve that, improve staffing, and patient outcomes will rise as well, Regan said, emphasizing that the union is not casting aspersions toward individual care givers in Indiana.
"It is an indictment of a business model that puts people who do this work in a nowin situation," he said.
Union recruitment was not a top priority, Regan said, even though his union represents no employees in Indiana.
"I don't want to say that doesn't matter, but it's not the primary drive behind this effort," Regan said.
However, union recruitment matters a great deal according to the Harborside management view of this publicity campaign. Harborside CEO Stephen Guillard said the ads and billboards amount to "legalized extortion."
The union wants to boost its membership across the chain by holding elections without management opposition and by avoiding some other organizational steps, he said.
Union leaders told Harborside officials they planned to wage their public relations campaign "until we agree to negotiate with them," said Brad Shiverick, Harborside's vice president for quality assurance and improvement.
Both the worm and fecal sightings were one-time events, Shiverick said. He said a resident had had an "incontinent event" in the shower, and staff focused first on cleaning the patient. An inspector who was at the home that day spotted the mess before workers could return to clean it.
As for the pressure sores, many Harborside residents have them when they arrive, the executives said.
Harborside executives reject the staffing gripe as well. They say the company staffs its nursing homes according to government regulations and patient needs.
"We are consistent [with], if not better than, all nursing homes in Indiana," Guillard said.
Regan said he was "not even going to dignify the extortion comment" with a response. He noted that Harborside representatives have not denied the incidents occurred. He said all the union was doing was "just publicizing documented facts from public sources."
The U.S. Centers for Medicare & Medicaid Services work with state agencies to monitor nursing homes and inspect locations, said CMS spokesman Greg Chesmore. They've become familiar with Harborside's Indianapolis home in recent years.
Chesmore said that home has seen 11 "federal enforcement cycles" since 1999. That means at 11 separate times, inspectors found deficiencies severe enough to warrant sanctions from the center's regional office. That, he said, was a high total. The Decatur location, in contrast, has seen seven federal enforcement cycles since 1997. The union campaign started recently in Massachusetts and it will expand further. They picked Indiana as a starting point simply because "we had to start somewhere," according to Regan. "We began in Indiana; it certainly will not end in Indiana," he said. "It's just the beginning of this effort, and it will go everywhere Harborside does business." Union officials declined to say how much the publicity campaign costs.