South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

As reported in an article from the HuffPost by Carole Herman, neglect and abuse are rampant in nursing homes. These reoccurring issues can be attributed, in part, to the lack of government standards or regulations.  As the article explained, the state agencies that are charged with overseeing the nursing homes fail to fix problems including the epidemic of short-staffing.  These overlooked issues diminish the quality of care but cut the facility’s costs and increase their profits. 

A Consumer Report in September of 2006 found that while nursing homes are receiving increased monies from tax dollars, their issues are still not being corrected. The increase in tax money is instead being used to increase profits, which increases their investors’ returns, and increases the money available for political contributions.

It is easy to see why there is such a lack of government initiative to correct these issues since government officials themselves are seeing a cut of the profits. It is an absolute disgrace that these agencies, who are being trusted to care for a human being, continue to be more concerned with increasing their profits than delivering an acceptable standard of care.

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The Hartford Courant had an article on the tragic death of a nursing home resident who choked on a peanut butter and jelly sandwich.  It was well known that the patient needed assistance while eating.  Because of short staffing, the resident was left unattended with the fatal sandwich. 

State inspectors said staff members at Torrington Health and Rehabilitation Center, whose parent company is Spectrum Healthcare Torrington, were required to carefully monitor the elderly patient, who suffered from mental illness and pulmonary disease. The staff was instructed by doctors to encourage the resident to eat slowly and take small bites, and to cue the resident to chew and swallow. Food had to be cut up in small pieces.  Despite this treatment plan, inspectors reported, "staff failed to supervise the resident when the resident was left unattended with a peanut butter and jelly sandwich.''

The patient was found unconscious. Medics performed CPR and the ambulance report indicated the resident's airway was completely blocked with peanut butter. The patient died at a hospital of cardiac and respiratory arrest, and choking, according to the state Department of Public Health inspection reports.

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The Republic reported that advocates for the elderly are objecting with Kansas Gov. Sam Brownback's choice of Barbara Hickert to be the state's long-term care ombudsman, raising concerns that consumers' best interests will be ignored, and abuse and neglect will be covered up.  This is the third person coming from the nursing home industry to hold the post.  Brownback has appointed several people with nursing home ties, including Aging Secretary Shawn Sullivan and Joe Ewert as commissioner for licensure, certification and evaluation. Sullivan was a Wichita nursing home administrator and Ewert worked for LeadingAge Kansas.

"I'm not overstating it, it's life or death," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. "Right now, there's a heavy weight on the provider side. The concern is that consumer needs will be second to industry."

It's extremely rare for someone from the nursing home industry to be appointed as state ombudsman.  Mark Miller, the ombudsman for New York and vice president of the National Association of State Long-Term Care Ombudsman Programs, said "I can't think of a single colleague. I think that's something the average person would have a question about," Miller said. "'Where do this person's allegiances lie?'"

.

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Galesburg News reports on a new piece of legislation to be passed before the House in Illinois that would eliminate the ability to fine Nursing homes after serious injury or death.

The House Bill 5849 passed before the House unanimously and was the brainchild of Republican David Leitch.  This Bill leaves nursing home residents more vulnerable and at risk without any means of protection and creates more bureaucracy in the system of Nursing home review. Despite its unanimous passage, law makers still say: “ It is not a perfect bill. We will continue to work with the sponsors. We certainly still have some concerns, too.” 

Advocates for nursing home reform say this is a threat to advancements made on Nursing home reforms. Opponents of the bill sight its unanimous passage to lack of involvement from Public Health, who should have voiced concerns over the rights of nursing home residents.

In the state of Illinois, the passage of this bill will allow Nursing homes more room to get out of fines and citations through an appeals process. This bill will also lengthen the time of review on cases which resulted in serious injury or death, cases that need immediate action. The state of Illinois is aiding legislation which will allow Nursing homes more power and more abilities to avoid citations and fines through a system of bureaucracy.

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McKnight's had an article about thenew GAO Report showing that The Centers for Medicare & Medicaid Services need to make serious improvements in the tools it uses to evaluate the quality of nursing home care.  The Government Accountability Office conducted an investigation to determine whether CMS was doing an adequate job in monitoring implementation of the Quality Indicator Survey process. The GAO found that CMS has not established quality measures or performance goals to evaluate if QIS objectives are being met.

Both the GAO and the Department of Health and Human Services recommended that CMS “routinely monitor the extent to which progress is being made in meeting the objectives of the QIS and systematic methods for monitoring and facilitating states' efforts to implement the QIS.”

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The Center for Medicare Advocacy recently published a press release on the failure of nursing homes participating in the "Advancing Excellence in America's Nursing Homes"--an industry program to self-police and improve quality of care.  Below are excerpts of the press release:

Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country – the Special Focus Facilities (SFFs) – participate in the nursing home industry's voluntary quality improvement campaign, Advancing Excellence in America's Nursing Homes.  Forty-three percent of all facilities identified by the Centers for Medicare & Medicaid Services (CMS) as SFFs have participated in Advancing Excellence for more than two years.

Participation in Advancing Excellence has neither prevented facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents to warrant removal from the SFF list.  That nursing facilities participating in a quality improvement campaign are nevertheless identified by the federal government as among the most poorly performing facilities in the country demonstrates, once again, that voluntary quality improvement efforts by the nursing home industry do not guarantee high quality of care for residents and cannot replace a strong public regulatory system.

Each month, CMS identifies nursing facilities that are providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three years. There are 15,568 nursing facilities in the United States. Only 150 facilities (less than 1%) were identified by CMS as SFFs that were either newly added to the SFF list or had not shown improvement as of December 15, 2011.

Advancing Excellence in America's Nursing Homes
Advancing Excellence is a voluntary quality improvement initiative implemented by the nursing home industry and others in October 2006.   When Advancing Excellence was implemented in 2006, facilities chose at least three goals from among eight available goals. Four goals were clinical goals – reducing high risk pressure ulcers, reducing the use of daily physical restraints, improving pain management in long-stay residents, and improving pain management in short-stay residents.  Four goals were non-clinical – setting individualized quality improvement targets; assessing resident satisfaction, family satisfaction, or both; measuring and reducing staff turnover; and consistent assignment of staff to residents.

Participation in Advancing Excellence has neither prevented nursing facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents so that they are removed from the SFF list.  SFFs are defined as among the 1% of worst performing nursing facilities in the country, yet they participate in Advancing Excellence at high rates. Many facilities appear to have participated in Advancing Excellence when they were first identified as SFFs. Participation in the Campaign clearly has not improved their performance.
These findings give little reason to believe that Advancing Excellence is making a difference in improving quality of care and quality of life for residents. And they provide no reason to believe that voluntary quality improvement campaigns can be a substitute for an independent, objective, public regulatory system

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The Center for Medicare Advocacy reported that allowing facilities to self report key data on staffing, quality of care, and complaints does not work.  See report here. The Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are providing the worst care to their residents. These facilities, called Special Focus Facilities (SFFs), receive extra attention from the survey agency – at least two surveys each year and enhanced enforcement activities.

The Center concludes that facilities’ self-reported staffing and quality measure data cannot be relied on to provide an accurate picture of a nursing facility. This conclusion refutes the nursing home industry’s claim that facilities can effectively regulate themselves.  In light of SFFs' "over-reporting" [read lying] of their staffing levels and quality measures, the Center for Medicare Advocacy recommends that:

Staffing and quality measures not be reported on Nursing Home Compare for any SFFs;

 No SFF be given more than one star on their composite scores unless and until it graduates from the SFF program;

 Pain not be used as a quality measure for any facility on Nursing Home Compare.

 The Center for Medicare Advocacy study shows that SFFs often report high staffing and high quality measures, despite their extremely poor performance on publicly-conducted, objective surveys. The study did not evaluate whether all other nursing facilities' self-reported staffing levels and quality measures are similarly inconsistent with their survey results.

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The Knoxville News reported Maryland's Colonial Hills Nursing Center will likely lose its status as a Medicare service provider and take only private-pay patients for at least the next six months effective Jan. 7.  CMS has determined that the nursing home "is not in compliance" with its regulations.   More than six months ago, Colonial Hills was added to a national list of "special focus" facilities in danger of losing certification, and as of October, the list said, conditions at Colonial Hills had not improved enough for it to be removed from the list.  Medicare will not pay for the care of any residents admitted after Jan. 7 and will pay only for 30 days' care, through Feb. 6, for residents admitted before Jan. 7.

Beecher Hunter is president of Cleveland, Tenn.-based Life Care Centers of America, which manages Colonial Hills and more than 100 other nursing homes. Hunter blames previous administrator, Rick Sharp, who was "dismissed". Director of Nursing Donia Amburn is serving as interim administrator while Life Care looks for the "best person" to fill the position full time. 

So they blame everything on the Administrator--I would like to hear his side of the story.

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Journalist Robert Garrett wrote a great article for the Dallas News about the failure of Texas to penalize nursing homes that neglect and abuse residents.  Current and former inspectors say that they’re being discouraged from reporting bad care and unsafe conditions. Experts fear that elderly and frail residents are at risk of abuse and neglect as some operators routinely cut corners and understaff facilities. 

The state has stopped imposing the most severe penalties, such as revoking a home’s license and government contracts, or seeking a court-appointed overseer.  Four employees who performed inspections for the state in recent months told The News that their superiors often resist letting them cite homes for possible life-threatening abuse and neglect.  Without that implicit threat, corporate owners will treat minimal fines as a cost of doing business instead of correcting the problem.

The Dallas News investigated and found:

State regulators whose job is to keep shoddy operators from owning or running homes have done cursory, and at times inaccurate, background checks that in at least one case failed to keep out a federally banned health-care provider.

State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.

Legislative changes, especially limits on lawsuit damages passed in 2003, have virtually eliminated trial lawyers as de facto watchdogs of nursing homes. Other changes limited the state’s ability to fine nursing homes and have created an industry-friendly cadre of “quality monitors.”

After inspectors discovered practices endangering the lives of elderly and disabled residents, the state regulatory agency hasn’t gone after the homes’ licenses.

AARP said the state’s relatively infrequent use of harsh sanctions “raises serious concerns about the agency’s commitment to quality.”  AARP , a leading advocacy group for seniors, recently gave Texas poor marks for quality care. Using data from the federal government, it ranked Texas 34th among states in avoiding bedsores for high-risk nursing home residents and 42nd in preventing hospital readmissions.

In 2001 (the nursing home industry spent as much as $575,000 during the 2001 session),
Republican lawmakers removed about 45 of the 557 inspector positions and converted them to “quality monitors” who try to help operators solve persistent problems, such as bedsores. Today, the inspector force has dwindled to about 400.  And the quality of care has suffered.  Budget documents show that state nursing-home enforcement has remained on tight rations.  For the last several years, inspection teams have had fewer people and spent less time at a home during annual visits than in previous years.

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The NY Times had an informative article on the state of care in New York's adult homes.  The Times undertook its own analysis of death records and found disturbing patterns: some residents who were not supposed to be left alone with food choked in bathrooms and kitchens. Others who needed help on stairs tumbled alone to their deaths. Still others ran away again and again until they were found dead.

In New York, it is unusually common for developmentally disabled people in state care to die for reasons other than natural causes.  "One in six of all deaths in state and privately run homes, or more than 1,200 in the past decade, have been attributed to either unnatural or unknown causes, according to data obtained by The New York Times."   State officials in New York cannot even agree on how many people are dying. The Office for People With Developmental Disabilities says 933 people in state care died in 2009. The Commission on Quality of Care says 757 did. Neither agency could explain the discrepancy.

New York has made no effort to track or investigate the deaths to look for patterns or trends, resulting in the same kinds of errors and preventable deaths, over and over.  The state does not even collect statistics on causes of death, leaving many designated as “unknown,” even after a medical examiner has made a ruling.

The records shows neglect may be contributing to those unexplained deaths. The average age of those who died of unknown causes was 40, while the average age of residents dying of natural causes was 54.

New York, like most states, relies heavily on the operators of the homes to investigate and determine how a person in their care died and, in a vast majority of cases, accepts that determination without investigation or corroboration.  Courtney Burke, the commissioner of the Office for People With Developmental Disabilities, which operates and oversees thousands of group homes, acknowledged that her agency suffered from a lack of transparency and what she called “a culture of nonreporting.”

The problems in the New York system appear especially troubling given that the state spends $10 billion a year caring for the developmentally disabled — more than California, Texas, Florida and Illinois combined — while providing services to fewer than half as many people as those states do.

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