Here is a very interesting story from a resident's point of view. Billy Bogardus, a retired engineer, said he received poor care while he was a patient in Haven Health Center of South Windsor earlier this year. "You had to beg and plead to get them to pay attention," he said. Bogardus of West Hartford went into a Haven Healthcare nursing home to recuperate from a hospital stay, but ended up fighting for his life.
For four days in April, Bogardus and his close friend, Leona Brenner, tried to convince the staff of the Haven Health Center in South Windsor that he was dying. Bogardus, who had sought nursing-home care after complications from heart surgery, was coughing, struggling to breathe and couldn't walk the six steps from his bed to the bathroom, he and Brenner said.
Only after Brenner threatened to call 911 herself did the nursing staff finally summon an ambulance, the couple recounted. By the time the 69-year-old retired civil engineer arrived at St. Francis Hospital and Medical Center in Hartford, hospital records show, he was dehydrated and his kidneys were failing.
"If it wasn't for [Leona], I'd be dead half a dozen times," said Bogardus, who landed in the hospital several other times during his seven months in the nursing home — once when a blood test found his level of the medication Cumadin was five times higher than normal. "You had to beg and plead to get them to pay attention. I think I would've been better off out on the street."
Bogardus' complaints were not new. Last year, a state inspection report detailed numerous complaints from residents about the "difficulty they have experienced in obtaining staff assistance."
The South Windsor home is one of 13 Haven Healthcare homes with staffing levels that fall below both state and national averages, according to the most recent federal data. Nationwide, nursing homes provide an average of 3.6 hours of care per resident per day — 1.3 hours by licensed or registered nurses, and 2.3 hours by certified nursing assistants. A study commissioned by the federal government recommends that each resident receive 4.1 hours of care a day.
But in Connecticut, nursing homes have had little incentive to boost staffing. The state's minimum-staffing law, which has not been updated in more than 25 years, requires only 1.9 hours of nursing care a day per resident — less than half of what the Centers for Medicare & Medicaid Services' study recommends.
Although the state's public health code also requires that each facility has sufficient staff to ensure residents receive appropriate care, state public health officials have been reluctant to use that provision to penalize homes for understaffing, or to make demands on homes to add staff when deficiencies are found, records indicate.
Federal data show that Connecticut in 2006 cited only 2 percent of nursing homes, under federal rules, for failing to provide sufficient nursing staff — a lower rate than 27 other states. In 2005, its rate of citing homes for staffing deficiencies was among the lowest in the country — zero.
Haven Healthcare — which has the lowest staffing average of the state's three largest chains, according to the most recent data — is one of many nursing home operators in Connecticut that stand to benefit from those policies. But it also provides some compelling examples of the consequences.
Many of Haven's 15 homes in Connecticut have been cited in the last three years for bed sores and dehydration — two key indicators of understaffing, according to federal health officials and nursing home experts. In February, the chain's Waterford home was hit with the largest penalty imposed by the state in three years — a $100,000 fine and two years' probation — for neglecting a sore on a resident's heel for so long that his leg had to be amputated, in addition to other violations.
But in most cases where Haven has been cited for bedsores or dehydration, state officials have not mandated any increase in staffing. Even in the Waterford case and two other Haven cases that triggered "consent orders" by the health department — the highest level of enforcement — the department did not require increases in staffing ratios.
In a number of cases where serious patient-care deficiencies have been found in Haven homes, follow-up state monitoring often consists of the assertion: "Staffing was reviewed and found to be in compliance with the minimum staffing levels of the public health code" — a certification that nursing home advocates say is meaningless.
Jennifer Keyes-Smith, an advocate for the elderly who formerly worked for the state as a regional nursing home ombudsman, complained in a letter last winter to the attorney general's office that she had tried repeatedly several years ago to get the ombudsman's office and the state Department of Public Health to address chronic understaffing at Haven's New Haven home — without success.
"I continued to visit the facility and observed resident call bells going unanswered, residents not being fed, residents not being toileted, and staff treating residents disrespectfully," she wrote last November. "With basic human needs not being met, I continually urged the program's prompt intervention and DPH's expedient response. I was then told to stop working on the case."
Haven Healthcare CEO Raymond said he could not recall the state ever punishing the chain for understaffing or mandating higher staffing ratios.
Last week, state Attorney General Richard Blumenthal disclosed that state and federal officials were investigating whether Haven Eldercare, the chain's parent company, improperly diverted government funds away from patient care. Termini said the company's financial issues never impacted the level of care.
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