South Carolina Nursing Home Blog

SCDHEC responds to questions regarding nursing homes

rmullman@gpoliakoff.com (Ray Mullman) — Wed, 03 Dec 2008 15:59:11 -0500

The SCDHEC website has an interesting question and answer session where they discuss nursing homes. SCDHEC is responsible for licensing and enforcing the standards at nursing homes. They are woefully understaffed and underfunded. Below is an excerpt from "conversations with the Commissioner.

How many licensing people in DHEC's whole health licensing side? How many are assigned only to Community Residential Care Facilities?

DHEC’s Division of Health Licensing has 45 positions; three are vacant. The division has 29 inspectors. The community care oversight program has 13 positions. An additional inspector position is proposed, but has not been hired. One administrative person from the division’s operation support program is assigned responsibilities of processing CRCF applications for licensure.

How many investigators in DHEC's whole health licensing side? How many are assigned only to CRCFs?

We have 30 investigator positions. Of these, 11 are specifically assigned to CRCF in the Community Care Oversight Program.

Does DHEC need more inspectors and investigators for the CRCF program? How many?

Currently, the DHEC’s Division of Health Licensing licenses 489 CRCF’s with a total of 16,637 beds. We are assessing the CRCF program to determine how best to achieve the goals and responsibilities of the program. We’ll be happy to share the results once the study is completed.

Does this program have annual reports? (DHEC's solid waste division, for example, produces annually a nice comprehensive report.)

No.

How many natural deaths occur each year in CRCFs?

We do not collect that information as it is not required to be reported to DHEC by the facilities. We are to be notified by the facility of a death where there is an unusual circumstance that involves an investigation by the coroner or local law enforcement. We would investigate to determine whether there would be any violations of DHEC regulations that occurred. The investigation into the cause of the death and any criminal charges brought in the matter would be left to the coroner and local law enforcement agencies under their authority.

How many deaths due to staff negligence or inadequate staffing occur each year in CRCFs? (This question includes residents like the wheelchair death of a Peachtree Manor man, who was a resident but he was being pushed down the road.)

We are to be notified by the facilities when there is a death that is investigated by the coroner or local law enforcement. Criminal charges that may be brought would be done by those local authorities.

How many injuries occur each year in CRCFs? What is the nature of the injuries?

The facilities are required to notify DHEC of serious injuries that require hospitalization due to incidents involving fractures, burns, lacerations, hematomas, etc. While that information is reported to DHEC, we do not have the specific numbers compiled.

How many complaints do you get each year about CRCFs? How many are justified? What are the categories of complaints?

For the fiscal year July 1, 2007 to June 30, 2008, we received 569 CRCF complaints alleging 2,592 various issues which resulted in 579 citations.

For the current fiscal year from July 1, 2008, we have received 186 complaints alleging 886 issues for which 14 citations have been cited. Some findings for this period are inconclusive at this time as most of the complaints are still open.

Often the citations noted were not associated with the original complaint. Many times we are unable to determine if the complaint was justified.

The complaints are typically taken under the following headings:

Abuse
Accessibility
Activities
Administrative
Animals
Background Checks
Care Plans
Charting/Records
Dietary/Food
Dirty Needles
Dumping
Finances
Fire Code
Housekeeping
Incident Reports
Level of Care
Maintenance
Misappropriations
Oxygen
Patient Rights
Pharmacology
Quality Program
Recreation Staff Unlicensed
Safety
Staff
Staff Training
TB Requirements
How many CRCFs has DHEC closed in recent years?

Within the most recent years DHEC has actively been involved in the forced closure of one facility; Peachtree Manor.

All other closures have been as a result of the voluntary surrender of the facility’s license or closure of the facility as a decision made by the licensee/owner. Our enforcement actions have contributed to many of the voluntary closures.

About how many CRCFs are like Still Hopes (a CRFC in West Columbia) where mostly upper income folks go.

We do not compile information whether a facility is strictly private or whether it accepts residents that receive the Optional State Supplement (OSS) or both. You can contact the S.C. Department of Health & Human Services to request information on those facilities residents who receive the OSS supplement.

The CRCF at Still Hopes is only one part of that overall facility. Still Hopes has apartments for independent living as well as a skilled-care nursing home.

Describe briefly DHEC's main concerns with its CRCF program.

Compliance with the requirements of Regulation 61-84, Standards for Licensing Community Residential Care Facilities. Pam Dukes and Commissioner Hunter can elaborate on this question at your meeting this afternoon.

Describe briefly how DHEC wants to address those concerns.

The Division of Health Licensing is reviewing Regulation 61-84 for possible revision. We are studying possible changes in the programs. We expect to have that process completed within the next 30 days.

Can I attend the 1 p.m. Oct. 22 CRCF meeting at the Heritage Building in Columbia mentioned in Ken Moore’s Sept. 26 memo?

This meeting is for our staff and invited directly affected stakeholders to review the CRCF program and potential regulatory changes. As such, the session is not considered a “public” meeting based on input from the agency’s legal staff as the group does not constitute a public body. Allowing media participation may significantly limit our ability to engage stakeholders in a completely open and frank dialogue. We do encourage you to attend future public CRCF meetings that will be held as we continue this process.

(Question 1 response) You write, “The Community Care Oversight Program has 13 positions.” Q. My questions: How many of these positions are filled with full-time on-duty people?

All 13 are full-time on-duty staff.

How many of these positions with full-time on-duty people are devoted EXCLUSIVELY to CRCFs? (The 489 facilities you regulate).

None of the 13 are devoted exclusively to CRCF.

Of the positions EXCLUSIVELY devoted by CRCFs and filled now by full-time on-duty FTEs, how many are investigators? Inspectors? (This entire question may be most easily addressed on the phone with someone. I just want to be sure we are describing your staffpower accurately. For example, we have a lot more positions in our newsroom than actual workers. We have lost many through buyouts, attrition, etc. Saying you have a position doesn't reveal much about actual staffing.)

The CRCF program staff that inspect facilities are inspectors. The program does not use the position title of investigator.

(Questions 2 response) Does the “Community Care Oversight Program” only concern the 489 CRCFs, or does it include other types of facilities?

The Community Care Oversight program includes 87 Intermediate Care Facilities for the Mentally Retarded (MR15 and MR16). There are a total of 1,864 ICFMR beds.

(Question 8 response) You say for FY 07-08 you received 569 CRCF complaints alleging 2,592 issues... etc. (my question: Does this include the complaints forwarded to you by the Ombudsman’s office and Gloria Prevost’s group, Protection and Advocacy, which does about 85 contract inspections of CRCF’s a year for Department of Mental Health and forwards complaints to DHEC?)

Yes, but not all information forwarded to the CRCF program from these groups requires a DHEC investigation. Often, either the findings provided from their complaint investigation or the complaint itself is not within our scope of authority.

(Question 9 response)... Any idea how many closures in the past 3-4 years have been attributable in part to DHEC enforcement actions besides Peachtree?

Approximately 16 since 2004

On a different but related note: How many patients in state nursing homes? How many nursing homes?

For clarification, are you asking how many nursing homes are owned by the State of South Carolina, and how many patients are served in those homes? Or, is your question more general?

The general answer is that in South Carolina, we license 195 nursing homes with 19,647 beds. Most nursing homes in the state operate at over 95 percent occupancy.

If you want to know how many are State of South Carolina owned and how many beds are in those homes, we will need a couple of days to get you that information.