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

Caymanmama.com had an article about problems found at Mustang Manor Assisted Living Center including 27 nutrition and sanitation-related issues..  The Oklahoma State Department of Health (OSDH) found problems with on-site cleanliness, nourishment, and the overall welfare of the elderly residents. Reports show the Mustang Manor has been cited for numerous unspecified violations of safety and health in the last two years. These issues amounted to an excess of $35,000 in OSDH-issued penalties. 

Beyond claims of safety and health hazards at the nursing home, officials from the Mustang Police Department have received complaints of criminal activity at the establishment. According to Mustang Police Capt. Willard James, “We received a call that a resident had actually written checks to an employee of the business and had them cashed to have the money returned to her, and she had not received those funds.”

Often the two major areas where a nursing home can cut operating costs to improve profits is staffing and nutrition.  Many nursing homes cut staffing especially of RNs and LPNs to make more money for their corporate owners. 

Nutrition and sanitation are very important to prevent pressure ulcers and infections.

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The Post-Tribune had an incredible article about the horrible conditions at Northlake Nursing and Rehabilitation Center. Complaints filed by residents and their family members depict horrors that sound unbelievable in a modern health and healing center. Indiana State Department of Health finally suspended the nursing home's license.  The state issued an emergency closure order on Feb. 1 for the home owned by Eric Rothner and his Evanston, Ill.-based company, Extended Care Clinical, which own three other nursing homes in Lake County and more than a dozen in Illinois, Nebraska and Ohio.  The story of Northlake's demise can be told through its residents and their families and staff, as well as state regulators and ombudsmen and physicians who have treated patients there.

Of the nearly 100 patients residing at Northlake in early January, fewer than 12 remain. The state-supervised relocation is winding down and more residents leave daily for new homes in other long-term care facilities.  At least nine resident and family-member lawsuits and numerous state inspection surveys tell a story involving repeated evidence of broken care.

The complaints and lawsuits point to repeated breakdowns in patient care. They point to high turnover, not only at the level of low-paid certified nurse assistants, but also among staff nurses and the top executive positions of administrator and director of nursing.

"He buys homes cheaply that are in terrible shape. They (Rothner's Northwest Indiana nursing homes) have a certain number of beds to fill and don't have high enough census to pay their bills. They start getting desperate and are not selective about accepting the residents they take, people they have no business accepting, just to fill the beds."

Local long-term care ombudsman Christopher Herrmann said Northlake wasn't always a problem home. He said when a Rothner predecessor company, Care Centers Inc., bought Northlake in 1995, he hoped for a good turnaround.

But once the state began issuing Nursing Home Report Cards in 2002, Northlake recorded poor scores. Herrman, of Northwest Indiana Community Action Corp., said Northlake staff expressed shock at those scores, complaining Indiana was tougher than the Illinois inspectors who survey Rothner's nearly 20 homes there.

In August 1995 Rothner purchased Northlake from Atrium Living Centers of Indiana. Its current administrator, Crystal Wray, took over in March 2009, shortly after the U.S. Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program, named Northlake a Special Focus Facility.

CMS confers that nursing home "hall of shame" designation to fewer than 150 of the nation's 15,000 nursing homes annually.

Arlene Franklin, the state's long-term care ombudsman who advocates for nursing home patients for the Indiana Families and Social Services Administration, said she wasn't surprised to see Northlake close.  "They had a bad record and couldn't return to compliance," Franklin said. "Since I've been state ombudsman I can only recall four or five other nursing home closures. Normally when a home is cited they work really hard to get back into compliance, but the ones that closed never did."

Rothner said state health regulators have it in for him.

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There were several articles about the lack of investigation by Texas regulators on nursing home complaints.  The Star-Telegram ran an article.  MySanAntonionews.com ran article.  Also American Statesman had one too.

Interviews with families and advocates and a review of thousands of pages of public records by the San Antonio Express-News show some of the city's most frail and vulnerable residents are suffering at the hands of their caregivers. Yet state officials allow troubled nursing homes to continue operating with little or no penalty.

The lack of oversight comes at a human cost. Elderly residents were left for hours in their own urine and feces. Infestations of cockroaches and rats plagued some facilities. Employees yelled insults at residents and handled them roughly. Nursing home staff stole medication and administered the wrong drugs to residents. State inspectors found dirty feeding tubes and broken medical equipment.

The state received nearly 16,200 reports of poor treatment last year in Texas, but most — about four out of five — were unsubstantiated by investigators, who often arrive at the nursing home weeks after receiving the complaint.   When investigators do cite facilities for serious problems, nursing home operators rarely face sanctions. In some cases, the state repeatedly threatened to suspend or revoke the licenses of facilities with chronic problems, yet Texas rarely took action against those nursing homes. Often, a facility promises to do better, state regulators back off, and problems crop up again in a troubling cycle.

Meanwhile, serious complaints against nursing homes have increased in Texas . Complaints about problems that put residents in “immediate jeopardy,” the most serious type of complaint, rose 26 percent since 2006, to more than 950. Complaints of “actual harm,” the second most urgent type of complaint, rose by 10 percent since 2006, to nearly 6,300.

Faced with alarming delays in investigating nursing home complaints, the state is creating teams to speed up scrutiny. State nursing home investigators blew their deadlines to investigate complaints of "high potential of harm" against residents in 66 percent of investigations in fiscal 2009.   In such complaints, mental, physical or psychosocial harm is possible, though not imminent, and an investigation must be initiated within 14 days. 

In response, the Texas Department of Aging and Disability Services will put together teams to speed the state's response. Next month, the department will begin to hire 35 new investigators.

Complaint investigation teams are being set up statewide. Made up of nurses, nutritionists, social workers and general investigators, the teams will be dedicated solely to conducting investigations of complaints and self-reported incidents.

This month, the department plans a two-week blitz to investigate 1,550 complaints at more than 300 facilities, a department spokeswoman said.

The department regulates 1,196 nursing homes statewide and investigated 16,200 complaints and incidents last year.

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The Charelston Gazette had an interesting article about a former employee of Broadmore Estates who has sued the Putnam County assisted-living facility for allegedly overlooking alcohol and substance abuse by its employees, and ignoring state regulations for drug distribution.  Lynn Gomez of Elkview filed the lawsuit in Putnam County Circuit Court on against Broadmore and the facility's director, Delores Miles.  Gomez alleges in her lawsuit that she was ostracized and lost her job because of several complaints she brought to Miles about drug abuse and employee conduct.

Gomez was hired in February as a registered nurse and as director of wellness at Broadmore's assisted-living facility in Hurricane.    When she began working, Broadmore's patient charts and medical records were in disarray, the facility was understaffed and staff members did not follow state regulations for drug distribution.

She also alleges that, within her first few weeks at Broadmore, she was approached by a staff member and a pharmaceutical representative about a nurse who consistently came to work drunk or with alcohol on her breath.  Gomez alleges that the nurse approached her and stated "Lortabs do nothing for her and that she had already had four Percocet that day."

Gomez states that she approached Miles about the woman's statement and was told the nurse "had been on drugs for a long period of time, and could practice while on the medications." She also was told the nurse had been off work for a medical condition, the lawsuit states.

Gomez alleges that the nurse falsified patient charts, saying she had administered drugs that she actually had not, and that Miles falsified documents to reflect that the drugs had been properly administered and were accounted for.

The nurse eventually was fired after an outside pharmaceutical representative discovered that the nurse had falsified drug distribution records, the lawsuit states.

Gomez wants back pay, compensation for emotional and mental stress and attorney's fees.
 

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Arizona Daily Star had an article about a ridiculously small fine issued against a nursing home for severe neglect of their residents.  Devon Gables has agreed to pay a state fine of only $1,450 after an investigation found several civil violations, including nearly a month's delay in getting a resident treatment for a skin problem that turned into a serious pressure sore.  State investigators found a total of 16 violations of state and federal rules and regulations governing long-term care at Devon Gables.

Among other things, Devon Gables staff did not immediately consult a physician about a resident's dark and reddened skin, which was rubbing against a wheelchair pedal. The resident ended up developing an infection that was serious enough to require hospitalization.  The state, which found several more violations during an inspection in April, gave the nursing home a state quality rating of "A" — the highest level, which denotes "excellent."

The Arizona Department of Health Services, which licenses nursing homes in the state, can only fine facilities a maximum of $500 per day for violations.

Other incidents cited in the state's report:
• The staff gave a narcotic drug to a resident who was documented as being allergic to narcotics.
• Investigators say the nursing home failed to develop a post-discharge plan for a resident who was released to an "unsafe environment" — a home with no electricity, and with dirt and mouse droppings on "counters and floors in virtually every room."
• Did not report to the state an allegation of abuse involving one resident. The allegation did not turn out to be substantiated, but state rules require any allegation of abuse be reported to the state within five days.
• Failed to document nursing assessments before and after three residents with end-stage renal disease went for dialysis.

Devon Gables is also the subject of three pending lawsuits in Pima County Superior Court alleging negligence, violations of the Arizona Adult Protective Services Act, and wrongful death in two of the cases. 

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 There is an article about The Justice Department's settlement with the state of Tennessee regarding civil rights violations at the Tennessee State Veterans Homes (TSVHs) in Humboldt and Murfreesboro. The TSVHs are state-owned nursing homes, each serving approximately 140 residents, most of whom are veterans. It sounds eerily similar to the Bush Administration's last minute settlement with South Carolina recently.

The agreement, filed in U.S. District Court, is designed to (hopefully) ensure that the nursing home residents will (finally) be provided adequate medical and nursing care and protected from harm. During its investigation of the TSVHs, the Justice Department discovered numerous violations, including medical and nursing care that violated generally accepted professional standards, and psychiatric medication practices so deficient that they contributed to the deaths of some residents. Further, staff at the veterans homes did not adequately protect residents from injuries associated with falling.

The Justice Department conducted its investigation pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), which authorizes the Attorney General to investigate and root out systemic deficiencies in care such as those found at the TSVHs, rather than focus on individual civil rights violations.  The Department of Justice's CRIPA enforcement effort reaches beyond nursing homes, and includes psychiatric hospitals, facilities for persons with developmental disabilities, juvenile justice facilities, prisons and jails.

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The Roanoke News recently had an article about the numerous deficiences and violations found by infrequent inspections of nursing homes. 

At Avante at Roanoke, an unannounced health and fire inspection turned up 34 deficiencies in 2007 -- more than four times the national average for for-profit nursing homes. During visits to the facility, inspectors found patients not being bathed because of staff shortages, problems with cleanliness and at least two instances where residents faced immediate harm.

A new national study finds that such problems are not uncommon. Inspectors cited 94 percent of nursing homes last year for federal health and safety standards, the Department of Health and Human Services reported this week.  Nationwide, about 17 percent of nursing homes had deficiencies that caused "actual harm" or put patients in "immediate jeopardy," the report noted, and for-profit homes were more likely to have citations than government-sponsored and nonprofit nursing homes.

Take bed sores, for instance. Last year, Virginia was ranked among the 10 worst states in the nation for high-risk pressure ulcers, she said, noting 2,260 instances.

Virginia's Medicaid reimbursement rate is so low that facilities lose an average of $7 per day per Medicaid resident, he said. "And yet we have to meet the same 150 federal standards as nursing homes in other states, some of which get close to double the reimbursement."

Avante at Roanoke, a 130-bed facility, had the most violations, with 28 health-inspection infractions and six fire and safety deficiencies. Average daily certified nursing assistant time per patient at Avante was one hour, 40 minutes -- less than the region's top performer by 70 minutes.  Clearly this proves that inadequate staffing impairs the quality of care provided.

The 180-bed Virginia Veterans Care Center had 26 health and three fire and safety violations. "The year before we had three or four total," said Bill Van Thiel, administrator of the Salem facility. "It's important to remember that any survey is pretty much a one-time snapshot, and there's a huge range in severity." The existence of bed sores is a much more telling gauge of facility excellence, he added. "Normally we run about three acquired bed sores for 180 patients; that's way under the national average [of 12.7 percent]. Today, I have none."

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 I have read several articles recently about how some cities like Cincinnati may stop conducting nursing home inspections.  That is fine with me since most inspectors in South Carolina are so overworked and underfunded that the inspectors don't have the time and resources to properly insure that the nursing home is properly caring for the residents. 

Typically, the nursing homes know when they are coming and improve conditions before the inspectors get there.  We hear countless stories from ex-employees of nursing homes in the area that all repeat the same chorus.  "They increase staff and clean everything when they know the survey team will be coming in". 

I have not seen any complaints substantiated or any fines incurred against any of the for profit nursing homes. The inspectors in South Carolina seem to ignore violations, and the concerns of residents and family members. Instead, they criticize the county run nursing homes or the charitable organizations that run the mom and pop nursing homes.  I can't tell if it is corruption or incompetence but certainly the inspection program in South Carolina isn't doing anything to provide better care or oversight for the residents.

Below is a summary of a story by Dan Horn about Cincinnati dropping nursing home inspections

The Cincinnati Health Department is considering whether to drop its inspection program for nursing homes and residential care facilities. Budget cuts and retirements could soon leave the department unable to keep up with annual inspections. Cincinnati is the only city in the state that does its own nursing home inspections, a policy that city officials have said allows the city to react more quickly and aggressively to problems.   He said the program once operated with six inspectors and supervisors, but that number fell to four by the start of this year. Another retirement will drop the total to three employees by this fall.

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The Milwuakee Journal had an excellent 2 part series on nursing homes recently.  They can be found here and here.

The Journal describes how dozens of nursing homes in Wisconsin have been cited for improper care after the deaths of 56 residents since 2005 - a period marked by a dramatic surge in serious violations around the state.  Neglect was noted after hundreds of elderly or disabled nursing home residents were found with bruises, broken bones or pressure ulcers - some so deep they tunneled to the bone.   In hundreds of cases, reports document how inadequate training, lack of supervision and understaffing contributed to a rising number of injuries.

The Journal Sentinel built a database from thousands of pages of nursing home regulatory records over the past 3 1/2 years. Among the findings:

• Health care violations that put patients in jeopardy or resulted in harm spiked 34% the past three years.

• Dozens of homes are cited repeatedly for serious violations.  Many of the homes cited multiple times are owned by out-of-state corporations.

• Deaths and injuries are occurring at a time of significant worker turnover. In one case, a problem home reported nursing staff turnover rates as high as 257% last year while it led the state in serious citations.

• Families are often kept in the dark about citations issued after the deaths of their loved ones. Four families learned from the Journal Sentinel that serious citations had been issued months and even years after their loved ones were buried. 

Uunprecedented growth and profits in the industry is expected to continue. Last year, the federal government spent about $75 billion on nursing home care through the Medicare and Medicaid program.

The ownership and operation of Wisconsin nursing homes has changed dramatically. Locally owned mom-and-pop operations have given way to out-of-state for profit corporations that own clusters of homes. 

Health care experts cite other factors that have affected nursing home care.   The increase in pressure iulcers are a major concern and a leading indicator of neglect.   Pressure ulcers occur when nursing home residents are left in one position too long. The ulcers get worse when people are forced to lie in their own waste which is common in uunderstaffed facilities.  Without immediate attention, the ulcers can be life threatening.

High turnover rate is an major problem.  The aides do not get paid well and are typically asked to do the work of 2 or 3 aides.  Most aides don't stay at one facility for long. The Journal Sentinel found that turnover for full-time nursing assistants at Wisconsin nursing homes can be as high as 200%, with an average of 42% last year.   Many nursing assistant jobs start at less than $9 an hour.

"It's a hard job, but it's better than working at McDonald's," said Jim Wilson, administrator at Oak Park Nursing and Rehabilitation in Madison.   The turnover of full-time professional nurses who monitor residents' care is also high. Among the homes cited repeatedly for serious violations, the turnover rate for full-time registered nurses averaged 57% last year with some homes reporting turnover as high as 300%. The state's average turnover for full-time registered nurses in all nursing homes was 32%.

Staff turnover can directly affect care, said Julie Eisenhardt, a spokeswoman for the union representing nursing assistants. Inspection records back that up.

Sava Senior Care, a Georgia-based corporation, operates 185 homes nationally. Two of its four homes in the state have been cited with serious violations at least three times since 2005.
Even when large fines or other enforcement actions are imposed against nursing homes after serious injuries or deaths, families might never know about them. Neither federal nor state law requires that families be notified.

A Journal Sentinel analysis found that nursing homes in Wisconsin were cited for poor care after the deaths of 56 residents since 2005. But Nursing Home Compare doesn't offer any details about those deaths.   The Web site also doesn't mention anything about corporate ownership, meaning that consumers would be unable to determine if the nursing home was owned by an out of state corporation or even one with a history of violations and fines.  "Figuring out who is accountable for poor care can be very difficult," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "Consumers often don't know who owns and operates a facility. Unless a facility tells them, there is no public way to find that out."   For consumers, knowing who owns a home is important if they want to determine whether the same problems are showing up in multiple homes owned by the parent corporation.


The number of nurses and aides on staff to help residents is a key factor in determining whether quality care is being provided, according to experts.   "The higher the staffing, the better the quality," said Charlene Harrington, a professor of sociology and nursing at the University of California in San Francisco.   Staffing numbers provided by Nursing Home Compare are merely a two-week snapshot from the most recent inspection - and in an industry that has widespread staff turnover, those numbers can't always be trusted, Hedt said.

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