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

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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CLARK KAUFFMAN at DesMoinesregister.com wrote an article about a nursing home employee who stole a resident's cat.  Luckily, the cat found his way back!  The article states that the Iowa nursing home has been cited by the state for numerous problems, including the theft of a resident's pet cat.

Granger Nursing and Rehabilitation Center, located in Granger in Dallas County, was fined $7,500. Recently, investigators with the Iowa Department of Inspections and Appeals looked into allegations that employees at the home were attempting to get rid of an unnamed elderly resident's cat.

The woman told inspectors someone had taken her cat and put it outside, although the cat did not run away. Later, the resident alleged, someone at the home took the cat and dumped it along a gravel road. The cat allegedly found its way back to the facility.   According to state records, inspectors interviewed seven employees, all of whom expressed concern that someone at the home intended to put the cat in the facility's trash bin and kill it.

One worker allegedly told inspectors that the staff had been trying to dispose of the cat. The worker said that one night, while the resident was eating supper, she entered the resident's room, placed the cat in a box and took it home for safekeeping. The worker said she intended to keep the cat only until she felt it could be safely returned to the nursing home.

Based on that worker's statement, state officials cited the home for taking a resident's property.

The Granger home has been cited for numerous other problems in recent months. Inspectors have alleged that:

• A worker stole a resident's pain medication for her own use. The worker allegedly took the resident's Imitrix, a costly drug that is prescribed for the treatment of migraine headaches. The resident's insurer had paid for the drug at a rate of $26 per tablet. The worker told inspectors she took the pills at the suggestion of the director of nursing. The director of nursing told inspectors she knew of only one instance in which the worker used the resident's medication. She acknowledged that she did not report the theft to police or to state inspectors.

• As inspectors watched, a resident who was totally dependent on employees for assistance with eating was given little or no help with breakfast. At one point, the resident motioned to workers, pointing to a cereal bowl. One worker stopped and put milk and sugar on the cereal but then walked away. Twenty minutes later, the resident reached for a worker as she passed, but the worker only paused and walked away with the resident still pointing at his or her plate. A few minutes later, the resident was wheeled out of the dining room with most of the food untouched. At lunch, workers again failed to assist the resident with eating.

• One resident was mistakenly given double the amount of prescribed insulin for diabetes treatment.

• The home was cited for failing to ensure that residents had ready access to drinking water and for inadequate infection control.

• Inspectors watched workers walk through urine while providing care for one resident.

• One resident walked out of the home and was later seen by a passer-by crawling along the shoulder of a nearby highway. The passer-by alerted workers at the home, who picked up the resident and took him to a hospital for evaluation.

The Granger home has 61 residents. Federal records indicate residents of the home receive, on average, 18 minutes of daily care from a registered nurse, which is half the average of all Iowa nursing homes.

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Tennessee nursing homes are seeking unprecedented legal protection from residents who are abused or neglected.   Politicians influenced by nursing home lobbyist campaign donations introduced a bill that would severely restrict the rights of nursing home victims to seek justice no matter how bad the injury they suffer and no matter how bad the conduct of the home.

NHC, which reported more than $500 million in annual gross profits in 2006 and whose CEO Robert G. Adams makes more than $1.3 million a year, pushed for the legislation.   The legislation would ensure that:

Residents would have little to no recourse against nursing homes no matter how bad the conduct of a home.

Nursing homes can demand that residents sign arbitration agreements waiving their constitutional right to a jury trial in order to get medical care, making nursing home residents the least protected class in the state.

“This proposed legislation is a slap in the face to some of Tennessee’s most vulnerable citizens – the residents of nursing homes and their families,” said Karla C. Hewitt, president of Tennessee Citizen Action, a grassroots consumer protection organization.  “Nursing home residents are suffering. Inspectors have found residents with maggots in their wounds and broken bones that aren’t treated,” Hewitt continued. “And now this billion dollar industry wants to take away the rights of individual residents to sue? This shows how low the nursing homes will go to protect their shareholders' profits.”

Though the multi-billion dollar nursing home industry complains of an epidemic of frivolous litigation, in fact only four verdicts were awarded against Tennessee nursing homes from 2005-2007.   During that same period, nursing home admission suspensions tripled. In 2007, 22 nursing homes had their admissions suspended for putting their residents in “immediate jeopardy.” According to records at the Tennessee Department of Health, the 152 immediate jeopardy violations in those homes include reports of patients suffering the following:

Risk of injury or death by fire
Maggots in wound
Broken bones unattended for days
Drastic weight loss due to improper nutrition/oversight
Impacted bowels caused by inattention/oversight
Extreme pain with no relief
Fear of staff

In addition to these violations, a worker at a home in Madison was arrested in May 2007 for raping a 70-year-old resident.

The State of Tennessee allocates 99% of funding from the Centers for Medicare & Medicaid Services – more than $1 billion a year – to nursing homes and only 1% to home and community-based care.  

About Tennessee Citizen Action (TNCA)

TNCA is Tennessee’s consumer watchdog organization working on behalf of a number of consumer protection issues, including patients’ rights; nursing home reform; quality health care; increased home- and community-based options with more consumer control; title lending; aftermath of sub-prime lending crisis; workplace health and safety; and voter education, registration, GOTV, problems with electronic voting and lack of a paper trail. TNCA is a grassroots citizen group based in Nashville seeking to build a unified movement for reform in Tennessee. TNCA works to create long-term political change by building diverse coalitions around our major issues. The organization actively works in coalition with a range of health care, environmental, government reform, and labor organizations. For more information, visit: http://www.tnca.org.


Contacts
Tennessee Citizen Action
Shelby White, 615-327-7999

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The below website is very helpful in researching South Carolina nursing home facilities. Family members should gather as much evidence as possible before determining which nursing home to place a loved one.

www.memberofthefamily.net/sc.htm

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