The Post and Courier reported on the six nursing homes in South Carolina identified as consistently poor-performing in a congressional list previously kept secret by a branch of the Department of Health and Human Services.

Riverside Health and Rehab in North Charleston is the only facility in the state given the full SFF designation. The other five South Carolina facilities listed in the report were listed as candidates for the SFF program:

  • Commander Nursing Center, Florence
  • Blue Ridge of Sumter
  • Life Care Center of Hilton Head
  • Compass Post Acute Rehabilitation, Conway
  • PruittHealth — Blythewood, Columbia

The list, current as of April, was released to the Senate Special Committee on Aging at the beginning of June after a bipartisan inquiry from Pennsylvania Sens. Bob Casey, a Democrat, and Pat Toomey, a Republican.

“It is outrageous that we continue to hear stories of abuse and neglect in nursing homes that do not live up to these high standards,” Casey said in a news release. “Choosing a nursing home is a difficult and often painful decision to make. Individuals and families deserve to have all the information available to choose the facility that is right for them.”

Homes that meet safety and health guidelines are typically inspected every nine to 15 months. If a facility is classified as a Special Focus Facility, however, it must be inspected every six months and must graduate from the SFF designation within 18 months or it risks losing the ability to offer Medicare or Medicaid.

The list of SFF-designated facilities has previously been made publicly available. But until now, the Centers for Medicare and Medicaid Services had shielded from the public eye the list of roughly 400 facilities that were considered for the program but didn’t make the cut.

 

McKnights had an article on The Ensign Group.  National nursing home chain The Ensign Group has taken over a skilled care unit in Sonoma Valley Hospital which was originally scheduled to be closed.  The Sonoma Valley Hospital has struggled in recent years to maintain the service, which has lost about $800,000 annually but has now decided to bring The Ensign Group.  Ensign has grown rapidly in recent months and is one of the largest nursing home chains in the country. Its portfolio includes 197 SNFs and 56 standalone senior living facilities. It also owns 26 hospice agencies and 25 home health operators, which it spun off into a second company called Pennant Group earlier this month.

“Under the draft proposal, Ensign would assume operations of the skilled nursing unit on July 1. Sonoma Valley Hospital will receive funds from the operator as part of a revenue-sharing agreement. The medical center will in turn provide certain higher-acuity services to nursing unit patients. This is expected to generate incremental revenues for the hospital while at the same time, SVH will not be held liable for any losses incurred by its partner. The facility will remain under the hospital’s license and oversight.”

The South Carolina Department of Health and Environmental Control is investigating Phaire’s Care assisted living facility in Orangeburg County after receiving a complaint last month.  A woman said her sister lives in the facility and claims she went missing.  The woman said she filed a complaint with DHEC after that incident.

DHEC has found several problems with Phaire’s Care in the past, including medical policy violations. DHEC records from an inspection in January show the department recorded problems like facility staff not administering medication correctly, not keeping patient records on hand and not feeding residents properly.

In February, a man living at Phaire’s care went missing from the center and was found later that day.  Officials from DHEC also announced in February they were taking “enforcement action” against Phaire’s Care following a history of non-compliance.

Despite several attempts via telephone and in-person, officials from Phaire’s Care have not responded to DHEC’s inspection.

THI OF SOUTH CAROLINA AT CHARLESTON, LLC is a nursing home in North Charleston owned and operated by Fundamental Long Term Care Holdings LLC which is now known as Hunt Valley Holdings.  The facility is known as Riverside Health and Rehab.  The facility is awful as most of the facilities in that infamous national for-profit chain tend to be because of the policy to under-staff to increase profits.

Riverside is again facing a wrongful death lawsuit because a resident was neglected and died after the facility failed to take care of her.  An expert affidavit states that based on the medical records of the woman who died, it was documented the woman was at high risk for falls, but the facility’s employees failed to “properly implement fall prevention measures” to keep her safe.

The lawsuit was filed last month and claims a woman was admitted to Riverside Health and Rehab in September 2015.  About a year later, employees at the facility allegedly found her on the floor of her room with a laceration above her right eyebrow.  A couple days later, the resident got a fever and was taken to the hospital and diagnosed with dehydration and severe malnutrition.

A couple days after that, the lawsuit says that woman died as a consequence of the traumatic fall.

Public records from the state’s Department of Health and Environmental Control show this facility has a long history of complaints.

In the last five years, people have filed at least 43 complaints against Riverside. That’s more complaints than any other nursing home in Charleston County.

Roughly 36% of skilled nursing facilities saw a drop in their overall star ratings after planned fixes to the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare system took effect last month. About 16% of providers gained at least one star under the ratings overhaul.  Approximately 47% of skilled nursing facilities had no change in their overall rating, but slightly more lost one or more stars on the quality measure, Martin told SNN.

Roughly 48% of providers lost one or more stars in the quality domain, and that’s largely driving the decrease in overall stars.  A building’s five-star score consists of three separate metrics, each of which CMS also ranks from one to five: survey, quality, and staffing.

Staffing had taken center stage in CMS’s ratings overhaul, particularly after a New York Times investigation last summer revealed that operators may have been less than accurate in reporting nurse coverage information. Federal officials responded by slapping 1,400 facilities with one-star ratings on staffing.

Both the staffing measure and the survey measure are important, with survey having the most weight. Still, practically speaking, providers receive one standard survey a year. And improving staffing will require extra funds coming in from somewhere, as well as the effort of finding competent employees in a major workforce crunch.  Improving a SNF’s quality metrics, however, can begin much more quickly.

SNFs can also take steps to improve how they keep track of patients when they are discharged. Readmission penalties are assessed 30 days after hospital discharge, and so SNFs could be on the hook for any complications that arise after a patient leaves their care.

 

The embattled administrator of Veterans Victory House nursing home resigned.  Sandra Ferguson stepped down and has been replaced with Greg McNeil.  The infractions and fines against Veterans Victory House are in a report by the Centers for Medicare and Medicaid Services.

According to the document, the Veterans Victory House was not in compliance with the Medicare and Medicaid guidelines.  According to regulations, conditions at the nursing home were likely to cause serious injury, harm, impairment or death to a resident or patient.

The report also says Veterans Victory House will not be paid any Medicare or Medicaid claims for newly admitted residents. The federal government is giving the facility until Jun. 14 to comply with the guidelines or face the total loss of Medicare and Medicaid funding.
Veterans Victory House filed 29 reports of adverse incidents at the facility in February alone, according to new data from the Department of Health and Environmental Control.  (Nursing homes are required to file a report when there is a serious injury at the facility although often times many do not get reported).  DHEC sometimes even requires two reports to be submitted for every incident–a 24-hour report and a 5-day report.

The reports for Veterans Victory House list several cases that fall under the category “neglect or exploitation, suspected or confirmed abuse.”

Reports filed by Veterans Victory House staff in February also include two instances with a category that uses terms like “severe burns,” “lacerations,” or “severe injuries that could include medical equipment malfunction or misuse.”

Cohousing is a community where people own their individual homes plus a share of common areas such as outdoor space and a clubhouse with kitchen, living and dining rooms. They typically prepare and share meals several times a week and become more than just neighbors.

They are usually structured as a condominium with a homeowners association, but are self-managed. Owners (called members) collectively make decisions, usually by consensus. Committees oversee the financial, administrative, maintenance and other work normally handled by a management company, although they may hire outsiders for some jobs. Each member is expected, and in some cases required, to pitch in, whether it’s cooking, cleaning or fixing the Wi-Fi.

Senior cohousing is a newer type designed for people who want to avoid the isolation that can happen when families move away and friends die. “There is a natural loss of community as you age. There is no way to replace it with jobs or schools,” said Christian Zimmerman, whose company developed Phoenix Commons, where he also lives.

JoAnna Allen called it “a great antidote to the loneliness that hits a lot of people.” She was familiar with cohousing, but her husband, Ken, was less gung ho. He came around “once he realized he could still have his privacy and independence,” she said.

There are 168 established cohousing communities in the United States including 14 that are senior-focused, said Karin Hoskin, executive director of the Cohousing Association of the U.S.  None have been established in South Carolina yet.

Some of the senior communities have minimum age requirements; others don’t but end up with mostly seniors because they lack the space and amenities most families want. In California, senior housing developments generally can exclude residents younger than 55 if they have at least 35 units and meet other requirements.

When members get sick, other members usually will help with meals or trips to the doctor, but “this is independent living. There is nobody there to take care of you if you really need greater levels of care. We are very clear about that,” said Katie McCamant, owner of CoHousing Solutions, a development and consulting firm.

Owners can sell cohousing units to whomever they want as long as they don’t violate antidiscrimination laws. Buyers must meet age requirements in senior communities that have them.

Cohousing is “a peculiar market,” said Bob Miller, a member of Wolf Creek Lodge. Buyers “are not buying real estate. They are buying into a very special community. It’s not going to work for everybody.”

Prices at his 30-unit community range from $300,000 to $500,000. “For Grass Valley that’s not cheap,” he said. “It’s significant to buy in,” but ongoing expenses are “very economical.” Association fees run about $360 per month.

There’s no solid research on cohousing resale values, but in 2010, Davis appraiser Lee Bartholomew did a limited study looking at new and resale prices at five all-age cohousing communities in Northern California. Initially, they sold for more per square foot than standard condos, but they also have green-building features that add to construction costs and appeal to cohousing buyers. From 2008 through 2010, they appreciated faster than standard condos, he said.

A Centers for Medicare & Medicaid Services (CMS) official in a letter to the journal Health Affairs suggested that the public would benefit from more information about resident safety at nursing homes — including the explicit identification of bad actors.  Writing in response to a November study about the correlation between Nursing Home Compare star ratings and safety, CMS chief medical officer Kate Goodrich laid out a case for strengthening existing data sources for consumers

“While we view patient safety and quality improvement as a continuum, we agree that specifically ‘calling out’ facility performance on patient safety can resonate with and be beneficial to consumers,” Goodrich wrote. “In fact, CMS highlights performance on safety measures as a discrete domain in programs for other types of facilities, including those for hospitals and dialysis facilities.”

“We do believe that NHC contains additional measures that either directly capture harm or are highly correlated with harm that were not evaluated by the authors  — such as the measure for inappropriate use of antipsychotics, which is strongly linked to falls and other adverse events,” she wrote. “Nonetheless, we agree that NHC captures only a subset of harm, and a broader set of harm measures may be beneficial.”

Carolyn Rosenblatt who is an RN, Elder Law Attorney, and author related to healthy aging and protecting our elders at AgingParents.com and AgingInvestor.com wrote the below article for Forbes.

Any family member who has had a loved one go to a rehab facility (aka nursing home) after being in the hospital may have encountered this problem. Anyone with an aging parent who has to stay in one of these facilities for more than a few days is sure to have seen it. Understaffing is the problem. There are not enough aides and of even greater concern, not enough Registered Nurses. Of course this endangers residents who have inadequate supervision.  

The New York Times recently reported on this and the piece was commented upon by a trusted resource advocating for elders, The Long Term Care Community Coalition (LTCC). The article and commentary by LTCC emphasized that many facilities do not comply with the legal requirement that an RN must be on duty eight hours a day seven days a week. Why aren’t there enough staff and what can families do about it?

As for aides, I can personally testify from experience that it is a very tough job, very physically demanding and that the salaries are low compared with other, probably easier jobs. I found it rewarding to work with mainly older people in these homes but not everyone gets satisfaction from doing this kind of work. The turnover rate of aides is generally very high. RNs can often find better paying jobs elsewhere. These facilities then use “licensed practical nurses” or “licensed vocational nurses” (LPNs/LVNs) who are significantly less educated than RNs. Less skill can mean limited ability to correctly diagnose problems and communicate effectively with physicians, other nurses, families and providers. While many LPNs/ LVNs are very good at their jobs, they cannot legally substitute for an RN, whose training is more rigorous and extensive. Adding to the problem is the fact that our aging population is growing, the need for long term care such as is provided in these homes is also growing and the number of available, quality aides is not keeping up with demand.

We can’t always predict when a family member will need to go to such a facility. For example, after a stroke or heart attack, an elder may be briefly hospitalized to address the immediate problem, the next step is to send the elder to a place for longer term rehab services, such as physical, speech and occupational therapy. Medicare will not pay for any patient to remain in an acute care hospital for long when rehabilitation is the next step. If your loved one needs any of these therapies, expect that he or she will be discharged from the hospital, sometimes on short notice, and you will be asked to pick a nursing home for the needed rehab services. Typically a discharge planner, who is a nurse or social worker will simply hand you a list of nearby rehab homes and tell you to let them know which one you want, assuming you have some to choose from.

How do you know which ones are good and which ones are not? Some people use Medicare’s Nursing Home Compare, which rates homes on a 5 star basis–5 being the top and going down from there. My suggestion is that you should never rely totally on Nursing Home Compare. The information they give Medicare is self-reported and is based on comparisons with other nursing homes. If they’re all understaffed the site may be giving you an inaccurate picture of how good that home is. Here are some tips for choosing a nursing home for a loved one. It will take work but without that, your loved one can be put into a dangerous situation.

  1. If you have a list of homes, go visit a few before you send your mom or dad there, particularly if you can do so on the weekend. Staffing on weekends is notoriously low. You’ll get the picture if you see no aides around.
  2. Use this site to learn the staffing requirements for nursing homes in your elder’s area  www.nursinghome411.org.  You want to find a place that follows legal requirements.
  3. Check out a website devoted to consumer’s interests in long term care https://www.caregiver.org/national-consumer-voice-quality-long-term-care-formerly-nccnhr-0. You will find there an overview of each state’s nursing home system and licensing agencies, and a consumer’s guide to choosing a nursing home.
  4. Finally, in my book The Family Guide to Aging Parents, I discuss the issues of nursing homes in greater depth including Medicare/Medicaid citations against homes and what that means, fall prevention, skin care, contracts and how to be an advocate for your loved one in a nursing home.

There are hidden dangers in these homes and every family should be aware of them. If we want to ensure our aging parents’ safety, being aware, visiting or calling often and watching over what happens there can help our vulnerable elders as much as possible. Personal contact from family can make all the difference.

 

The Anderson Independent Mail reported on the sad state of care at South Carolina’s Veteran Homes. The article discusses the issues at Veterans’ Victory House,  a nursing home in Walterboro whose sign says it is the “home of the greatest generations.”   It is operated by HMR Veterans Services, Inc. HMR receives nearly $36.5 million annually from the state to operate Victory House and the Richard M. Campbell Veterans Nursing Home in Anderson County, two veterans’ nursing homes that belong to the South Carolina Department of Mental Health. The company also manages seven other homes for veterans in Texas, Alabama and Maryland.

There have been some troubling incidents at the company’s facilities.  In May, a judge approved a $425,000 settlement involving the choking related death of an Air Force veteran at the Anderson home. According to a lawsuit, a latex glove was found lodged in his airway on Christmas Eve 2015. He died five days later.

According to another pending suit, a combat veteran of the Korean War died of injuries suffered when his roommate beat him with a shoe at an HMR-managed veterans’ home in Alabama. The veteran, William Bankston, lived at the Floyd E. “Tut” Fann State Veterans Home in Huntsville almost two years before he was attacked.  Court records show that in the past four years, settlements totaling $900,000 have been reached in three other cases involving the deaths of residents at Victory House.  The largest lawsuit settlement, $525,000, came in August 2014. It involved allegations that William P. Chrisanthis fell 18 times at Victory House between Nov. 18, 2008, and July 4, 2010, when he suffered a fractured left hip. He died two weeks later.

The veterans’ nursing home HMR manages in Maryland was fined $360,875 on Dec. 2, 2016. Federal records show the fine was imposed after a resident choked to death on a peanut butter sandwich. The facility also was faulted for its care of another resident’s bed sores and for allowing dehydration to contribute to a third resident’s loss of 16 pounds in 11 days.

 The frequency of liability claims for abuse and neglect against nursing homes and the costs associated with those claims are rising nationally. According to a biased report last year commissioned by the industry lobbyist American Health Care Association, the frequency of nursing home claims increased 54 percent from 2007 to 2017. The annual costs to providers from those claims nearly doubled during the same period, going from $1,170 per occupied nursing home bed in 2007 to $2,300 in 2017.
Staffing levels at Victory House and Campbell show that the amount of time licensed nurses at both homes spend with the residents each day is below state and national averages.