The Des Moines Register continues their excellent reporting of the problems at Iowa’s nursing homes.  Five Iowa nursing homes have each been fined more than $8,000 because of allegations of resident neglect that resulted in two deaths, a leg amputation and other injuries.

The Good Samaritan Home in Indianola was fined a total of $24,500 for a series of problems involving different residents, including one who allegedly lost a leg to gangrene. The staff noticed the resident had a blister on his or her left foot on Christmas Day last year. Over the next four weeks, staff members documented the resident’s complaints of severe pain as the wound grew in size, turned black, then emitted a foul odor. On Jan. 23, the resident begged for help, telling the staff, “I want to go to the hospital. I can’t take the pain anymore.” The resident was admitted to the hospital with a diagnosis of gangrene and bone infection, which resulted in the left leg being amputated above the knee.  Good Samaritan was fined $10,000 for failing to adequately care for the resident.

The home was fined an additional $9,500 for failing to monitor a resident who sustained a bleeding head wound and a hip fracture after falling out of a mechanical lift.  After the resident fell, the staff went to dinner or were summoned to work in the dining room. When the resident’s daughter arrived, the resident was alone, on the floor with no blanket and was bleeding from the head wound.  The daughter remained by her side for the next 35 minutes until an ambulance  arrived. No workers checked on the resident or provided any services.

Good Samaritan was fined an additional $5,000 for failing to prevent a serious injury. A resident of the home had fallen out of a recliner four times over a period of several weeks. The last fall resulted in a broken clavicle.

Several other Iowa care facilities have recently been fined for problems related to resident care. Among the cases:

The Keystone Nursing Care Center was fined $15,000 when a resident died six days after a series of falls there.  The facility allowed the resident to fall in March, April and May. On July 12, the resident was found on the floor and taken to a local emergency room. Doctors diagnosed the resident with a skull fracture and brain bleed. The resident died on July 18, and the home was cited for failing to provide adequate supervision of residents.

Altoona Nursing and Rehabilitation Center was fined $8,000 after state inspectors reviewed 19 patient files and found that in 16 cases the home hadn’t taken adequate measures to prevent falls. In a four-month period, the home documented 133 falls.  In one case, a resident was found on the floor crying out in pain, then taken to the hospital and treated for a broken leg. The resident died 10 days later.

The home’s dementia unit reportedly had only one nurse aide to care for 17 residents during an eight-hour shift, although several of the residents were incontinent, needed feeding assistance or required the help of at least two workers to get to the bathroom. Some of the alarms used to alert the staff to wandering residents weren’t working properly, the state alleged.

“I have told them about the alarms being broken,” one worker reportedly told inspectors. “It gets scary back here when you’re trying to care for two to three residents at once and alarms are going off. You can’t even call for help because you are so busy.”

Ogden Manor was fined $8,000 after staffers allegedly tried to prevent a resident’s dentist from calling 911 to summon emergency medical personnel.  The resident arrived at a dentist’s office by bus and was helped inside by the driver. The dentist’s staff called Ogden Manor to report that the resident was crying, seemed to be in pain and was asking to be taken to the hospital. The Ogden Manor staff allegedly told the dentist’s staff not to call 911, adding that the resident had been like that for days and was fine. When the resident was finally admitted to a hospital, he was diagnosed with gastrointestinal bleeding, severe anemia, dehydration and a dental infection. 

The Akron Care Center was fined $10,500 for allegedly failing to provide residents with a safe environment, and $2,000 for allegedly failing to provide residents with the required nursing services. One resident was hospitalized with a head injury after a fall, and another was hospitalized with bowel problems the staff had allegedly failed to assess.

 

The Miami Herald reported on the closing of Harmony Heartland and Rehabilitation in Sarasota by federal regulators for a pattern of neglect and abuse.  One patient on a ventilator was given a cookie and choked to death.  Of course, the facility went bankrupt instead of fixing the problems.

 

Des Moines Register had an article explaining Iowa’s bait and switch with the American taxpayer.  Six months ago Iowa desperately begged for additional federal money to rehire 10 nursing home inspectors.  Those inspectors were fired because of a lack of money.  After recieving the taxpayer money, Iowa now says those inspectors aren’t needed and won’t be rehired.

The Iowa Department of Inspections and Appeals says the $650,000 it was given to restore the inspectors’ jobs will instead be used for other purposes.  Sen. Pam Jochum, a Dubuque Democrat, said lawmakers made it clear to the department that they wanted the inspectors’ jobs restored once the money was provided.

"This is an outrage," said John Tapscott, a former state lawmaker who now advocates for nursing home residents. "This just goes to show you that it’s the nursing home industry that is running our state inspections department."

Governor Terry Branstad appointed Rod Roberts, a minister with no prior management experience or background in regulation, to head the inspections department. Three months later, Roberts scrapped plans to add the 10 inspectors, then eliminated the jobs of two prosecutors who handle allegations of abuse in care facilities.

Roberts and Branstad said then that the cuts were necessary because of projected budget shortfalls. Roberts told lawmakers that without the additional staff, the average time between nursing home inspections was likely to increase and that there would be delays in investigating complaints of poor resident care.

The Des Moines Register reported earlier this year that the department now inspects stronger hospice facilities on a schedule of once every 20 years. The agency exercises no oversight of privately run home health agencies; is unable to impose fines of any size on hospitals or hospital-owned nursing homes; is years behind in the inspection of dialysis treatment centers; and doesn’t require licensing or government inspection of outpatient surgical centers.

 

Press of Atlantic City wrote an article discussing the dismal record of New Jersey nursing homes. Seven New Jersey nursing homes received the lowest quality ratings from the federal government last year based partly on state inspections in 2009 and 2010. Inspection reports show that residents in the worst-rated homes live in dirty conditions, endure verbal and physical abuse, and are neglected.

Hundreds of violations of rules that govern quality of care, safety and sanitation were found by inspectors during the past two years at the 60 nursing homes in Atlantic, Cape May, Cumberland and Ocean counties. The reports are used by the U.S. Department of Health and Human Services to develop consumer ratings of one to five stars for nursing homes. The majority of area facilities – 65 percent – are rated three stars or lower, federal data show, and half are in the bottom two levels.

A review of more than 1,800 pages of New Jersey Department of Health and Senior Services inspection reports from 2009 through April 2011 for 10 nursing homes showed that residents are routinely found living in dirty conditions, endure verbal and physical abuse, and are subject to neglect. Other violations include staff giving out the wrong medications, residents being strapped into wheelchairs and ignored for hours, theft, untreated infections, falls resulting from fragile residents being left unattended, and fire- and building-code violations.

State reports provide details of problems found during inspections. Some residents live in fear of reprisal if they complain about conditions.

A recurring theme was a failure to investigate or report incidents of abuse. Another recurring problem was failure to properly administer medication.  The medication error rate is not supposed to exceed 5 percent. A November inspection found an 18 percent error rate at South Jersey Extended Care. Our Lady’s Residence had a 14 percent error rate. Lincoln Specialty Care was at 9 percent, and Arcadia was at 8 percent. In one case at South Jersey Extended Care, a resident was supposed to get morphine every three hours for rectal pain, but went days without it because there was none.

A nurse and an aide allegedly told a resident who wanted help getting out of bed frequently overnight that she could not get up before 4 a.m. The inspection report states the staffers threatened to take away her wheelchair, withheld snacks and threatened to keep her in bed longer if she complained. The report states the resident shook in fear in the presence of the nurse and aide.

There are 367 nursing homes in New Jersey charging an average of $250 per patient per day, said Paul Langevin of the Health Care Association of New Jersey, a trade group of 185 homes.  Most homes are for-profit businesses run by companies that have multiple facilities. Costs of more than $90,000 per patient per year are often paid through Medicare and Medicaid, so tax dollars pay much of the bill.

KAALtv reported serious problems with the quality of care at St. Mark’s Lutheran Home in Austin.  Many family members have complained.  The family council –which is made up primarily of family members of residents in the nursing home–are saying quality of care has been a battle with the facility for far too long.

"We’ve continually come to the board and the management, and it seems quite often to us some of the same problems keep reoccuring," says President of the Family Council Dick Heuton.

"St. Marks basically is considered a low performing below average facility," says Jean Mueller, regional ombudsman for the state.

According to Medicare’s website, St. Mark’s Lutheran Home was inspected in April and had 11 deficiencies. Inspectors found they failed in areas of quality care and nutrition.  Inspectors found evidence they failed to prevent or promote the healing of bed pressure sores and they failed to ensure the unpasterized eggs, served to residents, were cooked properly. Another major deficiency is staffing or lack their of, "we have some really good nurses and aids and support staff here, but they just don’t have enough of them," say Huebner.

"A lot of time after the state inspectors have been here, what’s happened is they get a little better for a little time then they just fall right back off, then we’re in the same boat we were in before, " says Huebner.

 

 

 

The Chicago Tribune and KWQC had articles on the investigation into alleged tip offs to facilities before inspections.  State authorities are investigating whether a city Department of Family and Support Services official tipped off a Chicago nursing home to a surprise inspection led by the state attorney general’s office that was designed to protect vulnerable residents at the facility.  Officials and advocates for the elderly and disabled call unannounced inspections the backbone of safety enforcement, but the alleged security breach added to long-held suspicions that some nursing homes have been given advance warning of state inspections.

When a team of law enforcement officials arrived at the Grasmere Place nursing home in Uptown for the surprise "Operation Guardian" sweep on July 22, facility administrator Celeste Jensen was waiting for them in the lobby. "What took you so long?" Jensen asked.  Under questioning by authorities with the state attorney general’s office, Jensen said she had been warned of the impending sweep by a city official whose job was to safeguard elderly and disabled people in nursing homes.

Officials expressed outrage at the alleged leaking of the sweep. Grasmere was fully staffed and bustling with painters and carpenters, said the attorney general’s deputy chief of staff, Cara Smith, and state long-term care ombudsman Sally Petrone, who both took part in the raid.

 

When officials returned to Grasmere for an unannounced follow-up sweep on the night of Aug. 16, there was less staff and the facility was in less pristine condition, according to Smith. "What we experienced was literally night and day," she said.

One industry executive recently alleged to public health officials and the attorney general that a health department supervisor was providing advance copies of a monthly "master schedule" of inspections to a Chicago-area nursing home executive in return for cash, sports tickets and other gratuities.

The attorney general began sweeping nursing homes in December in response to Tribune reports about residents being assaulted, raped and even murdered by other residents in facilities that house high numbers of felons and sex offenders. The 17 raids have led to 20 arrests of offenders with outstanding arrest warrants, Smith said.

Despite the alleged tipoff of the July 22 sweep, Petrone said authorities still found problems at Grasmere. Going room to room visiting residents, Petrone’s ombudsmen staff found "a lot of them seemed overmedicated," she said.

Authorities are now more closely guarding the schedule of the sweeps and are limiting the number of agencies involved, Smith said. "We have tightened the information loop," she said.
 

Lexington Herald Leader reported the guilty pleas of Moses Young, assistant director with the Office of Inspector General, and Sharon Harris, a state-employed nurse who covered up the inappropriate relationship and unethical behavior they had with at least one nursing home operator.  Kentucky investigators learned they each lived in Lexington homes owned by Ralph Stacey Jr.  At the time, Stacey owned Garrard Convalescent Home in Covington.

An April 1 indictment against Young alleged that Young lived rent-free from July 2005 to March 2008 in a condominium owned by a third party in violation of state ethics rules, identified in documents only as "R.S."  A plea agreement said Young admitted that he and others made bogus rent receipts and presented them to a federal grand jury. sIn exchange, the indictment alleged, Young provided R.S. with inside agency information and instructions that would assist R.S. in passing inspections and obtaining favorable treatment with regard to administrative actions of the Cabinet for Health and Family Services. In exchange for the guilty plea, prosecutors said they would drop the charge related to Young allegedly providing inside information.

In her plea agreement, Harris admitted that she had "watched as others fabricated the receipts to thwart a criminal investigation." Her plea agreement said she told an FBI agent in April 2009 that she knew the rent receipts Young provided were genuine because she had personally delivered the receipts over time to the landlord.

Why didn’t they arrest Ralph Stacey for bribery or something?

 Maybe this article from the Kentucky Lexington Herald Leader explains why. The Herald-Leader examined the industry’s campaign donations following stories earlier this summer that revealed systemic gaps in the state’s handling of abuse and neglect cases at nursing homes.  The nursing home industry gave at least $1.8 million to Kentucky politicians over the last decade while lobbying against bills that would require them to hire more direct-care employees, face higher fines for violations and abide by stronger precautions against elder abuse, among others.

Nursing home reform bills usually are assigned to the House Health and Welfare Committee, where they perish.  Committee chairman Tom Burch is invested in a real estate trust that includes nursing homes. Burch’s former House aide, Eric Clark, now is chief lobbyist for the Kentucky Association of Health Care Facilities, the group representing for-profit nursing homes, and runs its political action committee, which has given at least $90,750 in campaign donations since 2005.  U.S. Senate Republican Leader Mitch McConnell gets more of the industry’s money than any other Kentucky politician, at least $266,350 over the last decade. McConnell does not support nursing home reform.

The Kentucky Association of Health Care Facilities gives annual awards to nursing homes that raise the most money for its political action committee, with special emphasis on companies that use payroll deduction to collect the money from employees.

In 2008, for instance, Barren County Health Center in Glasgow won an award from KAHCF for "most contributions raised overall per bed" for its region. That same year, the same nursing home received a Type A citation — the most serious — from the state after a resident choked to death on a fried chicken dinner.

Overall, KAHCF honored four nursing homes and consultants Wells Health Systems that year for their political fund-raising, according to the group’s 2009-10 Membership Directory and Buyer’s Guide.

The majority of the industry’s campaign money goes to Kentucky’s congressional delegation. The industry’s national group, the American Health Care Association, reports spending more than $1.1 million so far this year lobbying Congress on Medicaid payments and rules that would require public disclosure of the size of nursing homes’ direct-care staffs and how much they are paid, among other items.

Also, the Herald-Leader in July reported that Type A citations issued against nursing homes by the state sometimes sit in Conway’s office or with local prosecutors for more than 18 months while officials decide whether to pursue criminal charges.

 

U.S. News & World Report issues the best and worst nursing homes every year based on federal and state inspections, surveys, and required data on staffing.  Here is the most recent article.  The rankings are only as good as the investigators which in most cases is poor.  On a given day, 1.5 million people are living in the nation’s 16,000-plus nursing homes, and in a typical year more than 3.2 million Americans will spend at least some time in one. 

 

The U.S. News rankings rely on Nursing Home Compare, a program run by the federal Centers for Medicare and Medicaid Services. CMS analyzes information on all homes enrolled in Medicare or Medicaid.  The homes also receive ratings of one to five stars in each of three areas: health inspections, nurse staffing, and measures of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code. But you can’t assume that all five-star homes, or those with three or four stars, are of the same quality. There are so many homes in each rating—1,855 in the five-star and 3,661 in the four-star categories alone—that the range of performance is bound to be very wide. Nor can search terms be combined if, say, you want only five-star homes within 50 miles of a specific city.

America’s Best Nursing Homes addresses these and other issues. Homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on.

Here are more details about the measures that go into the CMS ratings.

Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined, as is evident in the 180-some items on the checklist. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents’ rights and quality of life, and proper skin care. A home’s rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings do not factor into the CMS ratings.

Nurse staffing. Even the best nursing care is not enough if there are too few nurses to spend much time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. 

Quality measures. Nursing homes have to furnish the latest three quarters of clinical data showing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. The Best Nursing Homes rankings and Nursing Home Compare display data for each home on all 19. The ratings, however, are based on 10 that are considered the most valid and reliable, such as the two above and measures related to pain, bedsores, and mobility.

 

Pittsburg Tribune Review had an article discussing the failures of Pittsburgh’s nursing homes.   The article mentions several examples such as one resident cried out for water before going to the hospital with dehydration; another broke an eye socket when a wheelchair rolled down a ramp and crashed; a patient died when workers improperly adjusted a breathing tube; two were so malnourished that they weighed less than 80 pounds each;  a resident did not get a hair wash for nearly four weeks;  and another was told to "go in your pants" when requesting help with going to the bathroom.   These are common complaints at all nursing homes around the country due to understaffing, burn-out, and lack of training.

Those cases and more were drawn from a Tribune-Review analysis of state surveys conducted at 118 nursing homes in Western Pennsylvania over the past three years.  Inspectors cited homes for 3,798 deficiencies, and in 33 cases, found serious lapses posing "actual harm" or "immediate jeopardy," under federal definition.  Among the deficiencies, inspectors noted hundreds of incidents that caused pain or discomfort for nursing-home residents. Those violations have the "potential for more than minimal harm." They include failures to treat skin ulcers or to help patients eat when they can’t feed themselves.  Most often, problems related to quality of care or unsanitary conditions.

Rosalie Kane, a professor of public health at the University of Minnesota, said that the quality of life for nursing-home residents has not improved — even if surveys don’t find as many alarming violations.  "Those surveys don’t make nursing homes better over time," Kane said. "They just represent the lowest common denominator keyed to issues that are considered unacceptable."

The Trib’s review followed the November arrests of five employees at Kane Regional Center in Glen Hazel, who were charged with abusing and tormenting a 94-year-old Alzheimer’s patient. More than 2,800 complaints of abuse or neglect of nursing home patients are substantiated each year, according to the inspector general for the Department of Health and Human Services.

Nursing homes do not spend enough money on staffing required to ensure adequate care.  Nursing home staff members decide whether residents’ preferences are met. Too much of nursing home operations revolve around what’s convenient for staff, not patients.

Nursing home staff and inspectors should ask residents whether they participate in meaningful activities, whether they have opportunity to have private conversations, and what they like or don’t like about the food.

Under federal law, state health inspectors must survey nursing homes at least once every 15 months and whenever they receive a complaint. Often, homes are cited for a serious deficiency only after a patient is seriously harmed.