Numerous media outlets have been discussing the ongoing problems with Indiana’s oversight of nursing homes including The Indianapolis Star and The Journal Gazette,   Over the past five years, the Health Department has passed along about 300 inspection reports to the attorney general in accordance with a federal law that says health inspectors must report major problems to licensing officials. At some homes, inspectors found such problems year after year. Complaints against nursing home administrators in Indiana are less likely to reach the Indiana State Board of Health Facility Administrators—that state’s nursing home regulatory body—than in other states.  Most states take a broader approach to complaints against nursing home administrators, and will file complaints based not just on personal responsibility, but on facility wide or systemic issues.

But from those 300 reports, an Indianapolis Star investigation found, the attorney general brought the board a grand total of six complaints.  None since 2009.  The Indiana state attorney general’s office has said it only files complaints with the board if it finds the administrator was personally responsible for the infraction.   In forwarding a complaint to the state board, the attorney general simply calls for a review. It becomes the state board’s responsibility to follow through and determine if action is warranted.

 

The connection between Indiana’s abysmal record for nursing home performance and what appears to be lax oversight can’t be a coincidence. The Centers for Medicare and Medicaid Services reported that in 2007, nearly 90 percent of Indiana nursing homes were cited for violations of federal standards. Thirty-five percent of the facilities – almost twice the national average – were cited for causing actual harm or placing patients in jeopardy.

It wasn’t always like this in Indiana.  Here is the history:

In 2000 alone, Indiana Attorney General Karen Freeman-Wilson reviewed 300 inspection reports of nursing homes and forwarded 92 of them to a state board for review. At least 40 of the reviews resulted in a fine, reprimand or other discipline.

In November of 2000, nursing home owners and trade groups representing them contributed at least $11,000 to her Republican opponent, Steve Carter. He was elected, and the number of reports resulting in complaints fell dramatically. Of 463 reports forwarded by health officials during his two terms, Carter filed only 38 with the Indiana State Board of Health Facility Administrators.

Greg Zoeller, who served as Carter’s chief deputy and succeeded him in 2009, received 40 inspection reports last year. Not a single report resulted in a review by the state.

Numerous incidents over the last few years show an atmosphere of lax oversight. In June 2008, health officials and police investigated a rape at a Marion nursing home and learned that the administrator knew that the resident accused was a sex offender on parole. The administrator did not convey the history and make sure nurses and aides knew that history and developed no plan to protect other residents. When the attorney general’s office received the report from health officials, it could have filed a complaint, triggering a review by the state board. No complaint was filed; no review of the case was made; no disciplinary action has been taken against the administrator.

In another case, health officials forwarded a report on an Indianapolis nursing home where emergency call lights were disabled for 11 days, leaving residents with no way to summon help. Six residents suffered falls in the meantime. No complaint was filed by the attorney general.

At a Muncie nursing home in January 2009, inadequate heating units in 26 rooms left residents shivering in temperatures in the mid-50s. The inspection report found the administrator was aware of the problem. Again, no complaint.

 

 

The New york Times had an article explaining the Obama administration’s plan to overhaul financial regulation by subjecting hedge funds and traders of exotic financial instruments to potentially strict new government supervision. Many of these hedge funds and financial instruments own or have a financial stake in numerous nursing homes around the country.  It states that the government would have the power to peer into the inner workings of companies that currently escape most federal supervision, and specifically cites "private equity firms like the Carlyle Group."   

The Carlyle Group bought out Manor Care a couple of years ago and have created sham L.L.C.s to protect themselves from liability while cutting the budgets of the nursing homes that they own.  In fact, two men who worked in the New York State comptroller’s office were arrested recently after it was discovered they took millions of dollars in kickbacks from private equity and hedge funds.  David Loglisci, who was the top investment officer of the state’s $122 billion pension fund, along with Henry Morris, who fund-raised for former comptroller Alan Hevesi, were nailed in a 123-count indictment, which included charges of money laundering, securities fraud and bribery. It was discovered that over 20 transactions made by the pension fund involved kickbacks, with five of those coming from the renowned private equity fund The Carlyle Group. Morris, who was released after posting a $1 million cash bail, allegedly received $13 million from The Carlyle Group, from investments that totaled $730 million.

The administration would require that all standardized derivatives be traded through a regulated clearinghouse. Traders would be required to provide documentation on their collateral and borrowings. They would also be subject to new eligibility requirements, and their trading and settlement practices would be subject to new standards.

 

Keloland.com had an article about the sexual abuse allegations at an elderly home in Hot Springs, S.D.  Many family members are appropriately concerned. The DCI is finally looking into reports dating back to January at the Castle Manor Nursing home.  Hospital officials say they know of more victims. Board President of Castle Manor Rich Nelson knows of at least three victims and has received several other complaints. The suspect is a male nursing assistant.  Family members of the alleged victims claim Fall River Health Services tried to cover up the abuse.

When sisters Sharon Deboer and Gwendolyn Ketterer needed a long-term care facility for their mother two-and-a-half years ago, they had no doubts about the care at Castle Manor. That changed when the 84-year-old dementia patient started acting out of character late last year when a male nursing assistant began taking care of her.

"I just felt that there was something with him that I just couldn’t put my finger on. I couldn’t put my finger on it but I suspected that type of thing. It was just a feeling," Deboer said.  On January 17, Deboer’s suspicions were confirmed.  "One of the staff called me and told me she had to talk to me, that she had something to tell me. She told me right when we met that this CNA, this male CNA, had been molesting my mom," Deboer said.

That was the only type of notification the sisters received from Castle Manor, despite an abuse report filed with the Department of Health three days earlier. The suspect stayed on as an employee for weeks before Manor officials say he was finally let go. That was part of Fall River Health Service’s efforts to cover up the abuse.

How many others suffered abuse silently while Manor staff looked the other way.

 

The Hour had an article about Connecticut Governor M. Jodi Rell announcement that her administration has given the Legislature’s Public Health Committee testimony in support of her bill to provide greater state oversight over nursing home administration and management including ongoing financial monitoring and expanded quality of care reviews of nursing homes.

An Act Concerning Oversight of Nursing Homes would:

1.  identify areas of the state which either need or have a surplus of nursing home beds;

2. create an oversight committee to focus on financial solvency and quality of care issues;

3.  enhance the public’s access to important nursing home data;

4.  provide for greater oversight by the Department of Social Services when there is an application for a change of ownership;

5.  require expanded financial reporting to DSS;

6.   require that nursing homes submit quarterly reports of accounts payable to DSS — as unpaid bills are a key indicator of financial health; and provide state regulatory agencies with expanded subpoena authority.

"Placing a loved one in a nursing home is often a necessary, but difficult decision and family members deserve the peace of mind of knowing that the finances and the quality of care issues of these facilities are closely monitored," Rell said. "When a nursing home goes out of business due to financial issues, both patients and their families must suffer through the turmoil of a new placement.

"Nursing homes are an important part of the network of care and services for Connecticut residents and quality of care issues are paramount to individuals who have a family member in a nursing facility," the governor said. "We must do everything in our power to ensure a standard of care that instills confidence in the people who are entrusting loved ones to a nursing facility."
 

I wish every State especially South Carolina would pass similar legislation.

Here is a link to the recent GAO Report that shows a lack of investigation into nursing home neglect and abuse.  The NY Times ran a great article on this report.  Below are some excerpts from that article.

Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.   In the report, the investigators from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

The accountability office found that state employees had missed at least one serious deficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectors missed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.   Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare.

Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he had often been frustrated in trying to identify the owners of nursing homes that provided substandard care.  “We have found nursing home residents who were grossly dehydrated or malnourished,” Mr. Morris said. “We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended.”

Here is a link to the list of nursing homes that are failing in providing good care for pressure ulcers and physical restraints.  There are over 50 nursing homes located in South Carolina on this list.  South Carolina can certainly do better.  Pages 81 and 82 list the South Carolina nursing homes on the list.

 

The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don’t make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration’s action.

"People in nursing homes have a right to know how well they’re performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.

I ran across a sad but interesting article discussing the difficulties in choosing the right nursing home for a loved one.

The author was looking for the right place for his wife who suffered from Alzheimer’s Disease. He used the federal database (the Nursing Home Compare Database) that is supposed to help in choosing a nursing home for our loved one. This can be found at: www.medicare.gov/NHCompare.

He visited dozen facilities, making a careful inspection of each, before finally deciding on one that seemed just right.  Afterwards he realized, after reading an editorial in the Boston Globe, that he could easily have made a really bad choice.

The Boston Globe April 27 piece entitled, “Enforce Quality Care for Elders,” the Globe points out that the Department of Health and Human Services (DHHS) is failing in its duty to make sure that nursing homes correct their shortcomings and then continue to meet quality standards. That is the conclusion of an April 23 report Congress mandated from the Government Accountability Office (GAO). Here’s a quote from that report, referring to the Centers for Medicare and Medicaid Services (CMS):

In general, the effectiveness of CMS’s management of nursing home enforcement is hampered by the overall complexity of its immediate sanctions policy, intended to deter repeated noncompliance, and by its fragmented data systems and incomplete national reporting capabilities.”

You’ll find this report at: www.gao.gov/htext/d07241.html.

According to the Globe, the U.S. has more than 16,000 nursing homes, caring on an average day for about 1.5 million patients. Another report that Congress mandated dated Feb. 21, 2002 — more than five years ago — begins: “HHS Nursing Home Compare Website Has Major Flaws.”

This report said: “The report finds that ‘Nursing Home Compare’ has major flaws that can mislead families seeking to find a safe nursing home.”

Here’s what they’re hiding from consumers: the data on ‘Nursing Home Compare’ does not include tens of thousands of recent violations of federal health standards, including nearly 60 percent of the violations involving death or serious injury. 

Tthe Nursing Home Compare Web site is being used by millions of familiest. The Web site receives approximately 100,000 visits a month and is one of the most popular destinations for individuals who view the Medicare homepage. HHS says, “the most important information on this site is the searchable database that allows the public to determine the compliance status of virtually any nursing home in the United States.”

Despite this talk of compliance, the report shows that the HHS Web site in fact excludes information on many documented health violations in these nursing homes. Information is missing because Nursing Home Compare does not include the results of complaint investigations conducted by state inspectors.

You can read the whole thing. Just search on: “Nursing Home Compare Website Has Major Flaws.”