Articles Posted in Neglect

New York lawmakers plan to strengthen oversight of the state’s nursing home industry with a package of two bills introduced in Albany this month. According to Sen. Robert Ortt, an upstate Republican, the first bill would forbid the New York Department of Health from approving nursing home owners with a record of providing poor care. The second bill would require 40 percent of all inspections conducted by the Department of Health to be conducted outside regular business hours. Sen. Ortt also plans to introduce a third bill later this year which would strengthen the Department of Health’s oversight power and require an independent third party to monitor all failing nursing homes in the state. According to the lawmaker, the third bill still needs an additional sponsor before it can be introduced in Albany.

In an informative interview with Skilled Nursing News, Sen. Ortt expounds on the three bills and the problems facing the New York’s nursing home industry. According to the state senator, New York’s nursing home industry lacks accountability and New York’s vulnerable senior citizens are not receiving the quality of care they deserve. For example, when a nursing home fails a state inspection then the facility’s owners and the Department of Health create a “corrective action plan” outlining corrective actions for each violation. However, the state agency does not monitor whether the facility implements the plan. The Department of Health only finds out if the nursing home corrected their violations at the next inspection.

The new legislation also confronts the increasing number of nursing homes owned by large corporations and operating for profit. Under the second bill introduced in Albany, a nursing home owner with “significant compliance issues” in any of their existing facilities would not be allowed to purchase or assume ownership of any nursing home in New York. According to Sen. Ortt, this bill will prevent the current problem of “prospective [owners] coming here to buy a bunch of nursing homes for the sole sake of making as much money as they can while putting little money into these facilities and providing substandard care.” The bill will also increase fines on nursing homes so nursing homes do not simply ignore regulations when the cost of compliance is higher than the regulatory fine.

A new edition of the Long Term Care Community Coalition Elder Justice Newsletter asks a simple question: does providing a nursing home resident breakfast in their soiled bed constitute harm? How about failing to provide a stop date for a resident’s psychotropic medication?

“No Harm” deficiencies refer to citations of rule violations at nursing homes in which health inspectors determined that the violations caused “no harm” to residents. As the LTCCC notes, data provided by the Centers for Medicare & Medicaid Service, which mandate minimum standards of care for nursing homes participating in their programs, show that more than 95% of nursing home health citations describe “no harm” deficiencies. The LTCCC argues, however, that these no harm citations reflect systemic failures to recognize the suffering of nursing home residents, which in turn results in systemic failures to hold nursing homes accountable through financial penalties. “In the absence of a financial penalty,” the newsletter states, “nursing homes may have little incentive to correct the underlying causes of resident abuse, neglect, and other forms of harm.”

The newsletter proceeds to provide instances of health violations in which regulators determined that no harm was done to the resident in question. For example:

New York Senator Kirsten Gillibrand proposed a new federal law aimed at improving staff levels at nursing homes across the country. According to Sen. Gillibrand, the impetus for the new legislation on nursing homes comes from a bipartisan report released this summer, which detailed widespread problems at nursing homes across the state and country. Speaking to reporters, the New York Senator said, “Unfortunately, a report came out on nursing homes and long-term care facilities that have had problems, and 17 are located in New York State.” 

Sen. Gillibrand is referring to the 488 nursing home facilities across the country which the report found a “persistent record of poor care.” Currently, the federal government only applies extra scrutiny on 88 so-called “special focus facilities” across the country. This leaves 400 nursing homes with records of abuse and neglect without sufficient oversight.

According to Sen. Gillibrand, insufficient and incompetent staffing is one of the root causes of the poor performance and conditions at these nursing homes. The bill she proposed in the Senate last month aims to fix that problem. The bill, which has bipartisan backing and is sponsored by Colorado Republican Cory Gardner, would expand access to Medicare and Medicaid data to “nursing homes, home health agencies, and hospice programs,” reports The Buffalo News. The bill, called Promote Responsible Oversight and Targeted Employee Background Check Transparency for Seniors (PROTECTS) Act, would improve the standard of living at nursing homes by “bringing more transparency to workforce quality,” says Sen. Gillibrand. 

In 2018, one-third of all nursing homes in the country received a citation for violating federal standards on safely storing, preparing, and serving food to their residents. This makes food safety the third most common violation at nursing homes in the United States. The safety violations are not minor infractions, either. The Centers for Disease Control and Prevention (CDC) reported 230 foodborne illness outbreaks at nursing homes between 1998 and 2017. These outbreaks resulted in 532 hospitalizations and 52 deaths, reports NBC News. Further, the news agency says this number is almost certainly undercounted since the federal agency relies on voluntary reporting by nursing homes – facilities who do not have a track record of following even mandatory reporting requirements for heinous crimes such as sexual abuse or theft.

Similar to stories of nursing home abuse, horror stories about foodborne illnesses abound. In California, one woman described moving her 98-year-old mother out of a nursing home after finding cockroaches in the kitchen. In Arkansas, one facility was cited six times over the course of two years – including one health inspection detailing “grimy kitchen appliances” and “staff with unwashed hands,” according to NBC News. Such occurrences are not uncommon, according to the news report many nursing homes with the worst problems are usually repeating offenders. 

According to NBC News, food safety is especially imperiled for nursing homes owned by for-profit chains. For example, nursing homes owned by Genesis Healthcare, one of the largest nursing home corporations in the country, were 11 percent more likely to receive a citation for food safety violations in the last year. Speaking to NBC News, a representative for the nursing home chain said, “We are aware of some regulatory compliance issues and are working diligently to resolve any problems as quickly as possible.”

Riverdale Nursing Home received 37 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 21, 2019. Those citations number five more than the statewide average of 32. The Bronx nursing home’s citations resulted from a total of four inspections by state authorities. The violations they describe include the following:

1. The nursing home did not ensure it provided an accident-free environment. Section 483.25 of the Federal Code stipulates that nursing homes must provide residents an environment as free as possible from accident hazards, and with adequate supervision and assistive devices to prevent accidents. According to a December 2015 inspection, the facility failed to provide adequate supervision when a resident exited the premises “unnoticed by staff.” The male resident left Riverdale Nursing Home “around 4:36 AM,” according to the citation, and “was not identified as missing until 2:23 PM, nearly 10 hours later.” A surveillance video showed the resident exiting through a door to a patio area, wheeling a barbecue grill to a 6-foot fence, putting a chair next to the grill, and trying three times to climb from the chair to the grill and over the fence; he fell on the first two attempts, then made it over the fence on the third. A report found that the security guard on duty had “failed to lock the patio door” and to monitor security footage.

2. The nursing home did not maintain an effective pest control program. Section 483.70 of the Federal Code requires that nursing homes “maintain an effective pest control program so that the facility is free of pests.” A September 2016 citation describes an inspector’s observation that “numerous live roaches were… crawling on walls and floor” of a second floor closet. The citation notes that the closet is across from several resident rooms and adjacent to a common area. The closet itself was used for the storage of “cleaning supplies such as broom and detergents.” An inspector noted live roaches crawling in the closet, as well as dead roaches on the floor. The citation states that this deficiency had the “potential to cause more than minimal harm.”

Brooklyn Gardens Nursing & Rehabilitation Center received 39 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 22, 2019. It also received a Department of Health fine of $11,000, in April 2011, over alleged violations of sections of the health code relating to the pressure sores and nutrition. The Brooklyn nursing home’s citations resulted from a total of six inspections by state surveyors. The deficiencies they describe include the following:

1. The facility did not provide adequate supervision to prevent elopement. Section 483.25 of the Federal Code stipulates that nursing home facilities must provide adequate supervision and assistive devices to prevent residents from sustaining accidents. A December 2016 citation found that Brooklyn Gardens failed to provide adequate supervision in an instance where a resident who had been placed on hourly monitoring “was able to walk out of the facility’s front gate undetected by staff.” The citation states that the resident exited through the facility’s front gate at 5:17PM on the evening in question, but a Registered Nurse Supervisor was not made aware of such until 9PM, at which point a missing resident alert was activated. The resident was returned to the facility by local police at about 12:57AM “with injuries of unknown origin.”

2. The nursing home did not take adequate infection prevention and control measures. Section 483.80 of the Federal Code states in part that nursing homes must “establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment.” An October 2018 citation described the facility’s failure to maintain infection control practices and procedures in two instances. In one, an inspector observed a resident’s oxygen tubing touching the floor, in contravention of protocol. In a second instance, an inspector observed a Licensed Practical Nurse neglecting to clean a glucometer after using it, also in contravention of protocol. The citation states that these deficiencies had “potential to cause more than minimal harm.”

Boro Park Center for Rehabilitation and Healthcare received 31 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 7, 2019. The facility was also the subject of a 2018 fine of $10,000 in connection to “multiple deficiencies” described in a December 2017 survey. The Brooklyn nursing home’s citations resulted from a total of five inspections by state authorities. The violations they describe include the following:

1. The nursing home did not provide adequate care and services to sustain the resident’s highest practicable well-being. Section 483.24 of the Federal Code requires that nursing homes provide each resident with “the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident’s comprehensive assessment and plan of care.” A December 2017 citation found that the nursing home failed to provide services in accordance with professional quality standards. An inspector specifically found that a resident had received numerous physician orders that “were not carried out,” such as orders directing blood tests, urine tests, and outpatient surgery. The citation notes that a facility Medical Doctor twice examined the resident but “did not document resident status or MD recommendations” on the resident’s record. The citation states that these failures resulted in the potential delay of care for a leak in the resident’s feeding tube. The survey referenced in this citation was the survey resulting in the 2018 fine of $10,0000 against Boro Park Center for Rehabilitation and Healthcare.

2. The nursing home did not protect residents from accident hazards. Under Section 483.25 of the Federal Code, nursing home facilities must maintain an environment as free as possible from accident hazards, and provide adequate supervision and assistive devices to prevent residents from experiencing accidents. A July 2019 citation found that the resident failed to provide adequate supervision to residents. An inspector specifically found that the nursing home failed to adequately monitor a resident who left the premises “undetected by staff.” According to the citation, the resident was discovered missing at 10:30 PM on the evening in question, and was later returned from the home of one of his emergency contacts. As a result of the incident, the Certified Nursing Assistant who reported him missing was suspended, and the resident was placed on wander guard and re-assessed as at high risk of elopement.

Franklin Center for Rehabilitation and Nursing received 26 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 12, 2019. The Flushing nursing home’s citations resulted from a total of three inspections by state authorities. The deficiencies they describe include the following:

1. The facility did not adequately implement measures to prevent and heal pressure ulcers. Section 483.25 of the Federal Code states that nursing homes must prevent residents with “care, consistent with professional standards of practice, to prevent pressure ulcers.” A November 2017 citation found that Franklin Center for Rehabilitation and Nursing did not ensure the provision of professional standards of care to a resident suffering from a Stage 4 pressure ulcer. The citation states specifically that a nurse applied to the wound “a dressing appliance that was too small,” and employed an “improper technique” to dry the resident’s pressure wound. According to the citation, the nurse applied gauze that only partially covered the wound, leaving its border as well as some “excoriated redness” exposed. The citation states that this deficiency had the “potential to cause more than minimal harm.”

2. The nursing home did not adequately protect residents from abuse and neglect. Section 483.12 of the Federal Code ensures nursing home residents “the right to be free from abuse, neglect, misappropriation of resident property, and exploitation.” A July 2019 found that the nursing home did not protect this right in an instance in which residents sustained an injury during a “resident-to-resident altercation.” According to the citation, the altercation specifically resulted in one resident experienced “a laceration to her right leg that required sutures,” and another “was punched in the head by another resident and suffered a headache and poor vision.” The facility undertook a plan of correction relating to this incident that included the education of licensed nurses on the facility’s Resident to Resident Abuse policy, as well as the adoption of a Behavior Monitoring policy.

Meadow Park Rehabilitation and Health Care Center received 27 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 12, 2019. The facility was also the subject of a 2017 fine of $4,000 in connection to findings it did not provide residents with an environment free of accident hazards. The Flushing nursing home’s citations resulted from a total of five inspections by state authorities. The violations they describe include the following:

1. The nursing home facility did not implement adequate measures to prevent residents from sustaining accidents. Under Section 483.25 of the Federal Code, nursing homes must ensure residents have an environment “as free of accident hazards as is possible.” An October 2016 citation states that the nursing home failed to protect all 135 of its residents from the risk of experiencing “burns and scalding” resulting from “excessive hot water temperatures from the facility’s domestic hot water system.” An inspector found specifically that the water in 17 resident rooms were “extremely hot,” and in fact “so hot that the surveyors had to remove their hands.” A reading found that the hot water temperatures in resident bathrooms and shower units ranged from 127 degrees Fahrenheit to 137 degrees Fahrenheit, whereas the “acceptable temperature range” was 90 degrees to 120 degrees. This deficiency, which was connected to the 2017 fine of $4,000, was found to have resulted in “Immediate jeopardy to resident health or safety.”

2. The nursing home did not keep residents free from abuse and neglect. Section 483.12 of the Federal Code requires nursing homes to protect their residents’ right to freedom from “abuse, neglect, misappropriation of resident property, and exploitation.” A March 2018 citation found that the nursing home failed to comply with this sanction in an instance in which a Certified Nursing Assistant “willfully neglected to provide care and services” to a resident who was “incontinent of bowel and used incontinence briefs.” The citation specifically states that when the resident’s family requested on three instances that the Assistant “change the resident’s soiled incontinence brief,” the Assistant willfully declined to do so, resulting in “the resident sitting in a soiled diaper” for more than two hours.

Waterview Nursing Care Center received 22 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on December 12, 2019. The facility was also the subject of a 2010 fine of $4,000 in connection to findings it failed to comply with health code provision concerning accidents and administrative practices. The Flushing nursing home’s citations resulted from a total of four inspections by state authorities. The violations they describe include the following:

1. The nursing home did not employ adequate measures to protect residents from abuse. Under Section 483.12 of the Federal Code, nursing home residents have the right to be free from abuse and neglect. A May 2019 citation found that Waterview Nursing Care Center failed to prevent residents from abuse in an instance in which one resident hit another resident with his wheelchair’s footrest. According to the citation, the resident who was hit “suffered a laceration and bleeding to his head,” and was subsequently transferred to a local hospital for care. The resident received four staples on his head before returning to the facility. A plan of correction undertaken by the facility included the transfer of the aggressor to another unit and his placement on regular visual checks.

2. The nursing home did not ensure its residents’ drug regimens were free from unnecessary medications. Under Section 483.45 of the Federal Code, nursing homes must maintain “each resident’s drug regimen… free from unnecessary drugs.” According to a November 2016 citation, Waterview Nursing Care Center did not ensure one resident’s drug regimen was free of unnecessary medications. An inspector specifically found that the resident was administered an antipsychotic medication even tough the facility did not have “documented evidence of non- pharmacological interventions being attempted prior to [the medications] administration.” In an interview, the facility’s psychiatrist said that the medication should not have been administered without documented evidence of such.

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