Articles Posted in Nursing Home Violations

The Trump Administrations deregulation effort has led to decreased oversight across the country’s nursing home industry. According to The Washington Post, President Trump’s deregulation agenda has indiscriminately removed “essential protections for vulnerable Americans.” Citing the Trump administration’s popular boast of removing 22 regulations for every single regulation added, the newspaper understandably questions the necessity of these regulations and the consequences of their removal.

Sadly, the nursing home industry has never been a priority for many Presidential administrations. Despite the highly regulated nature of the industry, nursing homes have often escaped the scrutiny lodged at hospitals and other healthcare providers. Late in his second term, President Barack Obama attempted to change that and directed the Centers for Medicare and Medicaid Services (CMS) to aggressively pursue nursing homes flouting the law. Beginning in 2014, nursing home violations would not result in a one-time fine. Instead, the nursing home would be fined every single day until the violation was rectified. By 2016, over two-thirds of nursing home violations resulted in a per-day fine. Unfortunately, the Trump administration reversed this change – which was viewed by elder care advocates as broadly effective and necessary.

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State prosecutors charged seven nursing home employees with involuntary manslaughter after a patient died from a bedsore in 2017. The nursing home employees, which includes one nurse, are collectively charged with 37 crimes for their gross mistreatment and neglect of two nursing home patients during their time working at Whetstone Gardens and Care Center in Ohio. Announcing the charges, Attorney General Dave Yost says, “Evidence shows these nurses forced the victims to endure awful mistreatment and then lied about it.”

Yost says first patient “literally rotted to death” after developing a preventable bedsore or “pressure injury” in 2017. The patient, who entered the facility on a short-term basis, developed several bedsores after nursing staff failed to move the patient every few hours. Once the bedsores developed, the staff continued to ignore the nursing home resident and failed to treat the sores, also called pressure injuries or ulcers. Within weeks of developing the bedsore, the patient’s bedsores became infected with gangrene. The nursing home resident passed away just weeks later after the staffers at the nursing home failed to take “any medically appropriate steps.”

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The Centers for Medicare and Medicaid (CMS) announced it will launch a ‘comprehensive review’ of nursing home regulations across the country. According to Health Leaders Media, CMS Administrator Seema Verma announced the new initiative last week in response to mounting criticism by states and federal legislators. Administrator Verma said the government agency will seek $45 million in additional funding from Congress for its review.

CMS says the review will focus on several primary areas. First, CMS will work with state agencies across the country to strengthen oversight of the country’s nursing homes. According to CMS, federal and state agencies will work together to ensure CMS health and safety requirements are being followed and ever nursing home is inspected at least once a year. Second, the federal agency plans to increase enforcement of nursing homes by, according to Administrator Verma, “developing new ways to root out bad actors and repeat offenders.” Administrator Verma says nursing homes with insufficient nursing staff will be targeted will begin receiving more “unannounced inspections” to encourage compliance. Finally, nursing homes will now be more severely penalized for poor patient outcomes and less severely penalized for failing to follow CMS protocols. In addition to improving outcomes for current nursing home patients, the focus on patient outcomes will also be more helpful to prospective nursing home residents by providing a more meaningful metric to judge nursing homes.

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The Department of Veteran Affairs released its first report on the status of its nursing homes this month and the results show widespread neglect and abuse at the government-run facilities, perhaps even worse than the well-documented problems seen in its private-care counterpart. The federal government is responsible for caring for the country’s 40,000 veterans and, according to its own report, is doing a poor job. The report analyzed 99 VA nursing homes across the country and reported the findings of surprise inspections conducted by outside contractors. The VA spokesperson said that releasing the report in its entirety is part of a new push by the agency for transparency and accountability.

The findings of the report are daunting. Eleven of the 99 nursing homes were so unsafe that veteran safety was in “immediate jeopardy.” More than half of the nursing homes (52) were deficient enough to cause “actual harm” to their veteran residents. “That is really bad. It’s really bad,” Richard Mollot, executive director of the Long Term Care Community Coalition, a nursing home advocacy nonprofit told USA Today.

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New York’s Department of Health appears unable to adequately monitor the nursing homes across the state and hold poor performers accountable. Elder care advocates say the state agency must reform to protect senior citizens from poor care and nursing home abuse. Thankfully, legislators in Albany appear to finally be listening.

According to The Buffalo News, Assembly Majority Leader Crystal Peoples Stokes is co-sponsoring a bill regulating the number of nurses at each assisted care facility in the state. The appropriately named Safe Staffing for Quality Care Act would mandate that each nursing home have RNs (registered nurses) and that practical nurses and CNAs (certified nursing assistants) spend a minimum of 291 minutes with each resident. According to federal data, nursing staff levels are the largest indicator of whether a nursing home is providing quality care to its residents. Unfortunately, the same federal data shows that most nursing homes are grossly deficient when it comes to staffing. According to a study released in January 2019, only 7.5 percent of nursing homes across the state currently satisfy the requirements laid out in the Safe Staffing for Quality Care Act.

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Government regulators and lawmakers appear finally ready to do something about the widespread use of antipsychotics at nursing homes. These powerful drugs are often prescribed to residents diagnosed with Alzheimer’s or dementia by nursing homes hoping to sedate them. Not only are these drugs not an approved treatment for these conditions, but antipsychotic drugs also have a range of serious side effects and drug interactions. In the elderly, antipsychotic medications substantially increase the risk of falls. Sadly, the practice of prescribing dangerous, unnecessary antipsychotic medication is widespread in the nursing home industry. The federal government reports that approximately 16 percent of nursing home residents take antipsychotics.

Thankfully, the government appears ready to tackle widespread nursing home abuse. In a letter to US Centers for Medicare and Medicaid Services (CMS), the government agency responsible for regulating nursing homes, Rep. Richard Neil excoriates the nursing home industry’s illegal prescribing habits and the government agency for inadequate enforcement. Rep. Neil described instances of nursing homes who “falsified diagnosis” and failed to attain informed consent, all for the purpose of sedating a patient with unnecessary antipsychotics. The Democrat then sharply criticized CMS saying that “nursing facilities are getting away with this practice.” According to Rep. Neil, nursing homes are “neither being cited nor penalized.”

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After what one upstate nursing home doctor called the “worst bedsore ever seen” killed a once-healthy resident, the elderly man’s son is demanding accountability from the negligent nursing home. Four months after entering Safire Rehabilitation of Northtowns, the 82-year-old Frank L. Williams passed away from an entirely preventable bedsore, also called a pressure ulcer. According to The Buffalo News, Williams’ hospital records list cardiac arrest caused by sepsis, a deadly infection resulting from his bedsores, as the cause of death. According to the New York Department of Health, the number of residents developing bedsores at Safire Rehabilitation is almost double the state average. In the last few years, the number of bedsores has increased at the nursing home.

Speaking to The Buffalo News, Williams son describes his father’s experience at Safire Rehabilitation as a nightmare from the beginning. After suffering a stroke, Williams was released by the local hospital to Safire Rehabilitation. The nursing home apparently accepted the elderly man without having space to treat him, which caused him to spend his first three days in long-term care instead of the rehabilitation unit. Williams son describes the nursing home as windowless and reeking of urine. The nursing staff ignored his father’s pleas to move him around, necessary to prevent a bedsore from developing. After spending three months at Safire Rehabilitation, Williams doctors told his son there was a “little pressure sore” and refused to let the son see the wound.

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The police have arrested a nurse who is reportedly responsible for sexually assaulting a nursing home resident who has been in a vegetative state since 1993. According to The New York Times, the nursing home resident and mother has been under the care of Hacienda HealthCare in Phoenix since 1993, when she was only four-years-old. The Arizona nursing home said it did not know the woman, who has not been identified by Phoenix police, was pregnant. Upon the birth of her child, police required all male staff members to provide DNA samples. The police then identified the father as 36-year-old Nathan Dorceus Sutherland and charged him for sexual assault and abuse of a vulnerable adult.

Speaking on behalf of the woman’s family, a representative described the woman as possessing “significant intellectual disabilities” and is only able to move her limbs, head, neck and respond to sound. The representative called for a full investigation into Hacienda HealthCare and the staff responsible for the woman’s care. State legislators have not wasted any time in responding to the horrific abuse that occurred at the nursing home. On January 30, the nursing home came under new ownership. Earlier in January, the two doctors responsible for the woman’s care and the CEO of the facility were removed from their positions.

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New York State routinely allows nursing home owners with a record of poor care and government fines to operate more long-term care facilities in the state, according to a report by The Buffalo News. Speaking to the upstate newspaper, Toby Edelman at the Center for Medicare Advocacy described the problem as a “disturbing but all-too-familiar pattern” and joins elder advocates in demanding the New York Health Department provide more transparency and stricter scrutiny when selecting nursing home owners. In response to the criticism, the New York Department of Health, the state agency responsible for regulating nursing homes, drafted legislation intended to allow stronger and more effective government oversight of the long-term care industry.

The evidence uncovered during The Buffalo News investigation paints the portrait of a government agency whose incompetence is endangering elderly New Yorkers. Of the 47 nursing homes in the newspaper’s geographical area, sixteen were purchased in the last decade by for-profit nursing home corporations, which have a documented record of provider lower-quality care to their residents.

In one instance, the Department of Health approved the takeover of a nursing home by a group of New York City investors fined almost $90,000 in the last two years. In another example cited by the newspaper, a nursing home corporation with poor ratings and federal and state fines totaling “at least $325,000” was approved to purchase another nursing home in the state. In both cases, the state agency amazingly concluded that it had received “no negative information” about the nursing home owners. The deputy health commissioner told the newspaper that the agency now vets potential nursing home owners more thoroughly.

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In response to the increase in for-profit nursing homes and recent data on nursing staff levels across the state, New York lawmakers plan to introduce a bill establishing minimum levels of nursing staff at long-term care facilities across the state. According to state legislators, under-staffing remains a serious problem at New York nursing homes and directly contributes to a lower quality of care for their elderly residents. Originally drafted two years ago, Republicans in the state legislature blocked the measure. However, with Democrats set to control all branches of government next year, the Safe Staffing for Quality Care Act will likely become law.

The proposed legislation will establish a minimum ratio of nursing staff to patients, which will vary by the level of care required for the patient. For patients undergoing active rehabilitation at a nursing home, there cannot be less than one nurse or nursing assistant for each patient. Further, the bill would require a nurse to spend an average of 291 minutes with each patient every day. According to The Buffalo News, this would be a significant change for most nursing homes. According to the newspaper’s analysis, only 8 percent of New York nursing homes currently satisfy these requirements.

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