New Report Questions “No Harm” Citations at Nursing Homes

A new report by the Long Term Care Community Coalition highlights “no harm” deficiencies in nursing home facilities.  “No Harm” deficiencies are citations that find a nursing home violated health code provisions in a manner that did not cause residents harm. The LTCCC argues that many such citations in fact reflect harm done to nursing home residents, and more broadly reflect systemic failures in elder care facilities. But since the citations rarely if ever result in financial penalties, the LTCCC suggests, nursing homes have no incentive to address these systemic deficiencies. The report specifically discusses citations at nursing homes in four states:

In the Manhattanville Health Care Center in New York, a state inspector found that the nursing home did not comply with its safety protocols when a Certified Nursing Assistant performed a solo transfer of a resident who was documented as requiring the assistance of two people for transfers. The resident later reported “significant pain” resulting from the transfer and was found to have a fractured hip. “Despite the serious injury,” the LTCCC notes, “the surveyor cited the violation as no-harm.” In an interview, the CNA in question said they had previously performed solo transfers of the resident, and that it “was a poor judgment” to do so. An investigation conducted by the facility and summarized by its Director of Nursing “documented there was reasonable cause to believe abuse, mistreatment or neglect occurred,” and the facility reported the cause to state authorities while suspending the CNA for three days.

In the Maple Springs of Wasilla nursing home in Alaska, an inspector found that a resident’s care plan was not adjusted to accommodate their need for social service. The citation states that the resident “faced increased risk for unnecessary medications and experienced numerous adverse outcomes including anxiety, hallucinations, confusion, agitation, and violence,” but as the LTCCC notes, the failure to adjust the resident’s care plan was nonetheless categorized as “no harm.” The citation stated more specifically that the facility’s administrator said in an interview that the resident “was involved in an accident that included increased aggression and physical violence towards staff,” after which they were hospitalized and placed on emergency medication. The facility’s administrator acknowledged in this interview that the nursing home had neither psychiatric services nor the means to “manage the resident other than chemical constraints.” Before the incident that resulted in hospitalization, the resident “experienced numerous adverse behavioral outcomes” such as hallucinations and agitation; in spite of this, according to the LTCCC, their care plan included no behavioral health or non-pharmacological interventions.

Meanwhile in New Hampshire, Oceanside Skilled Nursing and Rehabilitation was cited for failure to monitor multiple residents’ weight loss and to follow dietary protocols for those same residents. An inspector found specifically that two residents “experienced significant weight loss” and that another was given a “regular diet” instead of a required “special diabetic diet.” As for the residents who experienced weight loss, one had a care plan intervention for weekly weight monitoring that staff did not follow, according to the citation; the other was recommended for weekly weight monitoring after a staffer observed significant weight loss, and the facility again did not follow through on the recommendation, according to the citation. The resident on a special diabetic diet “was receiving sugary desserts” in spite of that recommendation, and the facility’s Food Service Supervisor said in an interview that kitchen staffers were providing the resident with a regular diet. In spite of all this, the citation was categorized as “no harm.”

Finally, Southern Specialty Rehab & Nursing in Texas received a citation finding it failed to provide adequate supervision to prevent a resident from sustaining accidents. According to the citation, an inspector found that a resident was not supervised and “left the facility late at night and was stopped by police and arrested on a warrant.” Facility staffers did not realize the resident was absent until they observed his “untouched breakfast tray” the following morning. Following a search of the facility’s interior and exterior, a social worker “checked the jail roster and discovered the resident was in Lubbock County Jail.” The citation found additionally that a Certified Nursing Assistant had documented “that the resident had a large bowel movement” the previous night at a time they were already in jail; according to the facility’s administrator, the CNA documented such because the resident “usually has a bowel movement around that time.” The facility’s Director of Nursing stated in an interview that the facility had no policy regarding the supervision of residents, and that while staff were expected to complete rounds and identify each resident every two hours, they had not all done so that night. In spite of all this, the citation was categorized as “no harm.”

For more information about no harm citations, read the LTCCC’s report here.

The attorneys at the Law Offices of Thomas L. Gallivan, PLLC work diligently to protect the rights of nursing home residents.  Please contact us to discuss in the event you have a potential case involving neglect or abuse.

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