High fines for nursing homes

I report 'em as I find 'em: http://www.news-record.com/home/late...-nursing-homes

State and federal regulators have imposed some of North Carolina’s heftier fines on Triad nursing homes during the past several years, including a High Point facility hit with a pair of penalties totaling $372,970.

The region is home to 11 skilled-nursing facilities where government inspectors found “serious deficiencies” in patient care or accommodations, according to information compiled from Medicare files by the ProPublica nonprofit journalism group.

Unihealth Post-Acute Care of High Point racked up the biggest fines — a $223,795 assessment in March for patient neglect that was levied only 15 months after a similar penalty of $149,175.

Unihealth’s fines ranked as North Carolina’s second highest in total dollar amount since 2009 and the 12th highest in the nation, according to ProPublica’s calculations.

The U.S. Centers for Medicare and Medicaid Services fined Unihealth in one case for failure to summon rescue workers and properly transport a quadriplegic injured in an accident that left her sprawled on the floor of a van. In the other, inadequate security measures enabled a young man to escape while he was recuperating from a car accident that left him mentally off-kilter.

Unihealth declined to comment on the fines and the events that sparked them “due to company policy in discussing patient matters with the media,” said company Vice President Terri Davis in an email.

Inspectors from the state Division of Health Service Regulation do the nursing-home “surveys” that lead to such fines, but the actual penalties are determined by the federal Centers for Medicare and Medicaid Services agency, known by the partial acronym, CMS.
“CMS decides, they impose and they collect,” said Jim Jones, spokesman for the state health-services regulation office in Raleigh.


CMS measures the severity of nursing-home violations on a sliding, A-to-L scale that assigns higher penalties as the actual harm or potential threat to residents increases.

Problems uncovered by inspectors at nursing homes across the Triad include an attendant assaulting an elderly man who suffered from dementia, medication errors, improper pain management, poor infection control, failure to suppress odors of human waste, unsanitary or potentially problematic food handling, and general insensitivity to residents’ wants and needs.

Inspectors found serious deficiencies at three homes in Guilford County, five in Forsyth and one each in Alamance, Randolph and Rockingham counties. No home in the Triad falls into regulators’ “special focus” category, with problems so severe the facility faces possible closure.

Pro Publica assembled the data as part of its nonprofit news-gathering operation that in addition to its own reporting projects, taps the databases of governmental agencies and makes them available online. Its nationwide, nursing-home database presents material that goes back to 2009 without comment or interpretation, said Mike Webb, the group’s communications director.

“We’re just taking information that is publicly available and making it easier to search and go through,” Webb said.
But consumers need to be careful assuming that a bad report or an unfortunate incident in the past accurately depicts a nursing home’s current state, said Debbie Combs-Jones, director of operations for the management company that runs Adams Farm Living and Rehabilitation in Jamestown.

The Mackay Road nursing home carries a “much below average,” overall rating by Medicare, stemming in large part from the 2009 death of a frail, elderly woman under circumstances initially suspected to involve strangulation, possibly linked to the improper deployment of her bed rails.
The home also received a poor, overall review by state inspectors in March 2010.



A subsequent autopsy absolved the Adams Farm facility in the woman’s death. And the nursing home reacted aggressively to the sub-par, annual inspection by state regulators, Combs-Jones said.

“At that point, we replaced our management and hired some excellent, very experienced new management,” Combs-Jones said. “It’s so frustrating that people think that whatever they read online is automatically true.”

For instance, the online record suggests that inspectors cited Adams Farm for 10 deficiencies in their March 2010 report. In fact, it was seven and all were quickly corrected, Combs-Jones said.

Residents seemed happy and well cared-for Friday morning in the Adams Farm facility, which was clean and brightly colored after a new paint job that is part of a remodeling project near completion.

Staff members monitored patients’ medication on laptop computers with screens that turned yellow to alert them that a pill or other prescription was soon due. In other rooms, a group of wheelchair-bound women worked to improve their range-of-motion by playing catch with volunteers, and occupational therapists practiced coordination skills with patients being readied to return to their homes.
Nursing home staff members shoulder difficult jobs helping some of their community’s most vulnerable people, said Patti Anderson, administrator at Adams Farm. Residents need hands-on nursing care either for the rest of their lives or until they fully recover from surgery or a debilitating illness such as pneumonia, she said.



With the exception of a few bad apples, the vast majority of nursing-home employees care deeply about the residents in their facilities, go the extra mile to provide top-notch care, and take it personally when their workplace gets painted with a broad-based negative brush, she said.

“They go out into the community and they feel they have to defend their facility,” said Anderson, who is confident enough of the care at Adams Farm that her 103-year-old mother lives there.

“I’ve heard it said that we are the nation’s most regulated industry next to nuclear power,” Anderson said.

Still, bad things can happen even in places with the best of intentions. And that’s why the state sends teams of inspectors into every nursing home roughly once a year, said Jim Jones of the state Division of Health Services Regulation.

“They don’t announce ahead of time they’re coming. The last thing we want is for a nursing home to get a week’s notice so they have time,” he said, adding that inspectors also visit nursing homes in response to complaints about their performance.

Nursing homes face the biggest fines when residents suffer actual harm through misbehavior, poor supervision or outright negligence. Fines grow if corrective action isn’t swift enough.
In Forsyth County, officials levied $182,619 in fines against Clemmons Nursing & Rehabilitation Center three years ago, after state regulators uncovered abuse against an elderly woman by an assistant nurse who continued working on the resident’s floor after supervisors learned of the incident

The resident suffered badly bruised arms one night when the aide threw her into a bed so hard she struck a metal bed rail on the other side of the mattress, an unidentified state inspector wrote in an online report of the incident.

The victim remained upset a month later, concerns aggravated by the fact her abuser still worked there, the inspector wrote.

“I am afraid because the staff that hurt me worked in my room the earlier part of the week,” she told the state inspector a month after the April 2010 incident. “I don’t know if she will come back and hurt me (again).”

The inspector reported that the frail woman “was crying with very wide eyes and a facial expression of fear.”

In some cases, nursing homes summon investigators on their own, which they are required to do in a variety of situations in which residents’ safety is at issue.

That’s how Friends Homes at Guilford got a black eye last February and a $48,750 fine, after one of its nursing assistants struck an elderly patient two or three times in the stomach. The senile man had kneed the aide as she was helping to change his adult diaper; she struck back at him and he told her that she’d hurt him, according to the state report.

The assailant answered by saying that’s what it felt like when he hit her, another nurse’s aide who witnessed the attack told the state inspector.

“We self-reported this. We weren’t trying to hide anything from anybody,” said Wilson Sheldon, chief executive of Friends Homes Inc. who has worked there for three decades. “This has never happened here before in those 30 years. It’s very much an anomaly for us and out of the ordinary.”

Friends Homes fired both the aide who struck the man and the other nurse’s assistant who witnessed the assault without trying to stop it, Sheldon said. That witness also erred by waiting several days to report the assault to an administrator, he said.

“We had to write new policies to make everybody very aware of the severity of seeing an incident and not reporting it immediately,” Sheldon said.

Regulators tagged Unihealth with its quarter-million-dollar fine mainly for poor treatment on Jan. 6, 2012, of a homesick man suffering from traumatic brain injury after being hit by a car several months earlier.

The state inspector documented that Unihealth staffers took few precautions to prevent his escape although they noted he had “a behavior problem of wandering … intermittent confusion, short-term memory loss, flat affect, forgetfulness and repetitive thought process, and (inability) to make informed decisions.”

Before he escaped through a window that evening, staff members reported seeing him “pacing and touching the door handle and walking away, stating he wanted to go home.” A nurse discovered he was missing not long after that, a search ensued and the patient was found later that evening about 1.5 miles away walking toward town in search of his parents, the inspector said.

The subsequent state report also cited Unihealth for almost immediately sending the man back to a medical center where he’d been treated originally, without consulting his parents or physician. The report doesn’t give the man’s age, but his parents admitted him to the facility and were making medical decisions on his behalf.

State inspection teams that keep tabs on Unihealth and the other nursing homes include specialists in nursing, pharmacology and nutrition, said Jones of the state health-service regulation program.
“They are folks with medical specialties who understand what these facilities are supposed to be doing,” he said. “Any report is a snapshot. We don’t have the staff to send someone into every facility every day.”