SUNDAY EDITION: Violations costly for Louisville nursing homes
LOUISVILLE, Ky. (WDRB) – After visiting the Masonic Home of Louisville last year, state inspectors discovered five violations that they believed placed residents of the nursing home in "immediate jeopardy."
The problems alleged by the Kentucky Cabinet for Health and Family Services ranged from giving residents improper doses of medication to failing to ensure that medication errors were corrected.
As a result of the state's inspection, the U.S. Centers for Medicare and Medicaid Services levied a $413,173 penalty – the highest fine for any federally-funded nursing home in Louisville last year, according to federal data.
The deficiencies found at the Masonic Home were among hundreds identified during 2013 inspections of Louisville nursing homes that receive federal aid. Besides the Masonic Home, seven other long-term care facilities were fined a total of $113,296.
In all, local nursing homes were cited for a higher-than-average number of health deficiencies compared with other Kentucky facilities last year, according to a WDRB.com analysis of the most recent annual federal data.
But regulators who reviewed the 46 long-term care facilities in Jefferson County also identified fewer deficiencies – areas that fail to meet minimum federal standards – than during 2012.
The data shows:
- 276 deficiencies at Louisville nursing homes in 2013, nearly 40 less than the year before.
- An average of 6 deficiencies per home, down from 6.8 in 2012. The decline, however, was less drastic than it was across Kentucky, which fell from 6.5 in 2012 to 4.8 in 2013.
- 22 of the facilities, or 48 percent, were deemed "below average" or worse in the U.S. government's Nursing Home Compare's rating system.
Advocates for nursing home reform and a nursing home trade association official said the findings support their positions on the state of long-term care – even though those stances are somewhat at odds.
Ruby Jo Cummins Lubarsky, president of the Kentucky Association of Health Care Facilities, said her organization and the homes it represents "take this data very seriously. We review it. We learn from it."
"In order for a long term care facility to be recertified for participation in the Medicare and Medicaid programs, all deficiencies must be corrected within a specified timeframe," Cummins Lubarsky said in an email. "As in past years, the 2013 (Centers for Medicare and Medicaid Services) data clearly shows that Kentucky homes exceed the national average in terms of care of staffing and we are proud of the service provided."
She noted that the average number of deficiencies remains lower than the national average of 6.8.
But despite some signs of improvement, deficiencies are still widespread in Jefferson County nursing homes, said Brian Lee, executive director of the Tallahassee, Fla.-based Families for Better Care, a nonprofit advocacy group that produces an annual report card of the nation's nursing homes.
(In fact, 45 of the 46 facilities inspected in Jefferson County last year had at least one deficiency, according to the data.)
"There are still these problems that exist. These deficiencies are still high," Lee said in an interview.
"Nursing homes have a tendency to have a yo-yo (effect) where they clean things up for a short period of time," he said. "That could be one of those periods."
Seven nursing homes fined
Nursing homes in Kentucky are inspected annually during unannounced visits by the Cabinet for Health and Family Services, said Connie Payne, acting executive director of the agency's inspector general's office.
The state inspectors identify deficiencies based on their severity – with the highest level, "immediate jeopardy," reserved for a problem that "has caused, or is likely to cause, serious harm, injury, impalement, or death to a resident receiving care in a facility," according to federal guidelines.
Payne said her office then submits a report that is used by the Centers for Medicare and Medicaid Services in determining any fines.
The Masonic Home of Louisville, a 167-bed home off Frankfort Avenue, had five immediate jeopardy deficiencies and nine overall last year.
The most severe allegations included the case of a resident for whom a physician prescribed a daily antibiotic for a hip and elbow infection, but Masonic Home staff failed to transcribe the order to a medication record, according to the state report.
There was no evidence the resident received the antibiotic for 24 of the 28 days that were prescribed, and the resident later developed a "mental status change" and was admitted to a hospital, the report states.
Inspectors also found six other instances in which the facility's staff did not ensure that medication orders were being reviewed for accuracy.
For example, the report notes, the facility's assistant director of nursing ordered a resident to receive a medication for preventing blood clots daily "without direction from the attending physician for the frequency of the Lovenox." (The Masonic Home disputed the inspectors' account, arguing that the resident received the medication as ordered.)
Suzanne Rinne, the Masonic Home's executive director, wrote in a disclaimer included in the state report that the facility "disagrees with and disputes the deficiencies stated … and the scope and severity at which they are cited."
The Masonic Home, however, did not appeal the fine and paid it last November, spokeswoman CJ Parrish said in an email.
"In response to the 2013 survey, Masonic Home of Louisville completed a plan of correction that was accepted by state and federal inspectors. Masonic Home of Louisville, and all Masonic Homes of Kentucky facilities, strive to provide a high quality of care and service," Parrish said.
Despite the fine, the Masonic Home received an overall rating of "below average" in the Federal Nursing Home Compare system – the same rating as 14 other nursing homes that weren't penalized at all.
Lee, of Families for Better Care, said it's rare for a facility to be fined more than $100,000. Asked about the Masonic Home penalty, he said, "If I had a loved one in that nursing home, I'd be looking for the closest door with an exit sign above it."
Parrish declined to respond to Lee's comments.
Other fines in Louisville at facilities where inspectors noted immediate jeopardy deficiencies:
- Golden Living Center, Hillcreek, $27,040. The home failed to monitor and repair a hot water system when water temperatures exceeded 110 degrees Fahrenheit in some rooms, and tell staff that an automatic sprinkler system had been shut down for repairs. A fire later broke out in an ashtray while the sprinklers weren't working.
- Glen Ridge Health Campus, $24,148. A resident left the home without supervision and was found "alone in a wheelchair, self-propelling down the facility's driveway path" on a 94-degree day. In addition, the resident's electronic monitoring system wasn't working and its batteries should have been replaced more than a month earlier.
- Franciscan Health Care Center, $14,983. The home failed to update the care plans for a resident who had increased confusion and "wandering behaviors" and subsequently left the facility without staff noticing.
- Regency Care and Rehabilitation Center, $4,550. A resident had to be taken to the hospital after being injured when a sling strap slipped off a mechanical lift. The home's staff had noticed that the sling, which was meant for a different lift and didn't meet the manufacturer's guidelines, was on backwards, "but they continued to transfer the resident."
Residents' names and ages aren't included in the reports.
The highest number of deficiencies – 15 – was found at the Signature HealthCARE at Glenview nursing home. Spokesman Ben Adkins said the company acquired the facility last April and is working to make improvements.
Only one nursing home in Louisville – Signature HealthCARE of East Louisville -- had no deficiencies noted during its 2013 inspection.
"We're thrilled, and of course that's always what we strive for," Adkins said.
Mandated staffing standards
Some advocates of nursing home reform believe there is a simple solution for many of the deficiencies at long-term care facilities – staffing requirements.
Bernie Vonderheide, president of Kentuckians for Nursing Home Reform, has long pushed for legislation that would mandate certain staffing levels in Kentucky. He argues that inadequate staffing is "inevitably where the problem starts."
Federal law requires nursing homes to have staff levels that allow them to meet their residents' needs, but some states have gone further and enacted their own laws.
Connie Allgood Murphy, associate state director of advocacy for Kentucky AARP, said a Kentucky law would have "a lot of impact."
"Nursing homes aren't doing their job," she said. "That's the bottom line. They're not doing their job or we wouldn't have these deficiencies."
But Cummins Lubarsky, of the Kentucky Association of Health Care Facilities, noted that the federal Nursing Home Compare data shows that Kentucky's nursing homes have higher staffing levels than the national average.
According to Nursing Home Compare, licensed nurses spent an average of 1 hour and 51 minutes with residents each day at Kentucky homes, or 13 minutes more than the national average.
Still, Kentucky Gov. Steve Beshear announced last fall that the impact of increased staffing levels will be part of a sweeping plan to review care in the state's nursing homes. In a Nov. 5 letter to Vonderheide, Beshear noted that Families for Better Care gave Kentucky a "D" rating in a report card last year and that Kentucky was one of five high-risk states that received a below average or failing grade from Aon Global Risk Consulting.
As proposed by the governor, the Cabinet for Health and Family Services is planning eight to 10 regional forums starting later this spring or in early summer to seek input on improving nursing home care in Kentucky.
Those forums offer "a glimmer of hope," said Lee, the national advocate for nursing home reform.
"Unfortunately," he said, "those are not going to take place until after this legislative session."
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