Thursday, May 25, 2017
Nursing home fines skyrocket in 2017 after crackdown
This year's four-month total for fines was $796,750, compared with $639,500 for the three years ending Dec. 31, state Health Department records show. The totals do not include federal fines that are recommended by the state and are typically much larger.
State surveyors sanctioned 86 facilities so far this year, including three in the Lehigh Valley region, compared with 72 in all of last year and 47 in 2014 and 2015 combined.
The state Health Department said it was responding to an auditor general report issued last summer.
"When the auditor general looked at our oversight of nursing homes, one of the key recommendations was to be more aggressive in our oversight and we are," the department said this week in a statement.
As to whether the tactic is improving care at the state's 700 nursing homes, state regulators said "it is too early to tell the impact this is having."
An industry spokesman said the impact was clear: The heavier sanctions are a financial strain on operators and are not likely to produce better outcomes for residents.
"Any time a dollar leaves the bedside that didn't have to leave the bedside, that's an opportunity lost to enhance the care provided," said Russ McDaid, president of the Pennsylvania Health Care Association and the Center for Assisted Living Management, both trade groups in Harrisburg.
But an advocate for the elderly, who helped spur tougher oversight of nursing homes with a 2015 report that criticized the Health Department for dismissing 92 percent of the complaints against Philadelphia nursing homes, welcomed the change.
"This jump in fines sends a clear message to nursing home operators that the days of lax oversight are over," said Sam Brooks, an attorney at Community Legal Services in Philadelphia.
"For years, nursing homes were allowed to provide inadequate care that resulted in widespread harm to nursing home residents across Pennsylvania. Easily preventable deaths and injuries became common, as nursing homes did not fear any penalty," Brooks said.
Secretary of Health Karen Murphy announced in October that the department would start using more discretion in deciding how much it would fine facilities, taking into account the level of harm, how long it takes for a problem to be fixed, the facility's track record of compliance and other factors.
Old Orchard Health Care Center in Bethlehem Township was fined $1,500 in January for violations discovered during an inspection in September. According to that inspection report, a resident with a history of falling fell off a bed while a nurse aide was helping her dress. She fractured a hip and required surgery.
Old Orchard Health Care Center did not comment Thursday. The state report says the home disciplined the employee and changed procedures so the resident and others in similar conditions would not be dressed while sitting on the edge of their beds.
Kirkland Village in Bethlehem was fined $2,000 in February for violations discovered during an inspection in December. The Morning Call previously reported about that incident. A resident fell and fractured a hip after being left alone in a restroom despite instructions that she was not to be left unattended.
Kirkland Village did not return a call Thursday. It previously told The Morning Call it has policies and training to prevent such incidents, but the employee did not follow the policy and no longer works there.
An East Stroudsburg nursing home was fined $15,750 in January for violations discovered during an inspection in September.
The inspection found several violations including a resident who fell in a restroom and broke his thigh and a "pink slime-like film" in an ice machine, according to the report. Routine fire drills weren't done, two residents didn't receive adequate care plans for bladder problems and two residents weren't timely seen by a physician.
The home immediately cleaned the ice machine and submitted plans to correct other issues, according to the report.
The home, now known as The Meadows at Stroud for Nursing and Rehabilitation, was fined under its previous owner and operator, Golden Living Center-Stroud, according to Jeff Deutsch, vice president for business development at Priority Healthcare Group, which took over management in February.
Deutsch said he could not comment on the inspection and fine because they occurred under the facility's previous owner.
Golden Living, which is based in Texas, had the most fines from the Pennsylvania Health Department since 2014, a total of $165,150. It sold the operating licenses to its 36 facilities in Pennsylvania in October and February, the Health Department said.
Ron Barth, CEO of LeadingAge PA, a trade group for nonprofit long-term care providers, acknowledged there are horror stories in nursing homes and bad facilities, which the department rarely shuts down. Instead, he said the department seems to have decided that it will "fine all facilities into compliance."
One reason for higher fines is a new approach to citing nursing homes for "immediate jeopardy," which is defined by federal regulators as "a situation in which the facility's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident."
Brooks, the Community Legal Services attorney, said an example of immediate jeopardy is when residents who are not supposed to eat solid food are left alone during a meal. That is a dangerous situation that can and has led to choking deaths.
Last year, the state had 39 immediate jeopardy citations, up from 12 in 2015 and 11 in 2014. The state said a major reason for the increase was the decision to allow anonymous complaints in 2015. "Each time there is a complaint, our surveyors investigate, and by being on site more frequently they identified more immediate jeopardy cases. When there is an immediate jeopardy case, the issue must be corrected before the surveyor leaves to ensure the safety of the patients," the department said.
In a case that has baffled those in the industry, a surveyor cited a facility near Harrisburg for immediate jeopardy in March because the hot water available from a water purifier outside the CEO's office and near the activity room was too hot and residents could have been hurt if they pressed and held two red buttons to dispense hot water. In the past, the surveyor probably would have pointed out the potential problem and suggested that management fix it, Barth said. Now, the nursing home will be fined and its rating on Nursing Home Compare will plummet, he said.
"In the meantime, there are bad facilities out there that the department still allows to operate," Barth said.
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Nursing home fines skyrocket in 2017 after crackdown