25% of the state’s 1,200 long-term care centers have been cited for serious standard deficiencies

Illustration by Jason Stout

Back in July, news broke out of North Austin that a 90-year-old resident of a nursing home had accused one of its employees of abuse. The woman said that as punishment for wetting the bed, the employee would flip the disabled woman over and strike her repeatedly on her backside.

This was hardly an isolated incident. Just months before, the Texas Department of Aging and Disability Services told KXAN that it was investigating a gruesome video, recorded at another Austin nursing home, that depicted a patient, whose hand is covered with feces, getting her nose tickled with a feather being held by a nurse’s aide. The video was uploaded onto Snapchat, and showed the gleeful aide watching as the woman reached to scratch her face with her feces-covered hand.

Though Texas maintains a host of laws that pertain to nursing home care, the state has an equally long history of trouble doing right by its elderly citizens. In January, the AARP released a blistering report titled “Intolerable Care,” which paints DADS as a toothless regulatory system that allows bad actors to get away with hurting clients. “Texas nursing home quality is shamefully poor,” it reads. “As a result of this intolerable care, many residents of Texas nursing homes face unnecessary health and safety risks.”

Limits of the System

For at least one former nurse’s aide, this summer’s news did not come as any surprise. Ty, who requested we only report her first name, fearing professional repercussions, had no idea what awaited her at the Windsor Nursing and Rehabilitation Center of Duval – the long-term care facility now under investigation for the Snapchat video – when she applied to work there last June. The center, located at 5301 W. Duval Rd. in Northwest Austin, was offering a class that would allow Ty to become a certified nursing assistant – a foothold into the medical industry, which she hoped could support her and her child.

But the Windsor program “wasn’t much of a class.” Ty said she and her classmates did some book work, but “for the most part they had us out on the floor working.” She describes the program as a working internship where students couldn’t physically handle any of the patients because they were trainees. But that standard went out the window, she said, when she was put on a floor with no other employees.

“I didn’t have a choice,” Ty recalled. “I had to change people. I had to help people. I had to bathe people. I had to do everything, because there was nobody else there to do it. So that was one thing that kind of threw up red flags for me. But I was like, ‘Hey, if this is what I’ve got to do to get this certification, then that’s what I’m going to do.'”

Ty continued to work at Windsor until last October, and through those five months witnessed a number of incidents that caused her alarm. In one case, a client accused one of her co-workers of abuse. Ty said she navigated through a charge nurse, the director of nursing, and others within her chain of command to report the issue, but “nothing happened.” In another, she witnessed a woman whose soiled briefs were simply covered up with a fresh pair. “Not only is this woman soaked, but she is soaked all the way through all of her legs,” she recounted telling a co-worker. “And she has on two briefs, both of which are oversized.

“Neither one of those briefs were the ones she was supposed to have on. But she was soaked through both briefs. When was the last time somebody changed her?”

Of the more than 1,200 long-term care centers in Texas, 306 have been cited with serious standard deficiencies.

 

Abuse In Our Backyard

The severe abuse at Windsor seems to be compounded by severe neglect. Ty said that nurses often ignored or dismissed her concerns about patients’ health. During one shift, she noticed that a client had red splotches and busted blisters on and around her chest, and thought she may have shingles. Ty alerted the nurse, who said she would check on the resident. But instead, she continued to play on her phone and gossip with her colleagues, who should have been on the floor. The nurse didn’t visit the resident until later on in the day. It turns out she did have shingles.

Nurses also tried to cover up allegations of maltreatment. Ty said the son of one resident filed a complaint against the nurses, claiming they repeatedly abused his father. The nurse in that case tried to twist the father’s words so that the term “abuse” would not be used to describe the incident – instead trying to coax the father into saying that they were “being too rough,” said Ty, who was in the room when the incident was reported.

Ty was dismissed from her job after getting into an argument with one of the head nurses. She said she declined to follow the nurse’s command to move one patient from her bed to a chair. That patient, who had bruises all over her body, complained to Ty that she was in pain after a worker twisted her back during a treatment session. The patient didn’t want to leave her bed, nor did she want pain medication. When Ty told the nurse, she dismissed her concern and sternly told her to take the woman out of the bed. Ty refused, standing up for her patient’s wishes.

“She was crying, literally sobbing [about] how bad she was hurting,” she recounted. It was the incident “that broke the camel’s back.” The nurse became angry and “blew up.” She and Ty went into the hallway, where they had an argument. The nurse found another worker to put the resident into a chair, where she eventually sat all day. The nurse had Ty taken off the schedule, and she was later suspended. Ty went back to work after a couple of weeks, but was let go under the pretense that she first had to pass her certified nursing assistant certification.

Ty reported the abuse she witnessed to corporate management, but said leadership never responded directly to her complaints. Instead, they gave her the runaround, forcing her to go back and forth between corporate and the center’s administration. “It doesn’t seem like they’re doing anything,” she said.

In March, state and federal officials investigated six months’ worth of complaints lodged against Windsor Nursing and Rehabilitation Center. The 206-bed facility was found in violation of four federal and four state health standards, according to the Texas Department of Health and Human Services. (Texas facilities on average incur only three.)

The violations align with Ty’s allegations. According to state and federal records, Windsor had failed to protect residents from abuse, maltreatment, and isolation, and neglected to provide compassionate and competent care. The North Austin nursing home also fell short protecting residents’ privacy and confidentiality. These health infractions were allegedly corrected this year, on April 17. The Centers for Medicare and Medicaid Services, which manages the Nursing Home Compare rating system, ranks Windsor below average for quality of resident care, as well as for health safety. A CMS health inspection conducted in July cited the facility with nine deficiencies – four of which deal with mistreatment.

“There are explicit rights for residents, and these kinds of violations get directly at those rights,” said Amanda Fredriksen, associate state director of advocacy for AARP Texas. “Like the right to be free of abuse and exploitation, [or] the right to privacy.”

Neither Windsor nor its management company, Regency Integrated Health Ser­vices, responded to multiple requests for comment.

Intolerable Care

Annie Lynette Allen (Courtesy of Darla Culpepper)

The Irving-area nursing home Darla Culpepper took her mother to seemed like an excellent facility. A high turnover rate among the administrative staff and nursing directors did eventually lead to a discomforting lack of continuity in care, but Culpepper said she never thought her mother was in danger. Then, in December, Annie Lynette Allen suffered a stroke.

That was one of the things her mother’s doctor had told her she shouldn’t worry about. As long as Allen’s caretakers made sure to administer the anti-stroke medication according to doctor’s orders, she would remain stroke-free. It wasn’t until after her mother had her stroke that she checked again with Allen’s doctor, and found out that the medication had been discontinued without her knowledge. The family filed a report with the Irving police, and DADS eventually cited the home on Allen’s behalf. Culpepper said it took a substantial effort.

“I can’t remember if it was the third or fourth time that I called back, and I said, ‘I’m filing a new report, and I just want to tell you this: I’m not going away,'” said Culpepper. “‘Unless I die tomorrow, I’m not going away until you do something.'”

Statistics show that throughout the country, health-standard violations found in nursing homes are on the decline. But in Texas the number is spiking. According to The Dallas Morning News, cited deficiencies in Texas facilities rose by 20% between 2010 and 2014; severe infractions increased by 3% over that time. Over that same period, however, severe violations at nursing homes across the country declined by 16%.

Incidents of abuse, like what happened at Windsor, are not a new phenomenon in Texas. It’s part of a larger pattern of poor care that lands the state at the bottom of quality lists. In 2014, Families for Better Care, a nonprofit advocating for better nursing home care, ranked the state 51st out of 51 (including Washington, D.C.), and gave it an “F” grade. Texas stayed put the following year, according to the Houston Chronicle. And, as recently as August, found itself in third place for worst nursing home care – right behind New Mexico and Kentucky, according to ProPublica.

“There are very good nursing homes in Texas,” said Bastrop attorney David Bragg, a civil litigation attorney who specializes in nursing home and assisted living center abuse and neglect. “I’ve seen them firsthand; even way back in the dark days they were still there.

“A nursing home, even though it is excellent, can all of a sudden have a horrible night when two staff members call in sick, and suddenly they’re short of staff. And now they’ve got the same patient requirements but fewer people to do it with. And when that happens, even the really good nursing homes can have a bad night – a bad experience.”

Bragg has spent decades watchdogging the state’s nursing home industry. In the Seventies, when he headed the Attorney General’s Consumer Protection Division, Bragg was directed by Attorney General John Hill to start a task force to investigate reports of nursing home abuse in the state.

At the time, the nursing home lobby was one of the more powerful lobbying arms within the state. Bragg’s 20-member task force, made up of attorneys, a social worker, and other investigators, set about its task by going from nursing home to nursing home. Bragg recalls bringing a toy blow gun from his house into the office: He would shoot a dart from the gun at a map of the state that he’d positioned on a wall. Wherever the dart landed, the group would conduct surprise inspections of the facilities in that area.

“After the task force had done its work, you could see some improvement in this sense: If bad things were continuing to happen, they were better concealed and not so obvious,” he said. “We know we were able to stop some bad things from happening, but then it ended. Over time, the industry … went to its prior ways.”  (Click to Continue)

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25% of the state’s 1,200 long-term care centers have been cited for serious standard deficiencies