Six South Carolina nursing homes, including one in Columbia, were publicly identified as being eligible for additional oversight by the federal Centers for Medicare and Medicaid Services.
PruittHealth Blythewood, located at 1075 Heather Green Drive, was listed as a special focus facility candidate for its “persistent record of poor care,” according to a report released by two Pennsylvania senators.
After two investigations into Pennsylvania’s nursing homes by PennLive, Sen. Bob Casey and Sen. Pat Toomey teamed up to demand the list of special focus facility candidates and released the list publicly on June 3. Previously, only the names of special focus facility program participants were made public.
The secrecy undermines the federal commitment to transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified, according to the two senators.
In South Carolina, Riverside Health and Rehab in North Charleston is a special focus facility. Five other nursing homes are listed as candidates for the program:
▪ Commander Nursing Center in Florence City
▪ Blue Ridge of Sumter
▪ Life Care Center of Hilton Head
▪ Compass Post Acute Rehabilitation in Conway
▪ PruittHealth-Blythewood in Columbia
The Columbia nursing home that can house about 120 residents, according to its Medicare.gov profile, was fined over $100,000 in 2017. In September 2017, federal regulators slapped a $99,267 penalty on PruittHealth-Blythewood. That was after the facility was forced to pay $4,237 in March of that year.
The Columbia nursing home’s overall rating on Medicare.gov’s Nursing Home Compare site is “much below average.” PruittHealth-Blythewood received a one-star rating and five health citations at an inspection on Oct. 5.
During that visit, inspectors reported meeting a resident with “long, dirty fingernails,” who was not helped to brush his teeth and had only three documented showers in the previous three months. Several other residents also received infrequent documented showers, the report said.
Other residents reported hours-long delays when they asked for help, even for something as simple as getting out of bed in the morning. Those were attributed in part to the facility being short-staffed, according to the inspection report.
PruittHealth-Blythewood also received an “average” rating — three stars — for quality of resident care and for staffing, based on the average number of residents per day, registered nurse hours per resident per day and other criteria.
The facility fell below average when rated on quality of care for long-stay residents. According to the most recent information from Medicare.gov about the nursing home, 7.8% of long-stay residents at PruittHealth-Blythewood experience one or more falls with major injury — double the national average. A high percentage (13.3%) of high-risk long-stay patients also experience pressure ulcers, the report says.
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ST. PAUL, Minn. (AP) — Eleven Minnesota nursing homes are on a list of facilities cited by federal officials for patterns of health and safety violations.
The U.S. Senate Committee on Aging released a list of 400 nursing homes across the country that are in need of tighter oversight. The facilities were identified by the Centers for Medicare and Medicaid Services.
The St. Paul Pioneer Press says two nursing homes in Rochester and Red Wing already receive twice the normal amount of inspections and risk losing federal funding if problems are not addressed.
The 11 facilities identified for stricter oversight are just 3 percent of Minnesota’s nursing homes. The state has about 375 nursing facilities that serve 40,000 residents.
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The patient from Long Beach Healthcare Center was rushed to a hospital in August 2018 with an abdomen so distended from constipation that it looked as if she had “three soccer balls inside of her stomach,” according to state records.
She died 12 days later due to respiratory failure and severe sepsis from a urinary tract infection and pneumonia. A state investigation later found that the staff at Long Beach Healthcare Center made several critical errors, including not properly monitoring the woman’s deteriorating condition and failing to report that she had not had bowel movement for seven days.
The Wrigley-area facility in February was issued a rare “AA” citation—the state’s most serious violation when it’s determined that a nursing home directly caused a resident’s death.
Long Beach Healthcare Center is one of two Long Beach facilities that are named on a federal list of nearly 400 nursing homes across the country with serious ongoing health, safety or sanitary problems.
The list, released this month by U.S. senators, notes facilities with a “persistent record of poor care” that haven’t previously been released to the public, according to a Senate report.
The fact that the list has not been released to the public in previous years undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified, according to two senators who released the report.
“We’ve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis,” said Sen. Bob Casey, D-Pa., who along with Sen. Pat Toomey, R-Pa., issued the report.
About 1.3 million Americans live in nursing homes; they are cared for in more than 15,700 facilities. The senators’ report noted that problem nursing homes on both lists account for about 3 percent of the total.
In California, which has the country’s largest concentration of nursing homes, 34 facilities were on the list. Overall, California’s nursing homes average about 12.5 health citations, compared to 7.9 nationwide.
Records show that Long Beach Healthcare Center and the other facility on the federal list—Windsor Gardens Convalescent Center of Long Beach—have a history of health citations, according to the Nursing Home Compare website, which is run by the Centers for Medicare and Medicaid Services.
Long Beach Healthcare Center has 39 citations—more than three times the state average. Windsor Gardens has 22 citations, including one from July when a resident was found restrained in bed and soiled with feces and urine.
Both facilities are rated one of out five stars on the federal website, indicating they are “much below average.”
Jon Peralez, an administrator for Windsor Gardens, in a statement said the facility acknowledges that is it on the list and will “continue to make improvements that maintain and improve the quality of care.” A representative of Long Beach Healthcare Center could not be reached for comment.
Michael Connors, a spokesman for California Advocates for Nursing Home Reform, said the federal ratings provide only a snapshot of problem facilities because they include only federal sanctions, not state violations recorded by state inspectors.
The problem in California, he said, is much worse.
“There are hundreds of poor-quality nursing homes here in California,” he said. “This list only identifies a handful of them.”
Connors said the problem is due to understaffing, poor oversight and a complicated web of “unscrupulous” companies that are allowed to own chains of nursing homes. Connors said for-profit entities have been able to acquire nursing homes even without state approval.
Records show that Windsor Gardens in Long Beach is owned by Blythe/Windsor Country Park Healthcare Center LLC, while Long Beach Healthcare Center’s owner is listed as Long Beach Healthcare Center LLC.
Problem facilities that have faced multiple sanctions are rarely closed, Connors said.
“The state almost never closes them, in fact not only does it not close them, it allows the operators who are responsible for this poor care to continue to operate and acquire more nursing homes,” he said. “It’s really a troubling system.”
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Pennsylvania’s U.S. Sens. Pat Toomey, a Republican, and Bob Casey, a Democrat, released the names of nearly 400 nursing homes nationwide with poor safety records that, until Monday, had not been publicly identified.
The Kentucky nursing homes included in the list are:
Klondike Center, Louisville
Springhurst Health and Rehab, Louisville
River Haven Nursing and Rehabilitation Center, Paducah
Woodcrest Nursing and Rehabilitation Center, Elsmere
Mountain Manor of Paintsville, Paintsville
Twin Rivers Nursing and Rehabilitation Center, Owensboro
Problems at Louisville nursing homes
Representatives with Klondike Center and Springhurst Health and Rehab did not immediately return requests for comment.
On the federal Nursing Home Compare website, Klondike Center, 3802 Klondike Lane, received a rating of “Much Below Average.”
Among the complaints against Klondike Center detailed in federal reports is a failure by staff in May 2018 to immediately notify a resident’s doctor when needed medication was not available to treat the resident.
The resident “had periods of confusion and an elevated ammonia level during the time when the medication was not administered,” according to the report.
Klondike Center’s failure to have “an effective system in place” to ensure physicians were notified when residents did not receive their medications “has caused or is likely to cause serious injury, harm, impairment or death to a resident,” the report noted.
In August 2018, a resident accused a male staffer at Klondike Center of sexual assault. Investigators determined the facility did not remove the alleged perpetrator from his role to “prevent the potential for further abuse.”
Klondike Center also failed to train staff on abuse prevention after the allegation, according to the report.
The nursing home was hit with a $13,627 fine in November 2018 and a $104,878 fine in October 2017, according to records.
Springhurst Health and Rehab, 3001 N. Hurstbourne Parkway, also received a one-star rating on Medicare.gov and has received numerous complaints in the past few years.
In January, investigators said a medication cart was left unlocked and unattended with two drawers open in the middle of a hallway.
Investigators also described in undated incidents how open food items with no dates or labels and expired food and drinks were found in Springhurst Health and Rehab.
A walk-in freezer had no thermometer and chemicals were stored in areas where food was prepared, according to reports.
Springhurst Health and Rehab has received 23 health citations, according to its Nursing Home Compare page, well above the average of 5.3 citations given to facilities in Kentucky and 7.9 given nationwide.
The nursing home was hit with fines of $250,023 in May 2018 and $88,021 in May 2017, according to the Nursing Home Compare website.
River Haven Nursing and Rehabilitation Center in Paducah also was mentioned among cases of nursing home neglect and abuse in the Senate report.
One resident at the facility who suffered from a burn wound and was receiving treatment that included a skin graft did not have their “dressing changed or showers administered as ordered,” according to the report.
State investigators at the Paducah facility found the individual “lying in bed with a large amount of green drainage on (their clothing) and a pool of green drainage on the bed sheets,” the Senate report said.
The resident told investigators they were not sure the last time their clothing had been changed.
“As evidenced by this report, oversight of America’s poorest quality nursing homes falls short of what taxpayers should expect,” the senators concluded.
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GREENWOOD — A Johnson County family is taking on a senior living community they say abused their elderly father, contributing to his death.
Joseph and Shulamit Frankel shared love and life in good and bad times after nearly 60 years of marriage.
“He was a good man,” Shulamit said. “He loved the children unbelievably.”
The couple met in Israel and both served in the Israeli military before moving to America in 1968 where they raised three children.
Joseph, a mechanic in Indiana for most of his life, retired to Florida. But when his health started to decline he moved back to Indiana for care.
Joseph’s family decided the Hearth at Stones Crossing in Greenwood would be the best place for his quality of life.
There were various pieces that we looked at. [Hearth at Stones Crossing was] the one that we looked at that would check on him more frequently than others,” Glenn said. “And you pay a little bit more for that, but it was one of the pieces that we really excited about.”
Joseph only lived at The Hearth at Stone Crossing from March 31, 2016, until he was removed from the facility on May 26, 2016.
He died less than a month later on June 13, 2016.
A pending lawsuit filed in 2018 claims that an employee assaulted Joseph on May 9 or May 10, 2016, which resulted in severe physical, emotional and psychological trauma.
“Listen to everything,” Joseph’s son, Glenn Frankel said. “If something doesn’t sound normal, it probably isn’t. We were told, he told us many times: ‘there’s an issue, there’s an issue.’”
In documents obtained from a state investigation against Hearth at Stone Crossing, the company expressed that abuse or mistreatment of patients is strictly prohibited.
The Hearth and Stone Crossing also completed their own review and concluded that Joseph’s injuries could have been caused by his falling out of bed. The facility did fire two employees for failing to meet performance and patient standards, although they could not definitively conclude that the workers had injured Joseph.
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WASHINGTON — Nursing facilities have failed to report thousands of serious cases of potential neglect and abuse of seniors on Medicare even though it’s a federal requirement for them to do so, according to a watchdog report released Wednesday that calls for a new focus on protecting frail patients.
Just 2 of 69 cases checked in five states were reported to local law enforcement
Auditors with the Health and Human Services inspector general’s office drilled down on episodes serious enough that the patient was taken straight from a nursing facility to a hospital emergency room. Scouring Medicare billing records, they estimated that in 2016 about 6,600 cases reflected potential neglect or abuse that was not reported as required. Nearly 6,200 patients were affected.
“Mandatory reporting is not always happening, and beneficiaries deserve to be better protected,” said Gloria Jarmon, head of the inspector general’s audit division.
Overall, unreported cases worked out to 18% of about 37,600 episodes in which a Medicare beneficiary was taken to the emergency room from a nursing facility in circumstances that raised red flags.
Responding to the report, Administrator Seema Verma said the Centers for Medicare and Medicaid Services does not tolerate abuse and mistreatment and slaps significant fines on nursing homes that fail to report cases.
Verma said the agency, known as CMS, is already moving to improve supervision of nursing homes in critical areas such as abuse and neglect and care for patients with dementia.
CMS officially agreed with the inspector general’s recommendations to ramp up oversight by providing clearer guidance to nursing facilities about what kinds of episodes must be reported, improving training for facility staff, requiring state nursing home inspectors to record and track all potential cases and monitoring cases referred to law enforcement agencies.
Neglect and abuse of elderly patients can be difficult to uncover. Investigators say many cases are not reported because vulnerable older people may be afraid to tell even friends and relatives much less the authorities. In some cases, neglect and abuse can be masked by medical conditions.
The report cited the example of a 65-year-old woman who arrived at the emergency room in critical condition. She was struggling to breathe, suffering from kidney failure and in a state of delirium. The patient turned out to have opioid poisoning, due to an error at the nursing facility. The report said a nurse made a mistake copying doctor’s orders, and the patient was getting much bigger doses of pain medication as a result. The woman was treated and sent back to the same nursing facility. The nurse got remedial training, but the facility did not report what happened. The report called it an example of neglect that should have been reported.
The nursing facilities covered by the report provide skilled nursing and therapy services to Medicare patients recovering from surgeries or hospitalization. Many facilities also play a dual role, combining a rehabilitation wing with long-term care nursing home beds.
Investigators said they faced a challenge scoping out the extent of unreported cases. They couldn’t query a database and get a number, since they were looking for cases that weren’t being reported to state nursing home inspectors.
To get their estimate, auditors put together a list of Medicare billing codes that previous investigations had linked to potential neglect and abuse. Common problems were not on the list. Instead it included red flags such as fractures, head injuries, foreign objects swallowed by patients, gangrene and shock.
The investigators found a total of 37,600 records representing 34,800 patients. Auditors then pulled a sample of cases and asked state inspectors to tell them which ones should have been reported. Based on the expert judgment of state inspectors, federal auditors came up with their estimate of 6,600 unreported cases of potential neglect and abuse.
Investigators found that nursing facility staff and even state inspectors had an unclear and inconsistent understanding of reporting requirements.
Medicare did not challenge the estimates but instead said that billing data comes with a built-in time lag and may not be useful for spotting problems in real time.
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