BRP in the News

Reports outline nursing facilities’ flaws – from minute to life-threatening

featured in the Times-News on June 16, 2011
By Ben Botkin – Times-News writer

When Janice Stover was living at BridgeView Estates in Twin Falls, a staffer dropped by her room with a pill, telling her to take it for GERD.

Stover, 74, didn’t have the stomach ailment. In fact, she came to the nursing facility in January for a two-month stay after shattering her femur in a fall. She’s since returned home, taking physical therapy and recovering from the injury.

“I said I didn’t have anything wrong with me,” Stover told the Times-News. “And she said, ‘Well, you’re supposed to take this.’ So I took the pill and I thought, ‘Well, if it makes me sick, I’ll really be complaining because I really checked my meds every day.’”

The next day a different staffer came in with the same medication, she said. Stover insisted it wasn’t prescribed for her.

“The nurse on duty said, ‘Well, I think you are,’” Stover said. “And I again said, ‘You’ll have to check.”

The nurse came back with word that Stover was correct — it was medication intended for someone else with a similar name, Stover said.

Anecdotes like Stover’s bring to light some of the difficulties of caring for some of Idaho’s most vulnerable residents. In 2010, more than 57 percent of Idaho nursing homes provided unnecessary drugs to patients, according to inspection reports filed by the Idaho Department of Health and Welfare.

Medicinal mix-ups with lucid patients like Stover may prove to be minor, but may also point to larger issues of a facility’s oversight.

At BridgeView, for example, an inspector found in 2010 that a resident other than Stover was receiving an antipsychotic drug without a diagnosis.

Overall, Stover said her experience at BridgeView was good for her needs. She was laid up for a couple months with the broken leg and not ready to return to independent living. She’s quick to point out the home’s positives, like a good therapy and a nutritionist who helped her pick palatable meals.

For those looking for nursing homes to live in, or move their family members to, inspection reports offer one readily available tool to gauge a facility’s fitness. Inspections must take place at least once every 15 months, and their results offer the public a sense of where nursing homes need to make improvements.

Nursing homes are among America’s most heavily regulated industries because of their reliance on Medicare and Medicaid patients, which means they operate under hundreds of rules covering issues large and small — like keeping medical paperwork in order, safety, hand-washing and the prevention of bedsores.

State reports of area facilities reviewed by the Times-News show the following examples of the inspections’ depth:

• State inspectors visiting Twin Falls Care and Rehabilitation Center in February conducted interviews with residents who complained of staffing shortages and long delays for care. One resident told an inspector her call light was on for 90 minutes with no response until she used her telephone to call the nurse station. Two others said they had to wait two hours after requesting pain medication. Yet another resident, after asking for pain medication, was told by a staffer: “You’re not the only one in the building,” according to the report.

• Also at the same facility, staff waited two days before notifying a doctor when a resident developed respiratory problems and an elevated temperature. One day after being sent to a hospital, the resident died last October. The state found that during that two-day period, nursing staff failed to properly notify a doctor or to assess the patient’s condition. A full day before being sent to the hospital, the resident’s temperature was measured as slightly exceeding 100 degrees.

• Inspectors found that BridgeView caretakers didn’t take all the necessary steps to prevent sores for four of 18 residents sampled. BridgeView did not respond to multiple requests for comment.

• Other violations are less serious and can be quickly remedied. Fixing handrails, getting veterinarian inspections for pet birds and clarifying residents’ care plan documentation are all examples of minor violations the inspections note.

The inspections

Debby Ransom, bureau chief for facilities standards for the Idaho Department of Health and Welfare, oversees the teams that visit nursing homes for inspections, which are required under federal Medicare and Medicaid rules.

Inspections are also called site surveys, and they’re no quick task. Typically the state sends in a team of at least two people to do the inspection — sometimes more if it’s a larger facility.

Often, an inspection is a weeklong event that starts with an unannounced arrival. Inspectors talk to residents, staff members and residents’ family to see if they have questions or concerns. The team also looks at different practices like treatment of residents and food sanitation, and examines records to learn about residents’ care and the nursing home’s practices.

For the public, picking the best nursing home is more complicated than just looking for a deficiency-free inspection. That hasn’t happened in the last two years in Idaho, Ransom said, stressing that nursing homes take seriously the problems that are highlighted.

After receiving their inspections, nursing homes are required to submit plans to correct the highlighted problems and become compliant within 90 days.

Otherwise, penalties can follow, including the facility losing its ability to serve Medicare or Medicaid residents.

The inspections and results are posted online at the Idaho Department of Health and Welfare’s website. Nursing homes are required to make a copy available to the public as well.

Ransom said it’s important for those seeking a nursing home to look at more than just inspections. People should also get tours and find out how long the administrator and director of nursing have been there, she said.

“You just have to look at the whole picture, and our inspections are only a piece of it,” she said. “You have to go in and talk to people and look at things — see what it looks like.”

Nursing homes weigh in

Kelly Spiers, administrator of Twin Falls Care and Rehabilitation Center, responded to the Times-News’ inquiry with a written statement, saying the state inspections help guide the facility’s work of providing the best possible care.

“In the past, when the state has determined an area of concern, we immediately correct it, and provide our plan to improve our processes moving forward,” he said, adding that families are always welcome to tour the center and see the state survey results. “The state has accepted our plans of correction placing us in substantial compliance. Caring for the elderly is a role we take very seriously and our processes for improvement are addressed with assessment meetings, patient outcomes and ongoing staff training.”

The number of violations can vary greatly from site to site and inspection to inspection. Twin Falls Care and Rehabilitation had 22 violations listed from a February inspection and five from last year’s inspection, the most severe of which dealt with adequate staffing levels. The 22 violations are the highest combined tally of any Idaho facility for 2010 and 2011 so far this year, according to Medicare data .

Desert View Care Center in Buhl, had 11 violations noted last November, all of them considered minor, like paperwork that needed to be updated.

“I really think our facility takes care of the people first,” said administrator Cindy Riedel, adding that the center strives for a homelike environment for residents with a culture of caring.

Todd Russell, administrator of Lincoln County Care Center in Shoshone, said the 36-bed facility has a high staffing level of about one employee to three residents, which helps it do well on inspections. Also key to success is treating staff well, he said.

The center’s smaller size makes the care more personable, he said.

“I favor smaller facilities just because of the sheer numbers you tend to get a little better quality of care,” he said.

Advocates for care

Residents in nursing homes have another tool for getting problems corrected besides inspectors. The College of Southern Idaho Office on Aging has an ombudsman program that covers nursing homes in all of south-central Idaho.

Unlike inspections, which rely on whether or not regulations are followed, the ombudsman program works as a mediator between nursing homes and residents on challenges that aren’t necessarily a violation. The ombudsman isn’t bound by the rules, but still has authority from a federally-required program to visit homes, access records and advocate for residents.

“The ombudsman knows what those rules are, but our purpose is on a grassroots level to make sure that residents are getting the benefit of the rules day to day,” said Mary Edgar, director of the program. “We’re more a problem solver in the sense that we’re just trying to fix the issue.”

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