MA Nursing Homes with the Most Health + Safety Violations

Tuesday, September 09, 2014

Stephen Beale, GoLocalWorcester News Contributor

Massachusetts nursing homes have been hit with $2.7 million in fines for violations of federal health and safety standards over the last four years, national data shows.

The biggest fine of $133,901 went to Coolidge House in Brookline after an inspection in September 2013 turned up a whole slew of violations, including a resident with a food allergy who was twice served with fish. The second time the resident went into anaphylactic shock and had to be hospitalized.

The biggest fines are typically associated with serious deficiencies, which are violations of federal health and safety standards that cause harm, put a resident in immediate jeopardy of harm, or create a potential for harm, according to Charlene Harrington, a professor emeritus at the University of California at San Francisco School of Nursing and a national expert on long-term nursing care.

In Massachusetts, 13 nursing homes had serious deficiencies. Two were tied for four deficiencies in a three- to four-year period: Williamstown Commons Nursing and Rehabilitation in Williamstown and Hathaway Manor Extended Care in New Bedford.

Annual Inspections

Nursing homes are subject to routine annual inspections to assess their compliance with federal safety and health standards that are issued by the Centers for Medicare and Medicaid Services. Those inspections are carried out by state agencies—typically, the Department of Health. Inspectors mark deficiencies when a home fails to meet a particular federal standard. There are over 200 of them and they range widely, from using the wrong kind of plates to failure to secure a building so patients with dementia won’t wander off.

Four nursing homes had more than 40 deficiencies overall over the last few years. Topping the list is the Holyoke Geriatric and Convalescent Center in Holyoke, which had 48 deficiencies, according to federal data, which was obtained through a ProPublic database. Three of those four homes were also hit with fines, with the highest amount—$104,728—going to the Medford Rehabilitation and Nursing Center in Medford. Among its 42 deficiencies, one was deemed serious—causing harm, jeopardy, or the potential for both.

Nursing home industry officials say that having a high number of deficiencies does not necessarily indicate a poor quality of care. “Deficiencies are not equivalent to lousy care—they range in significance from crumbs under the toaster to failure to secure a locked unit,” said Virginia Burke, the president of the Rhode Island Health Care Association, a trade organization which represents nursing homes in that state.

Undercounted Offenses

Burke and her counterpart in Massachusetts, Ned Morse, the president of the Massachusetts Senior Care Association, say there are a number of factors that should be considered when deciding to place a parent or other loved one. Those factors include customer satisfaction surveys, staffing levels, and even the reputation a home has in the local community. “Inspections are important, but they are just one part of oversight,” Morse said in an interview.

But Harrington says the deficiencies are an accurate measure of health and safety conditions in a nursing home.

“They’re fairly accurate,” Harrington said. “If anything, they’re actually undercounted.”

She said state inspectors typically lower the scope and severity of deficiencies they find. (She blames a combination of poor training, low pay, and high turnover.) If a fine is issued, she said that means a state inspector is convinced there is a serious issue at a nursing home. That is because the issuing of a fine is almost always appealed by the home, making for a particularly cumbersome process, according to Harrington.

In Massachusetts, 158 out of 431 homes were issued a fine. Some were a few hundred dollars. Roughly a third of the fines issued were under $2,000. About as many were $15,000 or higher.

Those with the most fines also tend to have serious deficiencies.

Reaching out to Nursing Homes

At the Hathaway Manor Extended Care, management and staff “failed to ensure that residents were not exposed to risk of serious harm from medication error,” according to a September 13, 2013 inspection report. One of those residents passed away.

“For Resident #20, the facility failed to ensure the medication ordered by the physician was documented correctly on the medication administration record (MAR) and administered as ordered,” the report states. “Staff failed to recognize and clarify the medication administration record for three days and documented that the wrong dose of medication was administered. The resident, who showed significant changes in condition, was not provided timely clinical interventions following the administration of the incorrect dose of medication. The resident died the next morning.”

That inspection, which yielded a total of 18 deficiencies, ultimately resulted in a $128,863 fine for Hathaway Manor.

An administrator at the home did not respond to a message seeking comment on Friday.

At the Golden Living Center-Chetwynde in West Newton in April 2013, inspectors reported that inadequate supervision had led to a resident wandering outside the building and falling down the front steps, causing a traumatic head injury. Inspectors also found that staff had delayed CPR on another resident who was found unresponsive. Once CPR was commenced, one nurse trying to resuscitate a patient used a method of CPR—an initial blow to the chest—that has not been in use since the 1970s, according to the report. The patient subsequently died.

GoLocalWorcester also attempted to reach out to Golden Living Center-Chetwynde for comment. An employee who answered the phone and did not give her full name said the home’s corporate office would need to be reached for comment. She took a reporter’s name and number and promised to pass it on, but declined to name the corporate owner or provide any more information. “I’m not comfortable giving you any information at this point,” the woman said.

GoLocalWorcester received a similar response when attempting to reach officials for comment at the Clark House Nursing Center at Fox Hill in Westwood, which had two deficiencies. The woman who answered the phone referred all requests for comment to the corporation. She identified the corporation as Kindred Healthcare in Louisville Kentucky, but was unable to provide a number. “You have to go online and find it. It don’t have it,” said the woman. (A message left for two officials at Kindred Healthcare was not returned.)

Morse said he was unable to comment on any specific cases. Overall, he said his organization has worked closely with state health officials to cooperatively address any issues that have come up in inspections. (A spokeswoman for the Department of Health was unable to provide a comment in time for publication.) Morse pointed to stopping the inappropriate use of anti-psychotic drugs as an example. He also said that Massachusetts has become a pioneer and a model for other states in such areas as fall prevention.

Compared to most other states, Massachusetts nursing homes overall have lower average annual number of deficiencies, an estimated 4.7 per home, according to data compiled by the Kaiser Family Foundation. The Bay State is beat by just North Carolina, which had 4.4, and Rhode Island, at 2.7.

In terms of the average number of serious deficiencies per home, Massachusetts ranks sixth among the states, with .06 serious deficiencies per home, behind some states like Hawaii, which had no serious deficiencies in any of its homes during the period. At the other end of the scale are states like Kentucky, which had an average of 1.43 serious deficiencies per home, according to the ProPublica data.

Related Slideshow: Top 30 MA Nursing Homes with the Most Deficiencies

Below are the top 30 nursing homes with the most deficiencies in federal health and safety standards. Homes are listed in order of most to least deficiencies, starting with those that had serious deficiencies that caused actual harm to a resident. Data encompasses inspections over a three to four-year period in order to provide a more complete picture. Some nursing homes may have since corrected the deficiencies identified during the most recent inspections.

Source: Federal Medicare data obtained through the ProPublica database.

MA Nursing Homes with the Most Health + Safety Violations

Related Slideshow: Top 30 MA Nursing Homes with the Most Deficiencies

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