North Country Gazette



Report: State Nursing Home Inspections Deficient

Posted on Friday, 16 of May , 2008 at 9:05 pm

GLENS FALLS—State nursing home inspectors fail to cite serious deficiencies such as malnutrition, bedsores and abuse in their annual inspections of facilities such as Eden Park Health Care Centers and other nursing homes across the country, according to a report issued this week by the Government Accountability Office. 

The issuance of the report comes on the heel of purported investigations of two alleged wrongful deaths at the Eden Park nursing home in Glens Falls conducted by investigator Katy Kavarik of the state health department. Kavarik said she had reviewed the medical records of the two female patients in question and found nothing amiss, records that the nursing home controls without any outside review by family members or other oversight. Under contract with the federal government, state inspectors such as from the NYS Department of Health visit nursing homes annually. Nursing homes must meet federal standards to participate in Medicare and Medicaid. Nearly two thirds of the residents in the nation’s nursing homes are on Medicare or Medicaid at an annual cost of $75 billion.

The report was requested by the Senate’s Special Committee on Aging which has been spearheading reform in the nursing home industry. The report concludes that “poor quality of care—worsening pressure sores or untreated weight loss—in a small but unacceptably high number of nursing homes continues to harm residents or place them at risk of death or serious injury.”

Sen. Herb Kohl (D-WI) committee chairman, and Sen. Charles Grassley (R-IA) requested the report. They have introduced a bill that seeks to improve nursing home care. They hope to attach the legislation, that would increase fines for violations of federal standards at nursing homes, to a Medicare bill.

Under the bill, nursing homes would have to pay $25,000 for serious deficiencies, compared with $10,000 currently, and $100,000 for serious deficiencies that result in the deaths of patients. In addition, the legislation would require nursing homes to provide consumers and the government with more information about ownership and “affiliated or related parties.”

According to the report, state inspectors missed at least one serious deficiency in 15% of the inspections checked by federal officials during fiscal years 2002 through 2007. In nine states—Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming– inspectors missed problems in more than 25% of the surveys analyzed. http://www.gao.gov/new.items/d08517.pdf

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” according to the report.

Last year, about one-fifth of the nation’s nursing homes were cited for serious deficiencies. Over 1.5 million people live in nursing homes.

GAO reports since 1998 have demonstrated that state surveyors, who evaluate the quality of nursing home care on behalf of CMS, sometimes understate the extent of serious care problems in homes because they miss deficiencies. CMS oversees the effectiveness of state surveys through the federal monitoring survey program. In this program, federal surveyors in CMS’s regional offices either independently evaluate state surveys by resurveying a home (comparative surveys) or directly observe state surveyors during a routine nursing home survey (observational surveys).

During the same period surveyed, missed deficiencies at the lowest level of noncompliance–the potential for more than minimal harm–were more widespread: nationwide, approximately 70 percent of federal comparative surveys identified state surveys missing at least one deficiency at the lowest level of noncompliance, and in all but five states the number of state surveys with such missed deficiencies was greater than 40 percent.

Undetected care problems at this level are a concern because they could become more serious if nursing homes are not required to take corrective action. The most frequently missed type of deficiency on comparative surveys, at the potential for more than minimal harm level and above, was poor quality of care, such as ensuring proper nutrition and hydration and preventing pressure sores.

Federal observational surveys highlighted two factors that may contribute to understatement of deficiencies: weaknesses in state surveyors’ (1) investigative skills and (2) ability to integrate and analyze information collected to make an appropriate deficiency determination. These factors may contribute to understatement because they directly affect the appropriate identification and citation of deficiencies.

CMS has taken steps to improve the federal monitoring survey program, but weaknesses remain in program management and oversight.

The 2005 federal inspection report of Eden Park Health Care Center in Glens Falls indicated that the corrections were shown as being needed in dietary services; that significant corrections were needed in the quality of care and that corrections were needed in providing residents rights. The overall rating for the Eden Park Health Care Center in Glens Falls was that “significant corrections were needed”, just one step below the “immediate jeopardy” rating. The facility’s overall rating was “needing corrections” but yet it ruled that it was in compliance with Life Safety Code requirements. December 2005 Report

However, the state inspection reports conducted by the state Department of Health usually “find” only minimal concerns, if any. When the federal inspection was done as a followup to the state visit, deficiencies in the quality of care, residents’ rights and physical environment were found and reportedly corrected. But when the most recent federal inspection of the Glens Falls facility was released in early 2007, it was found that the facility was not equipped and maintained to provide a safe environment for residents, personnel and the public.

Inspectors determined that the Glens Falls home failed to hire only people who had no legal history of abusing, neglecting or mistreating residents, failed to report and investigate any acts or reports of abuse, neglect or mistreatment of residents; failed to give professional services that follow each resident’s written are plan and failed to make sure that a working call system is available in each resident’s room or bathroom and bathing area. http://www.northcountrygazette.org/2008/04/10/eden_park_abuse/

http://nursinghomes.nyhealth.gov/browse_view.php?pfi=1010http://www.medicare.gov/    

Eden Park has a history of poor care, especially under the management of Scott Hoffman.  In enforcement actions announced last spring by the state Department of Health for the last quarter of 2006, three Eden Park facilities were cited. The Cobleskill facility was cited for giving substandard care, putting their residents in jeopardy or causing resident harm.  As of last December, the Cobleskill facility was not allowed to admit any new Medicaid or Medicare residents until the care issues were corrected.  The facility closed and is no longer owned by Eden Park.Since last fall, Hoffman, owner of the Eden Park facilities in Glens Falls, Catskill, Utica and Poughkeepsie, has been advancing a plan to sell the facilities to a group from Lynbrook, LI, operating under the name of Marvin Ostreicher.

According to the records of the NYS Department of Health, Certificates of Need were issued last September to Glens Falls Crossings LLC, Catskill Crossings LLC, Poughkeepsie Crossings LLC and Utica Crossings LLC for the operation of the nursing homes operating under the Eden Park name in those cities.

DOH claimed that those entities were the new operators of the four facilities but none of those entities were legally registered with the Department of State.

The Warren County Clerk’s office says there’s no record of Glens Falls Crossings LLC doing business in the county and the Department of State confirmed as recently as Feb. 21 that there were no limited liability companies registered as “Crossings” with the state.

The North Country Gazette had written an extensive article regarding the Eden Park facilities on Feb. 9 and in particular, the extensive history involving poor care of residents in Eden Park facilities.

With days of the appearance of NCG’s article, the website for Glens Falls Crossings LLC which was shown to be “under construction” disappeared from the Internet and remains unavailable. http://www.northcountrygazette.org/2008/02/09/no_eden_park_paradise/

After a complaint was filed in March by The North Country Gazette with both the state Attorney General’s office and the state Department of Health concerning Certificates of Need having been issued to entities listing as operators of the Eden Park Health Care facilities but which were not legal entities registered with the state, on April 10, Articles of Organization were filed for Glens Falls Crossings LLC showing the principal place of business as 170 Warren St., Glens Falls, site of the Eden Park Nursing Home. The agent is shown to be Duane Morris LLP of 1540 Broadway in New York City, to the attention of attorney Jerome T. Levy.

How can one conduct operations in the state, billing Medicare and Medicaid without being a legally registered and established entity, especially a health care facility?

Glens Falls Crossings LLC and the other three Crossings did so at the Eden Park facilities for over six months.  So far, neither the Attorney General’s office or Department of Health has provided NCG with an explanation.  5-16-08

Category: Adirondacks, Business, Consumers, Disabled, Elder Care, Family, Government, Health, Nationwide, New York State, Opinion

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