Report: Eden Park Denies Rights To Residents
Posted on Saturday, 13 of September , 2008 at 10:24 pm
By June Maxam
GLENS FALLS—Over and over and over again, health deficiencies are found at the Eden Park Nursing Home, now known as Glens Falls Crossings LLC.
Now it’s escalated to the point where the residents are not being informed of their legal rights, particularly in regard to advanced directives and Medicaid benefits.
When the Department of Medicare and Medicaid Services of the U.S. Department of Health and Human Services inspected the facility in December 2005, it gave the facility an overall rating of needing corrections but yet ruled that it was in compliance with Life Safety Code requirements.
Deficiencies in the quality of care, residents’ rights and physical environment were found and reportedly corrected but when the facility was inspected last year, it was found that the facility was not equipped and maintained to provide a safe environmental for residents, personnel and the public.
But yet the nursing home is home to nearly 120 residents. The inspection reports are disturbing and raise grave questions about the administration of the nursing home under the direction of Lloyd Cote.
The most recent inspection conducted in January is even more disturbing in that the facility was found to have failed to inform residents of their legal rights, services and charges.
It was found that the facility failed to tell each resident who can get Medicaid benefits about which items and services Medicaid covers and which the resident must pay for or how to apply for Medicaid, along with the names and address of state groups that can help. http://www.nyhealth.gov/facilities/nursing/statements_of_deficiencies/1010sod012408_032408.pdf
When one first hears of Eden Park Health Services which owns and manages nursing homes in New York, Connecticut and Vermont, including the Eden Park Health Care Center in Glens Falls, now known as Glens Falls Crossings, they would perceive the facilities to be places of complete bliss, delight and peace.
And that would be a fallacy.
There is a serious absence of compassion and denial of dignity at Eden Park in Glens Falls. Patients are denied their rights, their dignity, their self esteem, their self worth. Even when they make their advance directives, choose their health care proxy, make their own decisions and are perfectly capable of doing so, the hierarchy forces them to disregard their personal choices and change to a person the nursing home wants to deal with, and fearful of retaliation, the residents sign the paper.
Residents who are cognizant are constantly keep in a level of stress and anxiety by staff members telling them they’ll have to go to the hospital if they don’t have a bowel movement, like that’s something in the resident’s control. On at least one occasion, the resident was admitted to the hospital for two days, without the knowledge of family members, just to have an enema administered because there was no doctor on duty at the nursing home. What a waste of Medicaid and Medicare funding or private insurance and what a emotionally devastating experience for the resident.
It’s inhumane to deliberately scare the residents, fearing that they’ll be forced to go to the hospital. Some of the residents have many times voiced that they wish they could go somewhere else because of abuse and neglect, but fearful of retaliation if they complain.
Last year, inspectors determined that the Glens Falls facility failed to hire only people who have 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.
Eden Park has a history of poor care. 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 and is no longer owned by Eden Park.
Eden Park’s four nursing homes—Glens Falls, Catskill, Poughkeepsie and Utica and an assisted living center in Troy, were sold to a group from Lynbrook, LI, operating under the name of Marvin Ostreicher.
Ostreicher, president of the National Healthcare Associates, is listed as a director of the Connecticut Association of Health Care Facilities and the owner of 17 skilled nursing facilities.
According to the state Department of Health, Certificates of Need were issued on Sept. 19, 2007 to Glens Falls Crossings LLC, Catskill Crossings LLC, Poughkeepsie Crossings and Utica Crossings LLC for the operation of the nursing homes operating under the Eden Park name in those cities. According to the DOH website, as of September 2007, those entities are the new operators of the four Eden Park Health Centers in New York State.
However, there’s just one problem. None of those entities which are supposedly operating the four Eden Park nursing homes were registered as legal entities with the Department of State until April. As of February, there was no record in the Warren County Clerk’s oOffice of Glens Falls Crossings LLC doing business in the county. How can one do business in the state without being legally registered, especially a health care facility and why weren’t they cited for the subterfuge?
http://www.northcountrygazette.org/2008/02/09/eden-park-no-paradise-sale-still-pending/
The most recent inspection, completed in January, indicates a serious and troubling failure to inform residents and their families about advanced directives.
By law, the facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. The facility must also provide the resident with the notice (if any) of the State developed rules under §1919(e)(6) of the Act. Such notification must be made prior to or upon admission and during the resident’s stay. Receipt of such information, and any amendments to it, must be acknowledged in writing.
The facility must inform each resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility or, when the resident becomes eligible for Medicaid of the items and services that are included in nursing facility services under the State plan and for which the resident may not be charged; those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services; and inform each resident when changes are made to the items and services specified.
The facility must inform each resident before, or at the time of admission, and periodically during the resident’s stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare or by the facility’s per diem rate.
The facility must furnish a written description of legal rights which includes:
A description of the manner of protecting personal funds, a description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment under section 1924(c) which determines the extent of a couple’s non-exempt resources at the time of institutionalization and attributes to the community spouse an equitable share of resources which cannot be considered available for payment toward the cost of the institutionalized spouse’s medical care in his or her process of spending down to Medicaid eligibility levels.
The facility must also furnish a posting of names, addresses, and telephone numbers of all pertinent State client advocacy groups such as the State survey and certification agency, the State licensure office, the State ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit; and a statement that the resident may file a complaint with the State survey and certification agency concerning resident abuse, neglect, and misappropriation of resident property in the facility, and non-compliance with the advance directives requirements.
The facility must comply with the requirements specified related to maintaining written policies and procedures regarding advance directives. These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and, at the individual’s option, formulate an advance directive. This includes a written description of the facility’s policies to implement advance directives and applicable State law.
The facility must inform each resident of the name, specialty, and way of contacting the physician responsible for his or her care. The facility must prominently display in the facility written information, and provide to residents and applicants for admission oral and written information about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by
such benefits.
Eden Park, or Glens Falls Crossings, failed to do so. The inspection report indicates that these requirements were not met as evidenced. Based on medical record review, staff interview, and resident interview, it was determined the facility did not ensure that residents were informed on admission and periodically during the resident’s stay, of the right to formulate advanced directives for 7 of 23 residents reviewed for advance directives during the standard recertification survey.
Specifically, the facility did not ensure that the residents were informed, at the time of admission, and periodically during the resident’s stay of the right to execute their wishes for a Do-Not Resuscitate (DNR) order, Living Will (LW), and/or Health Care Proxy (HCP). This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.
This is evidenced by the following:
1. Resident #76: The facility did not ensure that the resident’s wishes for advanced directives of DNR, LW, HCP were discussed in a timely manner after being admitted to the facility. The resident was admitted on 4/12/06 with diagnoses of Crohn’s disease, heart disease and hypertension. The Minimum Data Set (MDS) dated 10/30/07 assessed the resident as having intact short and long-term memory with
independent decision-making skills. Also, the MDS assessed the resident as being able to be understood and as being able to understand others.
Review of the advanced directive section of the resident’s medical record revealed a DNR dated 2/9/07. The physician’s order revealed that the resident had a DNR order written on 2/9/07 per the resident’s request (approximately 10 months after being admitted). The physician’s progress notes revealed no documentation of discussions with the resident in relation to her right to initiate a DNR at the facility prior to this date of 2/9/07.
The social worker (SW) notes revealed that there was no evidence that there had been discussion, education, or follow-up with the resident on her right to execute a LW and a HCP. In addition, there was no documentation in the SW notes of DNR discussions with the resident. The SW note dated 11/6/07 noted that the resident had a DNR form on file.
During an interview on 1/23/08 at 8:25 am, the Registered Nurse Manager (RNM) stated that if a resident was admitted into the facility with a DNR from the hospital, and wished to continue the DNR then the staff would refer to the physician to
complete a facility DNR form. The RNM said that if the resident did not have a DNR in place, then the physician would discuss the risks and benefits of DNR or Cardiopulmonary Resuscitation (CPR).
The RNM said that residents admitted for short-term rehabilitation were encouraged to complete an advance directive. The RNM stated that to her knowledge, the SW would address on admission if the resident had a HCP or LW. During an interview on 1/23/08 at 9:00 am the Director of Social Work stated that all residents admitted to the facility were provided with a policy statement on advanced directives. She said that the admissions department would briefly review the policy with the family/resident.
She stated that facility staff would assist the resident if interested in executing advance directives. She stated that presently the facility did not have a process of documenting whether or not staff followed-up on residents advanced directive decisions. In addition, she stated that she could not provide any written evidence of discussions held with residents on advance directives to include education, review, and/or follow-up.
During an interview on 1/24/08 at 8:10 am the resident stated that her physician in the community had reviewed DNR a long time before she was admitted to the facility, but she did not wish to have a DNR at that time. She stated she did not make a decision to execute a DNR until February 2007, when a family member became very ill. She said that she decided herself that she would not want to be kept alive in such a state. She stated the physician at the facility did not discuss a DNR prior to her request.
She said that she did have a HCP but did not have a LW, and she believed the HCP was in her medical record. During a second interview held on 1/24/08 at 8:45 am the Director of Social Work stated that she was unaware of the delay in advanced directives being addressed with the resident, but she stated that she had always left that up to the medical staff to address it. She stated that she was responsible for completion of the HCP and LW.
She was unaware of this resident having a HCP.
She stated that after admission, she did not review residents advanced directives regularly.
Resident #27: The facility did not address or follow-up on DNR or LW with the resident in a timely manner after admission. The resident was admitted to the facility on 2/21/07 with the diagnoses of hypertension, chronic renal insufficiency, and carotid artery disease. The MDS dated 10/30/07 assessed the resident as having intact short and long-term memory with independent decision-making skills, and as understood and able to understand. The MDS dated 1/7/08 assessed the resident as
having short and long-term memory loss and as being sometimes understood and as being able to sometimes understand others.
Review of the SW admission note dated 2/21/07 revealed that the resident had a HCP, but did not address that there was discussion or follow-up to be done on LW or DNR. This note also documented that the resident was alert and oriented and able to participate in goal oriented conversation. The initial SW assessment dated 3/5/07 also noted there was a HCP on file, but did not indicate any follow-up to be done on other advanced directives such as a LW or DNR.
The physician’s progress notes dated from 2/23/07 to 4/30/07 revealed that there was no documentation of discussions with the resident/family regarding advance directives. It was in the physician progress note of 5/14/07, three months after admission, that there was a discussion with the resident in regard to advance
directives which noted that the resident was “quite clear that she wanted nature to take its course should her heart or breathing stop”. This note indicated that the resident would like DNR status.
Review of the physician orders from 2/23/07 to 4/16/07 revealed the resident to be a CPR. Then on 5/14/07, the physician orders noted the resident as a DNR/do-not-intubate (DNI)/no dialysis. There was no documentation in the medical record that advance directives were discussed with the resident until 5/14/07, three months after admission.
The nursing note dated 5/14/07 documented that there was a new order for a DNR with capacity and noted that the physician explained it to the resident. This note documented, “the resident responded clearly that she did not want chest compressions and to just let me go.”
During an interview on 1/23/08 at 1:45 pm the SW stated that residents/families were given advanced directive information on admission. She stated that nursing staff usually approached the resident/family about advanced directives soon after admission. The SW said that the residents advanced directives would be discussed with nursing staff on an on-going basis but the SW said she did not document these discussions. During an interview on 1/24/08 at 8:05 am the RNM stated that the resident received advance directive information in the admissions packet.
She stated that the staff frequently speak to the family/resident about DNR, but staff do not document the conversations. She did not have any documentation that advanced directives were discussed with the resident.
Resident #90 The facility did not address LW or HCP in a timely manner after admission with the resident. The resident was admitted on 6/29/07 with
diagnoses of multifactorial falls and weakness, chronic obstructive pulmonary disease, and a history of atrial fibrillation. The MDS dated 11/13/07 assessed the resident as having impaired short-term memory and moderately impaired decision-making skills.
The Comprehensive Care Plan (CCP) for psychosocial dated 6/29/07 identified the resident with some memory impairment, but also as alert and oriented. This CCP noted that the resident was able to participate in goal based conversation. The admission SW note dated 7/2/07 revealed the resident was admitted on short-term
rehabilitation and that a DNR order was in effect.
The initial SW assessment note dated 7/11/07 revealed that the resident had a DNR order. Then on 11/20/07, a quarterly SW assessment noted the resident was admitted as a long-term resident due to his lack of rehabilitative therapy involvement. This latter note again noted that the resident had a DNR. There was no documentation in the medical record that the resident’s right to execute a LW or
HCP was ever addressed, discussed, or followed up on with the resident.
During an interview on 1/23/08 at 9 a.m., the director of social work stated that she did not always get advanced directives for residents during their rehabilitative stay since many were discharged in a couple of weeks. She confirmed that if there was no documentation in the resident’s medical record for advance directives, then she could not say that it ever occurred. She stated that there may be a problem addressing
advance directives when a resident goes from a short-term to a long-term admission. She stated that there should be follow up, education, and discussion with both short and long-term residents/families on the right to formulate advanced directives.
The Centers for Medicare & Medicaid Services (CMS) is the component of the Federal government’s Department of Health and Human Services that oversees the Medicare and Medicaid programs. A large portion of Medicare and Medicaid dollars is used each year to cover nursing home care and services for the elderly and disabled.
State governments oversee the licensing of nursing homes. In addition, States have a contract with CMS to monitor those nursing homes that want to be eligible to provide care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid. These requirements are broadly outlined in the Social Security Act (the Act). The Act also entrusts the Secretary of Health and Human Services (DHHS) with the responsibility of monitoring and enforcing these requirements. CMS, a DHHS Agency, is also charged with the responsibility of working out the details of the law and how it will be implemented, which it does by writing regulations and manuals.
CMS contracts with each State to conduct onsite inspections that determine whether its nursing homes meet the minimum Medicare and Medicaid quality and performance standards. Typically, the part of State government that takes care of this duty is the health department or department of human services. The State conducts inspections of each nursing home that participates in Medicare and/or Medicaid on average about once a year. If the nursing home is performing poorly, however, the State inspectors may go in more frequently. The State also investigates complaints about nursing home care.
During the nursing home inspection, the State looks at many aspects of quality. The inspection team observes resident care processes, staff/resident interaction, and environment. Using an established protocol, the team interviews a sample of residents and family members about their life within the nursing home, and interviews caregivers and administrative staff. The team reviews clinical records.
The inspection team consists of trained inspectors, including at least one registered nurse. This team evaluates whether the nursing home meets individual resident needs. In addition, fire safety specialists evaluate whether a nursing home meets standards for safe construction. When an inspection team finds that a home does not meet a specific regulation, it issues a deficiency citation.
The regulations cover a wide range of aspects of resident life, from specifying standards for the safe storage and preparation of food to protecting residents from physical or mental abuse or inadequate care practices. There are over 150 regulatory standards that nursing homes must meet at all times. Many are related.
Fire safety specialists evaluate whether a nursing home meets standards of the Life Safety Code (LSC) requirements established by the National Fire Protection Agency (NFPA). The LSC is a set of fire protection requirements designed to provide a reasonable degree of safety from fire. The LSC, which is revised periodically, is a publication of NFPA, which was founded in 1896 to promote the science and improve the methods of fire protection. The basic requirement for facilities participating in the Medicare and Medicaid programs is compliance with the 2000 edition of the LSC.
The Fire Safety inspection covers a wide range of aspects of fire protection, including construction, protection and operational features designed to provide safety from fire, smoke, and panic. When an inspection team finds that a home does not meet a specific regulation, it issues a deficiency citation. Facilities with waivers of the health occupancy provisions of the LSC or with an acceptable Plan of Correction are considered “in compliance.”
Depending on the nature of the problem, CMS can take action against the nursing home. The law permits CMS to take a variety of actions; for example, CMS may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it takes an enforcement action. If the nursing home does not correct its problems, CMS terminates its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiaries residing in the home at the time of the termination are transferred to certified facilities.
http://www.northcountrygazette.org/2008/05/16/deficient_inspections/
http://www.northcountrygazette.org/2008/04/10/eden_park_abuse/
http://www.northcountrygazette.org/2008/02/28/eden-park-nursing-home-cited-again-for-deficiencies/
http://www.northcountrygazette.org/2007/05/20/eden-park-nursing-home-unsafe-environment-inspection/
http://www.northcountrygazette.org/articles/102906EdenParkCorrections.html 9-13-08
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