Articles Posted in Resident Safety

With the population aging and life expectancies increasing, nursing homes are becoming a part of more and more Maryland residents’ lives. Although many Maryland nursing homes offer quality care and safe facilities, nursing home abuse and neglect are still persistent problems across the state. It can be difficult to know the risk of this type of abuse and neglect when choosing a nursing home. While there may be warning signs to look for – such as past instances of abuse, or unclean or unsecure facilities – there are some cases where a seemingly fine nursing home may make decisions that then lead to abuse and neglect. Specifically, facilities that fall into financial trouble may cut staffing in the home, leading to new problems in a previously fine home.

For example, one nursing home was recently cited by the Centers for Medicare and Medicaid Services for making staffing decisions that led to several dangerous incidents. According to a news report covering the story, the home, which once operated seemingly without issue, suffered financially in recent years, leading them to cut staffing to save money. These personnel cuts led to an increase in quality-of-care violations cited by state regulators, with six violations in 2017 that jumpted to 22 in 2018 and 36 in 2019. The incidents included not having portable liquid oxygen tanks for patients who needed them, hiring an unlicensed caregiver, allowing a kitchen worker to supervise the dementia ward, and multiple instances of sexual abuse and medication errors. Additionally, inspectors found that the home, because it was short-staffed, was unable to adequately respond to residents’ requests for assistance. Some residents reported soiling themselves as they waited 40 minutes for someone to come to help them.

Incidents like these, which were particularly bad at this specific nursing home, unfortunately happen in facilities all across the country. Oftentimes, the patients are extremely vulnerable and frail, and may be unable to defend themselves or even tell someone else what is happening. Because of this, it is particularly difficult to catch nursing home abuse and neglect. When it is identified and caught, however, the state law allows the victims and/or their loved ones to file a suit against the home and hold them accountable for their actions. These suits may be difficult but can result in significant monetary compensation for those who have been harmed as a result of negligent staffing or other negligent actions performed by the nursing homes.

More Maryland families are searching for nursing homes for their loved ones. Many utilize the Nursing Home Compare website run by the Centers for Medicare and Medicaid Services (CMS), which offers information on certified nursing homes across the country. The website allows families to compare how nursing homes rank for health inspections, staffing, resident care, and more. In October, CMS announced an addition to the website to better inform consumers about nursing home abuse:  adding a new abuse warning icon – a red circle with an open palm – next to the names of nursing homes with a history of abuse or neglect.

The plan sparked immediate backlash and controversy, with advocates from the long-term care industry speaking out against the new icon. According to a new article covering the controversy, leaders from AMDA (the Society for Post-Acute and Long-Term Care Medicine) have called the new icon “misguided,” arguing that it will actually be counterproductive to patients and will negatively affect the motivation of staff members in nursing homes. A spokesperson from the American Health Association even called the red hand “dumb,” arguing that it is overly punitive and may improperly lead consumers away from quality nursing homes.

The government and supporters of the icon stand by their belief that the icon is beneficial to consumers. The CMS administrator wrote in October that the icon puts “critical information at consumers’ fingertips, empowering them and incentivizing nursing homes to compete on cost and quality.” Opponents, in response, argue that the icon could make consumers not even consider certain nursing homes, even if the abuse was long ago and resolved appropriately. Additionally, nursing homes without icons may be discouraged from reporting new incidents of abuse, out of fear of earning an icon on the website. Instead of an icon, opponents argue that the best way to end nursing home abuse is to encourage reporting of incidents.

Across the country, approximately 1.4 million elderly or disabled individuals receive care in over 15,000 nursing homes. While many of these nursing homes take great care of their residents, a recent study from the U.S. Government and Accountability Office (GAO) finds that, unfortunately, nursing home abuse still occurs with some regularity. Because residents often have physical or mental disabilities and limitations, they are some of the most vulnerable to abuse. Maryland residents should be aware of potential issues of abuse when choosing a nursing home for themselves or a loved one.

The GAO’s report found that citations of nursing home abuse more than doubled between 2013 to 2017, with a particularly significant increase in severe cases of abuse. Importantly, the report also found gaps in the oversight of nursing homes. The Centers for Medicare & Medicaid oversee a program with state agencies to monitor nursing home safety, but their ability to do so may be limited for several reasons. First, state agencies who survey nursing home abuse typically do not note abuse and perpetrator time, meaning the Centers for Medicare & Medicaid may not have a complete picture of who is committing the abuse, or what type is most common. Second, when nursing homes report incidents, they typically lack vital information, which often delays state agencies’ investigations. And third, the GAO found gaps in the Centers for Medicare & Medicaid’s processes for referring incidents of nursing home abuse to law enforcement, which can slow down investigations and make it harder to end abuse in the homes overall. The GAO, finding these problems, also made recommendations to the Centers for Medicare and Medicaid on how they can fix them and improve the safety of nursing homes and the processes for dealing with abuse.

Cases of abuse in Maryland nursing homes, which can include medical neglect or physical, verbal, or sexual assault, can cause intense emotional distress and trauma for the victim and their families, not to mention medical bills for past and possibly continuing care. While the GAO’s report may hopefully lead to increased safety in Maryland nursing homes, there will, unfortunately, still be tragic instances of abuse. If tragedy does strike in a Maryland nursing home, state law allows the victim, or their family, to sue the home for negligence. The money won in a suit, while it can never undo the damage done, may help the recovery and healing process.

As the population ages, and life expectancy continues to increase, nursing homes are becoming a part of more and more Americans’ lives. As a result, Maryland nursing homes are caring for more residents than ever. Family members who place their loved one in a nursing home want to ensure that they are safe and being taken care of, but sometimes finances or other concerns force families to place loved ones in subpar institutions. Unfortunately, loved ones can suffer from nursing home abuse that often goes unreported. A common yet overlooked form of this abuse is food safety violations, which occur frequently in Maryland nursing homes and can cause serious illness, or even death.

A recent investigative report found that there are thousands of food safety violations in nursing homes across the country each year. According to a news article discussing the report’s findings, cockroaches, flies, mold, and mouse droppings are just a few of the unsanitary conditions found in nursing homes over the last three years. In fact, unsafe food handling was the third most frequent violation in nursing homes in 2018. That same year, 33% of nursing homes were issued citations for not safely storing, preparing, and serving food. And many of these instances are not just one-time mistakes: since 2016, approximately 33% of all nursing homes were cited multiple times for the same food safety violations.

These safety violations, while concerning in any kitchen, are of utmost concern in nursing homes because people over 65 are especially susceptible to foodborne illnesses. Unlike restaurants where a patron can get up and leave, nursing home residents often have no choice but to stay and eat in their institution. The result can be deadly: the report also found that, between 1998 and 2017, there were 230 foodborne illness outbreaks in long-term care settings such as nursing homes, which resulted in at least 45 deaths, 532 hospitalizations, and 7,648 people getting ill.

Incidents of Maryland nursing home abuse can be challenging to quantify because many victims are unable to report their injuries. Additionally, loved ones are often placed in subpar institutions because their families did not have the means or ability to evaluate the facility adequately. These factors, in addition to many others, have caused a rising rate of nursing home abuse incidents in Maryland.

According to a recent news report, the Centers for Medicare & Medicaid Services (CMS) launched a consumer alert feature on its website designed to warn people of nursing home violations. The CMS operates a website called “Nursing Home Compare,” which provides consumers with information about Medicare and Medicaid certified nursing homes in the United States. The website enables individuals to see whether a nursing home meets the minimum federal standards regarding things such as staffing, health, and safety. However, the website does not readily provide a way for people to discover any instances or allegations of abuse against a nursing home. In fact, a recent Senate report publicized a government finding of increasing nursing home abuse cases by facilities that rated as poorly performing but did not receive additional scrutiny.

The new alert intends to offer consumers a new and easy way to identify nursing homes with citations and other safety violations quickly. The alert will go live in October, 2019 and will flag facilities that had negative inspection reports on abuse in the past year or behaviors that could have led to harm in the past two years.

The federal government is keenly aware of the fact that many Maryland nursing homes, as well as nursing homes across the country, routinely provide residents with an insufficient level of care. For this reason, each year, the federal government releases a report detailing the state of the country’s nursing homes. This June, Senators Casey (D-PA) and Toomey (R-PA) released a report entitled “Families’ and Residents’ Right to Know: Uncovering Poor Care in America’s Nursing Homes.”

The report begins by noting that aging citizens who live in nursing homes too often experience “outright neglect,” and that some residents are subjected to physical or sexual abuse. In an attempt to reduce the number of homes exposing residents to this neglect and abuse, the federal government implemented the Special Focus Facility (SFF) program. The SFF program seeks to identify the most problematic nursing homes across the country and increase supervision over these facilities. Once a facility is in the SFF program, it must be inspected no less than once every six months. Non-participants must be inspected once every 15 months.

The selection process for the SFF program focuses on those nursing homes that “persistently underperform in required inspections.” Under the SFF program, up to 88 nursing homes are selected, which amounts to less than .6 percent of all skilled care facilities in the United States. These facilities are referred to as “participants,” and the government releases the name of the facility to the public to assist potential residents in making important care decisions.