Silver Linings: Complaints at Bedford Hills reflect issues at nursing homes nationally

Oct. 28--Silver Linings: Complaints at Bedford Hills reflect issues at nursing homes nationally

By ROBERTA BAKER

New Hampshire Union Leader

October 27. 2018 11:12PM

Hannelore Gartland of Milford kisses her husband, Ed, at Bedford Hills Center, a nursing home in Bedford. She says her complaints to administrators about lapses in his care and hygiene have gone unheeded. (DAVID LANE/UNION LEADER)

How to voice nursing home concerns

Overall, New Hampshire nursing homes compare favorably to those in many other states, as well as to national averages -- including for hours of per-patient care provided by LNAs, according to health care data.

"We have some of the nation's best care -- that includes nursing homes run by Genesis HealthCare, notwithstanding the fact that we're so underfunded and have one of the oldest populations," said Brendan Williams, president of the New Hampshire Health Care Association, which represents 63 of the state's nursing homes.

Nursing home residents can voice concerns through resident councils allowed by law at nursing homes and obtain guidance from the N.H. Department of Health and Human Service's Office of Long-Term Care Ombudsman, which receives, investigates and helps resolve residents' complaints. The Medicaid Fraud Control Unit of the N.H. Attorney General's office also hears complaints of potential neglect or abuse.

To contact the Long-Term Care Ombudsman, call 271-4375. To file a complaint against a health care facility with DHHS, go to www.dhhs.nh.gov/oos/bhfa/complaint.htm. To contact the N.H. Attorney General's Medicaid Fraud Control Unit, call 271-1246 or email mfcuinfo@doj.nh.gov.

Hannelore Gartland, 74, constantly worries about the care her husband, Ed, has been receiving at Bedford Hills Center, the nursing home where the 78-year-old Vietnam War veteran, who has Parkinson's disease and dementia, has lived for 15 months.

She's photographed his urine-stained sheets and unemptied bedpans. She's recorded missed eye drops after cataract surgery, and physical therapy that occurs twice a week instead of daily as ordered by his physician.

When she notified staff that he needed to be dressed, fed and ready to leave for a recent neurology checkup, she found him waiting in the lobby -- unshowered, without breakfast and wearing a stained T-shirt and swim trunks on a 45- to 50-degree morning.

Monday at 12:30 a.m. he phoned her because he said no one on the unit was answering his calls for help.

So far meetings with administrators and social workers have failed to correct ongoing lapses in care and hygiene that she fears are affecting his health.

"Their answers are always the same: I'm sorry. We're working on it. We'll get back to you. We're short of staff," Gartland said. "Then it goes into Never-Never Land."

The couple's frustrations are not rare in the world of nursing homes -- nor are they easily addressed. They are likely rooted in a chronic condition: not enough trained workers to provide direct care to patients -- a dilemma confounding nursing homes nationwide, and potentially compromising residents.

David Broadhurst, 62, chairman of the Bedford Hills Center's resident council, and a long-term patient who suffers from Parkinson's and severe diabetes, said residents share ongoing concerns about medication mistakes, unanswered call lights, patients in wheelchairs waiting 45 minutes or longer to be moved, and others left sitting on bedpans or on toilets for 30 to 45 minutes or longer, or in soiled clothing for hours.

Broadhurst himself has experienced medication errors: 23 in seven weeks, including a dangerous overdose of insulin that should have sent him to the hospital for observation, he said. Nurses dispense most medications, but licensed nursing assistants who receive special training can give ongoing medications that don't waver.

"When I get to the point that I can't tell the difference between my medications, I want to feel safe, knowing that I'm getting the right care. But right now, I don't," Broadhurst said.

Hannelore Gartland of Milford checks her husband, Ed, a resident of the Bedford Hills Center nursing home in Bedford, during a visit earlier this month. (DAVID LANE/UNION LEADER)

Reading the ratings

Although Bedford Hills received a rating of four out of five stars for quality last year, the nursing home's overall score was one star, much below average, from the Centers for Medicare and Medicaid Services, which ranks the nation's nursing homes with Medicaid and Medicare patients. Although the facility received three stars for average staffing, and four stars for registered nurse levels, the final grade was weighed down by one star for health inspection -- reflecting the results of two site surveys during the last two years, including patient and staff interviews, and a complaint investigation in August.

Violations cited were expired medications; failure to report mistakes and accidents, including falls, to state certification agencies, and to a patient's physicians in a timely manner; deficits in medical record-keeping; and medication errors made by licensed practical nurses and untrained nursing students, including unsanitary reuse of insulin injection pens, and giving insulin to the wrong patient.

The violations were rated minimal for actual or potential harm to few. The reports are available online at medicare.gov/nursinghomecompare/search.html.

Nursing home advocates say the surveys are focused snapshots -- not necessarily definitions of ongoing care.

Lori Mayer, spokesman at Genesis HealthCare's corporate office, said the company has taken action to improve conditions at Bedford Hills Center.

"We submitted plans of correction to the state and provided additional staff education and training as needed. Today we are in full compliance with state and federal regulations," including staffing requirements, Mayer stated by email Oct. 19.

Customer satisfaction ratings on the Bedford Hills Center website give the facility 3.6 out of five stars.

Genesis HealthCare has more than 400 for-profit nursing homes in 29 states, including Bedford Hills Center and 15 others in New Hampshire. Genesis has been the target of lawsuits against its facilities elsewhere, claiming negligence and substandard care due to understaffing and undersubsidizing, and one allegation of wrongful death.

In 2017, it agreed to pay $53.6 million for violations of the False Claims Act by residential nursing, rehabilitation, and hospice providers, most of which occurred before the corporation acquired them, according to the U.S. Department of Justice. The New Hampshire Attorney General's Medicaid Fraud Control Unit, which hears reports of nursing home negligence and abuse, has no formal complaints against Bedford Hills Center involving staffing levels.

During the last 12 months, 239 complaints were made against the state's nursing homes, according to the New Hampshire Department of Health and Human Services and the Centers for Medicare and Medicaid Services, which tracks consumer complaints.

Broadhurst says there are currently no routine walk-throughs or wellness checks at Bedford Hills Center. In the past, residents have found the call light system turned off at the nurses' station, disabling signals from patient rooms, according to the residents' report.

"Someone can be on the floor nowhere near the call button, yelling for help (or not) and no one knows until another resident or visitor sees the situation," the report states.

"We just want to be taken care of correctly," Broadhurst said. "All these things, they're happening to other people. A lot of these issues come up because of not enough staff."

Worker shortage impacts nursing home care

In the Granite State, licensed nursing assistants, who provide most routine care for nursing home residents, such as bathing, feeding and dressing, are in short supply. Nursing homes are scrambling to recruit and retain candidates who are easily lured away by higher wages and less-demanding work in retail and food service, according to health care watchdog groups.

In the state with the nation's second-oldest population, where 1 in 5 residents will be 65 or older in roughly two years, the problem is especially pronounced because residents are aging faster than trained workers are becoming available, according to demographic and labor projections.

"It's a crisis situation," said Roxie Severance, a former nursing home administrator who serves as health sector adviser for the New Hampshire Health Care Association. "LNAs are the heart and backbone of nursing homes." Severance is working on ways to increase the workforce.

"For too many people, it's not a living wage career," said Brendan Williams, president of the association. "We're not prepared for the additional residents we're going to see."

The Alliance for Healthy Aging, which comprises the state's nursing home and senior health advocates, is lobbying to attract young people to work in long-term care by boosting the state's Medicaid reimbursement rate -- currently the nation's second lowest, which would enable nursing homes to pay higher wages; LNAs now make $10 to $13 an hour on average in New Hampshire.

Leaving the profession

Each year, roughly 200 become licensed, while the same number graduate to become nurses, switch professions or retire. Of those who exit, 45 percent are between ages 20 and 28 -- compared to 20 to 25 percent in their 50s or 60s, according to the New HampshireBoard of Nursing. Their reasons include physical and emotional burnout, low wages and insufficient benefits such as health insurance, according to health care advocates.

In June 2018 there were 13,336 LNAs in New Hampshire, with a little over a third working in the state's 73 nursing homes. It's unknown how many actually hold jobs in New Hampshire, or only work part time. According to the state's Bureau of Economic and Labor Market Statistics, 6,725 health and social assistance workers in 2015 commuted daily to work in neighboring states, mostly in Massachusetts and southern Maine, where pay and benefits are typically higher.

Research has found that a shortage of one registered nurse on a given shift correlates with worse outcomes and higher mortality rates, according to clinical studies. A deficit of LNAs can easily translate to longer patient wait times and overworked staff who can't safely or adequately meet residents' needs, experts say.

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at rbaker@unionleader.com or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.

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