LOGAN — When families are looking to place a loved one in a nursing home, they want to ensure they’ll be receiving the best care possible during their stay. A recent report included Logan Care and Rehabilitation on a list that no facility wants to be on.
Up until recent findings and reports, elder abuse has never been a hot topic of discussion for many folks. Elder abuse includes more than just physical abuse, but emotional, sexual, exploitation, neglect and abandonment too.
According to the National Council on Aging (NCOA) approximately one in 10 Americans ages 60 and older have experienced some form of elder abuse. Some estimates range as high as five million elders who are abused each year.
The Special Focus Facility (SFF) program was designed to increase oversight of the facilities that persistently underperform in required inspections conducted by state survey agencies. As required by federal law, the SFF program targets those facilities that “substantially fail” to meet the required care standards and resident protections afforded by the Medicare and Medicaid programs.
This program includes a list of facilities that are titled “participant,” meaning they’ve been subject to more frequents surveying and progressive enforcement actions, and other facilities are “candidates,” or facilities that have been put on watch. The names of facilities who are “participants” are made public so people can further research if it’s a good fit for their family member, but the “candidates” was not available to the public.
Based on the amount of negative points a facility receives through citations is when they are put on the SFF list. Participants and candidates for SFF are identified based on the findings of a nursing facility’s three most recent standard surveys. However, community input, the results of other state investigations (such as complaint surveys) and other metrics, like staffing data, are not taken into account when determining eligibility for the SFF program.
Since the recent Pennsylvania survey findings, there have been a number of cases reported regarding elder abuse or neglect. It is because of two Pennsylvania Senators efforts, Republican Patrick Toomey and Democrat Bob Casey Jr., the national SFF list of care and rehabilitation homes of participants and candidates has been released.
Logan Care and Rehabilitation (LCR) is unfortunately on the list of “candidates” for the SFF program.
Crystal McCollister, LCR director of nursing, says they’ve had two incidents a couple years ago that has caused them to stay on the candidate list for the SFF program and it’s been hard to bounce back.
“Logan Care and Rehabilitation has not had any other significant findings with the Ohio Department of Health since. We had our annual survey last September and it went fairly smooth. There was no harm found. The CMS (Center for Medicare and Medicaid Services) star rating system is accurate based on their criteria, but it doesn’t shed light on the level of care that’s provided to these residents currently,” stated McCollister.
Medicare assigns a star rating based on a nursing home’s weighted score from recent health inspections and more stars mean fewer health risks. McCollister explained that because of the two major incidents, LCR has one out of five stars, which means “much below average.”
This month, Senators Toomey and Casey released a report detailing their findings and research that pertain to the SFF program nationally, along with the participants and candidates of the program.
According to Toomey and Casey’s report, the total number of SFF slots and total number of SFF candidates nationally are based on the availability of federal resources. Under the SFF program requirements, states must survey these poor performing facilities at least once every six months, instead of once every nine to 15 months for facilities not on the SFF list.
The SFF candidate list is updated each month based on the most recent findings from surveys conducted in each state. When a facility either graduates from the SFF program, or is terminated from participating in the Medicare and Medicaid programs SFF slots are opened.
To graduate from the program, the facility needs to have two standard surveys — at least six months apart — without serious deficiencies identified. If facilities are unable to graduate, they are subject to increased enforcement actions or termination.
Regardless of participation in the SFF program, any facility that performs poorly on surveys and continues to jeopardize the health and safety of residents will be subject to CMS enforcement remedies, such as civil money penalties, denial of payment for new admissions, or termination.
When a facility is inspected they have a three to five day visit from the state health department, where officials come in and fine tooth comb everything available. Roughly three to five people who are nurses, dietitians and social workers tour the facility, interview staff and residents, watch procedures, look through paperwork and more.
Most of their findings are provided through a helpful online tool called Nursing Home Compare (medicare.gov/nursinghomecompare), which has been designed to help individuals compare and contrast nursing homes in their community and CMS is required to maintain it. This site includes data on facility staffing, information on state surveys as well as specific content on surveys conducted in response to complaints.
It’s through this resource The Logan Daily News obtained the following inspections and citations LCR has had in the past year.
Within a year there have been four complaint inspections:
• On June 13, 2018: the level of harm was minimal harm or potential for actual harm. Based on interview and medical record review, the facility failed to provide three residents with multi-disciplinary care conference meetings.
• On June 13: the level of harm was immediate jeopardy. Based on closed medical record review, interviews with staff and physician, review of the Emergency Medical Service run report, review of the facility cardiopulmonary resuscitation (CPR) policy and procedure and review of the facility Code Blue policy the facility failed to initiate CPR for one resident who was found unresponsive, without a pulse, respirations or blood pressure, and who was identified as a Full Code status. Life threatening harm and death occurred when the resident did not receive ventilation along with chest compressions from staff who initiated an emergency Code Blue. This resulted in Immediate Jeopardy for the resident who passed. This affected one of three residents reviewed for an emergent change in condition and death.
• On June 28: the level of harm was minimal harm or potential for actual harm. Based on record review and interview, the facility failed to maintain sufficient levels of nursing staff to meet the total care needs of all residents in a timely manner. This affected two residents and had the potential to affect all 108 residents residing in the facility.
• On November 27: the level of harm was minimal harm or potential for actual harm. Review of housekeeping cleaning schedule/maintenance tasks and staff interview, the facility failed to ensure individual wall air conditioning units were cleaned routinely to keep them free from dust, grime build up and debris.
The most recent health inspection citation on November 14 indicated all were minimal harm or potential for actual harm:
• Based on observation, medical record review and staff interview the facility failed to provide timely care for one resident who sustained a mildly displaced distal fibular fracture following a fall. This affected one of three residents reviewed for falls.
• Based on surveyor observation, medical record review, activity delivery log review and staff interview, the facility failed to provide activities to enhance physical, cognitive and emotional health. This affected two of three residents reviewed for activities.
• Based on observation, medical record review and staff interview the facility failed to identify, assess and monitor bruising to one resident’s bilateral arms. This affected one of one resident reviewed for skin conditions.
• Based on medical record review, observations, staff and resident interviews, the facility failed to provide food that accommodated resident preferences, and options of similar nutritive value to residents who chose not to eat food that was initially served or who request a different meal choice. This affected one of five residents reviewed for food.
• Based on observation and staff interview, the facility failed to use proper hand hygiene when delivering trays and preparing a puree meal. This had the potential to affect residents who received meals on the unit and 11 residents who received pureed diets.
This is just a summary of the reports that were found on medicare.gov/nursinghomecompare.
“The main point is resident care and what can we do to make their care the best possible. We’re running a good building where the staff loves and cares for these residents. I’ve been in other buildings and I know this building is great. It’s people’s homes. The Logan team loves the residents. We cry when someone passes because they become our family. They put blood, sweat and tears on the floor,” shared McCollister.
McCollister started working as a nurse’s aid 19 years ago at LCR, worked as a licensed practical nurse for seven years, a registered nurse, moved up to manager and is now director of nursing. She says though she’s worked at other facilities throughout her career, she keeps coming back to LCR and loves the people she works with.
“I keep coming back to Logan. This is my home. Is this building perfect, no. We are working with people. Our employees are people — it’s not always textbook. If bad things happen, what will we do to fix it? What will we do to learn if mistakes occur so that it never happens again?” expressed McCollister.
Whether families are looking to place their loved ones at Logan Care and Rehabilitation or another facility, McCollister reminds families to take advantage of Nursing Home Compare site and to visit facilities.
“What I tell people and families who are thinking about bringing their loved ones to a facility — go in the buildings. Talk to the Director of Nursing, Administrator, Admissions Coordinator, STNAs, and nurses. Ask to be walked down the hallways. Ask to look into an empty room so that you can see if it would be a place you’d want your loved-one to live. Ask the nurse aids what they think about their building,” concluded McCollister.
If an older adult is in immediate, life-threatening danger, call 911. Anyone who suspects that an older adult is being mistreated should contact South Central Ohio Job and Family Services at 1-855-726-5237, option 1.