State cites neglect, abuse at nursing homes
by Karen E. Crummy, Boston Herald, Thursday, January 25, 2001

Elderly residents of some Massachusetts nursing homes routinely suffer neglect an abuse due to staff shortages and incompetence - risking injury or even death as they live out their final years, state inspectors claim.

With countless citations for needless and painful skin tears, limb-jeopardizing bedsores, oozing infections and dangerous weight loss, state records reviewed by the Herald reveal patterns of employee missteps, brutality against patients and stomach-turning living conditions.

"It is completely unacceptable and horrible for those individuals at those homes," said Paul Jacobsen, the state's deputy commissioner of public health.

A sample of nine nursing homes cited for near substandard care or "immediate jeopardy" - meaning the home's non-compliance with regulations has caused or is likely to cause serious harm, injury or death to a patient - revealed at least 200 public health violations from July 1999 to November 2000.

The nursing homes were cited for employing nurses who didn't know proper resuscitation techniques, life-threatening medication errors, elderly "runaways" who were never noticed to be missing, nursing assistants who physically assaulted their patients, and patients who were ignored, even after suffering broken bones and internal bleeding.

Most administrators at the nine homes declined to comment on specifics, and instead replied to Herald requests for interviews with faxed statements, most of which stated that they have rectified the problems and that their primary concern is patient care.

Jim Divvers, an administrator at Danvers Nursing Home, said that many homes - due to the deinstitutionalization of state hospitals for the mentally ill and over-burdened health care facilities - have become "mini-hospitals," something employees are unprepared for.

"You now see homes taking care of patients with psychiatric problems or younge patients suffering from debilitating strokes and other problems," said Divvers, who took over as administrator in July - after Danvers was cited for substandard care. "Because of that, the elderly have really been put on the back burner."

While many experts believe that the state's 518 nursing homes are typically safer than many in the country, they are far from being model homes. In the last three years, DPH has cited 14 homes with immediate jeopardy and 50 with substandard quality of care. And the problem may only get worse.

Nursing home experts believe that the poor care results from a combination of Medicaid funding cuts that affect 70 percent of the state's nursing home patients, an increase in assisted living homes for wealthier patients and a staffing shortage crisis due to a hot economy.

"It's a tight labor market and this extends to nursing homes," said Boston University professor Alan Sager. "With fewer people available and Medicaid not keeping pace with costs, there is a real dilemma."

A U.S. Department of Health and Human Services report sent to Congress in August links staffing shortages and high turnover rates with substandard quality of care: The less familiar staff are with patients and their conditions, the less likely they are to catch problems.

In fact, most of the nursing home reports reviewed by the Herald cited staff shortages as one of the major problems.

"There is high turnover and employees with less experience who don't have stron relationships with the patients," said Paul Dreyer, deputy director of the bureau of health quality. "Plus, they're working longer hours."

Some of the nine nursing homes cited nursing shortages and lack of training as a serious problem. Divvers said that the Danvers home citation for poor care was "directly related to staff issues," which he has tried to rectify in the last six months. Inadequate staffing and improper training citations have surged in the last year and a half, according to the public health department.

And the attorney general's office, which handles about 225 cases a year involving nursing home neglect, has also noticed an increase, according to Nicholas J. Messuri, chief of the Medicaid Fraud Unit.

As of September last year, the attorney general's office had 127 open investigations into patient neglect at homes. While outright physical abuse cases have declined to about 20 a year as a result of more vigilant state policies, there has been an increase in "institutionalized neglect," which "more often than not, comes back to staffing shortages," said David S. Nalven, business and labor protection bureau chief.

But Nalven cautioned that he could not be sure whether there was an actual increase, or whether resources once used for abuse cases have been diverted to neglect cases.

"It might just be that they went undetected before but now we are detecting them," he said.

Gov. Paul Cellucci has pledged almost $70 million to fund a 4 percent increase in nursing home rates and has already pumped more than $35 million into industry wage increases. The average pay for certified nursing assistants is only $10.50 an hour.

But some believe the governor's efforts won't make a dent in the problem, since it will only increase pay 70 cents an hour, according to Ernie Corrigan, spokesman for the Massachusetts Extended Care Federation.

"It's not enough to turn around the staffing issues, especially where 1 in 5 (nursing assistant) positions are vacant and it's getting worse," Corrigan said. "Each year, half of the staff - statewide - leaves."