******************** POSTING RULES & NOTES ********************
#1 YOU MUST clip all extraneous text when replying to a message.
#2 This mail-list, like most, is publicly & permanently archived.
#3 Subscribe and post under an alias if #2 is a concern.
*****************************************************************
(The CEO is a major donor to the Republican Party. What a great surprise.)
Washington Post, May 17, 2020
Major nursing home chain violated federal standards meant to stop spread
of disease even after start of covid-19, records show
By Debbie Cenziper, Sidnee King, Shawn Mulcahy and Joel Jacobs
Nursing homes operated by Life Care Centers of America, one of the
largest chains in the industry, violated federal standards meant to stop
the spread of infections and communicable diseases even after outbreaks
and deaths from covid-19 began to sweep its facilities from the Pacific
Northwest to New England, inspection reports show.
Over the past six weeks, as the nationwide death toll among the elderly
soared, government inspectors discovered breakdowns in infection control
and prevention at nine Life Care nursing homes that underwent covid-19
inspections overseen by the Centers for Medicare and Medicaid Services.
That does not include deficiencies found at the Life Care Center of
Kirkland, Wash., which suffered the country’s first reported outbreak of
the novel coronavirus in February.
At several Life Care nursing homes since then, inspectors discovered
staff who did not wash their hands or enforce social distancing
guidelines, according to the inspection reports. At one home in Denver
on May 5, staffers left an isolation room door open, allowing a patient
with covid-19 to slip outside into the hallway without a face mask and
sit next to a room with two healthy residents. At another home in
Colorado, a nursing assistant hovered 12 inches from the face of a
coughing patient who was not wearing a mask.
In Michigan, a nursing assistant rolled a blood pressure machine out of
an isolation room and into a non-covid-19 room without sanitizing the
equipment. In Kansas, inspectors found a nursing home’s infection
control log failed to include two patients with fevers — one was sent to
the hospital with a 103-degree fever and died. “This failure,” the
inspector wrote, “had the potential to affect all 52 residents that
resided in the facility.”
The Washington Post obtained a total of 24 Life Care inspection reports
from CMS, the federal agency that regulates nursing homes, as well as
the state of Michigan and Life Care, though the universe of total
inspections may be larger.
The Tennessee-based Life Care has said that no amount of preparation
could have kept the virus at bay and that administrators worked early
and often with health authorities to contain the spread of infection.
Since the outbreak in Kirkland, the privately owned company with more
than 200 nursing homes has seen at least 2,000 cases and 250 deaths
among residents and staff, according to a Post tally of state data and
local media accounts. Five Life Care nursing homes have experienced
outbreaks of 100 or more cases.
There is no comprehensive national data available to determine whether
the rate of infections and deaths at Life Care facilities is higher than
at other chains — or how often other chains have been cited for
violations after the pandemic began. Nursing homes across the country
have been hit particularly hard: About 1 in 4 have reported at least one
case of the coronavirus, according to a Post analysis.
Around the country, even nursing homes with strong track records have
publicly reported cases of covid-19, which is particularly lethal among
the elderly.
“We have a virus that has attacked our vulnerable populations who have
co-morbidities, and that has made this extremely difficult to manage,”
said Tim Killian, public information liaison for Life Care Centers of
America. “We need help. We need hands on the ground. We need money. We
need equipment. We need doctors. And none of that is happening in a
significant way anywhere in the country.”
Killian declined to comment on the specifics of the most recent
inspection reports. Life Care President Beecher Hunter said the homes
submit plans of correction to the government.
California nursing homes are examples of how cruel the pandemic can be
“Life Care Centers of America and its affiliated facilities are not
perfect; no organization is because it is made up of people, and people
are imperfect human beings,” Hunter said in an email to The Post. “. . .
Our healthcare heroes will from time to time unfortunately fall below
our standards for resident care.”
To critics, the size of the outbreaks reflects profound flaws in the
company’s management and the treatment of patients, which have been
documented for years in lawsuits by families, former employees and
federal prosecutors. Time and again, they described a company beset by
staffing shortages and compromised care, deficiencies that critics say
probably worsened as covid-19 infected hundreds of residents and caregivers.
In the past three years, dozens of Life Care homes received
below-average staffing ratings or were flagged during inspections for
not having enough nurses to properly care for patients, according to CMS.
At a Life Care home in Washington state, which has had at least 100
reported cases, residents last year recounted waiting extended periods
of time for help bathing and using the bathroom. One resident said she
developed sores from sitting for too long on a soiled bedpan, the
inspection report showed.
The Justice Department in recent years accused the company’s billionaire
owner of leaving Life Care “severely undercapitalized” while engaging in
a “systematic scheme to maximize its Medicare billing.” Prosecutors say
Life Care subjected patients to excessive, unnecessary and “sometimes
even harmful” rounds of rehabilitation therapy to draw Medicare dollars
and chastised or punished those who complained the practice undermined
the judgment of therapists at the expense of patients.
The company, without admitting liability and arguing the government did
not prove its case, settled with the Justice Department in 2016 for $145
million — the largest settlement with a skilled nursing chain in the
department’s history. Life Care also entered into a five-year corporate
integrity agreement with the inspector general of the Department of
Health and Human Services, which required an independent annual review
of the company. Life Care was in its fourth year of the agreement when
the coronavirus struck the United States.
Families, lawmakers and former and current employees say Life Care,
after years in operation and amid intense scrutiny, should have done far
more to protect patients and caregivers as the pandemic intensified.
After the early outbreak at the Life Care facility in Kirkland,
inspectors found the facility failed to properly treat sick patients or
alert authorities to widespread illness. The state banned the home from
accepting new admissions until fixes were made, including training staff
in managing infectious diseases.
“When you are a private, national corporation with skilled nursing
centers all over the country, you’ve got what others don’t, which is
economies of experience,” said Rep. Lori Trahan (D-Mass.), who called
for more federal oversight after dozens of residents and staff members
tested positive for or died of the coronavirus at the Life Care Center
of Nashoba Valley outside of Boston. “Their facilities in Massachusetts
and other states should have been way ahead, given what they learned in
Washington.”
At the Nashoba Valley home, several staff members told The Post that
critical information about the growing crisis was kept from employees
and that a shortage of nurses and aides vexed the home long before the
pandemic, including the weeks after the Kirkland outbreak.
“We kept waiting and waiting for them to do something, and they never
did,” said Diane Crowley, who worked at the front desk at the Nashoba
Valley nursing home, wiping her hands with a cloth soaked in bleach that
she said she kept in a plastic bag in her pocket. She eventually quit.
“I was literally surrounded by covid,” she said. “I just told my kids,
‘Please never put me in one of those places. These people live their
whole lives, there are teachers, poets and everything else, and this is
what they’re ending their lives with?’ ”
Washington state nursing home faces $611,000 fine over lapses during
fatal coronavirus outbreak
Killian, the Life Care public information liaison, said nursing home
administrators and staff followed federal guidelines and risked their
own well-being to continue to care for residents throughout the crisis.
He said personal protective gear was in short supply at nursing homes
across the country and that staff continued to come in even as their
colleagues fell ill.
“These are good people who have been caught up in a difficult
situation,” Killian said.
He added that an inspection at the Nashoba Valley facility on April 10
found no deficiencies in infection control or emergency preparedness.
“This environment of sort of conspiracy theories and negative news
stories that has set a narrative and tone . . . we think is simply
incorrect,” Killian said.
By early April, more than 60 people at the home had tested positive for
the virus. Five had died.
Inconsistent infection control
The federal government has not yet released a death count in nursing
homes nationwide, but state data has placed the number in the thousands.
CMS in early March temporarily called off routine inspections of the
15,000 Medicare-certified nursing homes in the United States to focus
most heavily on deficiencies in infection control.
Across the country, inspectors surveyed nursing homes to determine
whether front-line workers were unintentionally contributing to the
spread of the coronavirus. More than 6,000 nursing homes have been
assessed, with inspectors finding “sporadic noncompliance” involving
hand-washing, the proper use of personal protective equipment and the
separation of sick patients from healthy ones, according to Skilled
Nursing News, a publication that covers the industry.
At multiple Life Care homes, inspectors documented lapses in infection
control through observations, medical records and interviews with staff
and patients. Federal standards for nursing homes cover everything from
food safety to residents’ rights.
On March 30, shortly after regulators announced they had found
significant breakdowns at the Kirkland home, an inspector went to a Life
Care nursing home in Pueblo, Colo. During the visit, several staff
members did not wash their hands, wear masks or isolate residents. Doors
were left open even when residents were supposed to be isolated inside
their rooms, according to the inspection report.
A day later, in Greeley, Colo., an inspector found that residents in a
television room were not asked to wash their hands before lunch. At
another home in the Denver area, a nursing aide helping a resident with
a soiled bedpan did not wash her hands when she was done.
When an inspector showed up at a home in central Tennessee in April, the
receptionist did not ask questions about the inspector’s health or about
the health of a visitor who arrived afterward. The inspector looked at
the visitor log and noted the receptionist had checked no to a series of
screening questions, including whether the visitors had signs and
symptoms of respiratory infection or had been in contact with anyone who
had covid-19.
Concerns were also raised at a home outside of Detroit, where 10 people
had died by the time an inspector visited in mid-April. Staff shared
gowns, the inspector found, and one nursing assistant acknowledged not
knowing which patients had covid-19 and required isolation. A week after
the inspection, the relatives of a 77-year-old woman who died protested
outside the home, with signs that read, “Our elderly deserve better,”
and, “Liars. They are not ok.”
A Washinton nursing home assumed it hd influenza outbreak. Opportunities
to control coronavirus outbreak passed
According to the report, the nursing home told inspectors that training
had been conducted. Other inspection reports reviewed by The Post did
not include the company’s response.
“There are far more stories of success than will ever be published or
recognized,” said Hunter, the president of Life Care. “We thank our
dedicated associates for those successes.”
Lapses in patient care
Forrest Preston, the son of a Massachusetts pastor, settled in southeast
Tennessee in the 1950s to help his brother create booklets and public
relations material for hospitals. Over time, he developed an interest in
long-term care.
“He believed that if a person could build a beautiful building, highly
functional for patient care, staffed with people administering
professional skills in a spirit of love and compassion, a successful
facility would result,” according to a Life Care publication from
earlier this year.
Preston and his partners opened the first nursing home in 1970. From his
Tennessee headquarters, the company would grow to more than 200 nursing
homes, one of the largest networks in the country.
In 2015, the Chattanooga Times Free Press described the 45th anniversary
of the first Life Care home, when Preston recounted the first night in
operation: “I said these lights will never go off again until the second
coming.”
Preston kept a low profile even as federal regulators began to question
Life Care’s claims for Medicare reimbursement.
In 1999, the inspector general at the Department of Health and Human
Services audited Medicare claims from Life Care’s homes in Tennessee and
ordered $1.6 million returned, according to the report. Investigators
found Life Care billed for “inappropriate services,” including eight
occupational therapy appointments for an 84-year-old resident in a
semi-comatose state.
The inspector general’s report contained no response from Life Care, and
the company did not respond to questions about the audit.
Maryland forms strike teams to combat nursing home coronavirus outbreaks
In 2002, five whistleblowers with relatives at a Life Care facility in
Georgia sued in federal court, saying that severe staffing shortages,
inadequate training and an ineffective medical director at the home
resulted in the deaths of several residents. The Justice Department
intervened and filed a lawsuit on behalf of the whistleblowers and the
government.
In 2005, Life Care agreed to pay $2.5 million to settle the case.
“In failing to provide sufficient care for these nursing facility
residents, Life Care placed at risk the very residents who had been
entrusted to its care,” Thurbert Baker, then Georgia’s attorney general,
said at the time.
Killian, the public information liaison at Life Care, declined to
comment on the case.
“At this time, our entire focus is on the ongoing effort to fight the
coronavirus,” he said. “We are working hard to support our residents and
our staff.”
In court records, the company denied the allegations and said that the
nursing home’s conduct was lawful and appropriate.
In 2008, a registered nurse at a Life Care center in Tennessee sued,
saying Life Care’s corporate managers pressured nurses and therapists to
increase Medicare billing for physical and occupational therapy, even
when patients were permanently bed- or wheelchair-bound.
“The therapists would essentially drag the resident down the hall and
document the patient as having ambulated. The resident would gain a
false sense of being able to walk and would fall when he tried to walk
on his own,” according to a complaint filed in federal court.
A second employee also sued, this time a former occupational therapist
at a Life Care center in Florida. Federal prosecutors once again
intervened, suing Life Care as well as Preston, the company’s sole
shareholder, on behalf of the two whistleblowers and the government.
Prosecutors alleged that “every level of the corporate hierarchy” at
Life Care pressed staff to grow Medicare revenue. Some patients put in
therapy were terminally ill, sick or medically unstable, according to
the Justice Department’s lawsuit, filed in federal court in Tennessee.
In South Carolina, according to the complaint, a lethargic and frail
80-year-old woman was twice placed for 42 minutes in a standing frame —
equipment to secure a patient in a standing position — even though she
required assistance to control her head and open her eyes and her
physical therapist had said she was unable to participate in treatment.
She died five days later.
In Florida, prosecutors noted that a 92-year-old man dying of metastatic
cancer that had spread to his brain and lungs was sent to rehabilitation
therapy for at least two hours a day, including when he was spitting out
blood. On the day he died, according to prosecutors, therapists recorded
35 minutes of physical therapy, with occupational therapy scheduled for
later that afternoon.
In 2016, the company and Preston agreed to pay $145 million to resolve
the cases and entered into a five-year corporate integrity agreement
that required an annual, independent review of the organization.
Killian declined to comment on the lawsuits or the probe by the Justice
Department. In court documents, Life Care disputed the allegations. The
government, according to Life Care, “did not allege a single instance of
physician orders for therapy services being false or inappropriate.”
Life Care also said the Justice Department did not link “alleged
corporate practices and actual claims nor individuals involved with
submitting false claims.”
A year after the settlement, 96-year-old Evelyn Bornstein died at Darcy
Hall, a Life Care nursing home in Florida. Her son, Howard, said she
spent three days in a room without air conditioning after Hurricane Irma
hit Florida. Though a backup generator had restored cool air to the
lobby of the building, he said he discovered that residents had been
left in sweltering rooms.
Bornstein said he found his mother, a grandmother of four who grew up in
the Bronx, unresponsive and curled up in a ball, her face red and mouth
dry. He said he tried to put ice on her mouth and head and eventually
left in shock. She died that evening.
After Bornstein sued the nursing home, an arbitration panel in Palm
Beach County Circuit Court found that Evelyn Bornstein’s death was
caused by negligence and awarded $150,000 in damages.
“I’ll live with this for the rest of my life,” Bornstein told The Post.
In court documents, Life Care said that no evidence showed the home’s
conduct was “intentionally wrongful or showed conscious disregard or
indifference to the life, safety or rights of the plaintiffs.”
'It kept getting worse'
At the Life Care Center of Nashoba Valley, set amid the apple orchards
of Littleton, Mass., former marketing director Lina Le said nurses and
aides for months were working short, a term the caregivers used to
describe low staffing levels.
By the third week of March, long after the virus had struck Life Care’s
Kirkland home, Le said her colleagues were also short on masks, gowns
and other protective equipment.
Le called the Nashoba Valley Chamber of Commerce and a local sewing
studio and soon delivered 120 homemade masks to the staff.
Then she quit, leaving behind her job of two years.
“I was terrified for myself and my co-workers,” she said. “It kept
getting worse and worse and worse.”
Several caregivers at the home told The Post they had no time to wash
their hands, change soiled linens or help immobile patients get out of
bed. One nursing aide said she found herself caring for 30 patients at
once, helping them into bathrooms with filthy toilets or out of beds
soaked in urine.
One afternoon in March, the local fire chief called state Sen. James
Eldridge (D) and described two dozen ambulance runs to the facility in a
single weekend.
“Something’s going on there, but no one at the Life Care Center will
tell us,” Eldridge recalled the fire chief saying.
Eldridge reached out to the nursing home and to local and state health
authorities, worried that residents, first responders and caregivers had
been exposed. Much like in Kirkland, he said, Life Care provided little
information.
“I literally live 15 minutes away from this nursing home,” he said. “It
was just maddening to me that essentially state government didn’t have
the authority to intervene. We were relying upon a nursing home that’s
owned by a large corporation based in Tennessee that was being very
unresponsive.”
On April 2, Trahan, the lawmaker, sent a text message to a supervisor in
the Massachusetts National Guard, which had been activated after a
deadly coronavirus outbreak at a home for veterans. “We’re not getting
cooperation or visibility from management,” she wrote about Life Care.
“Is your team able to get there today?”
“Ma’am, let me speak with Department of Public Health representation
now,” the supervisor responded.
The following day, the National Guard tested more than 80 residents at
Life Care.
On April 10, inspectors surveyed the home and found no infection-control
deficiencies. By then, dozens of people were infected and about 10 had
died, including Maria Krier, a nurse who had quit her job at the end of
March after developing a fever. She died on the day of the inspection.
Killian said the Nashoba Valley home worked to provide quality care
under challenging circumstances and that administrators and company
executives regularly reached out to lawmakers and both state and local
health authorities. He said local politicians and others created
“acrimony” in the community by alleging that Life Care did not properly
report the spread of infection.
Hunter, the president of Life Care Centers of America, wrote to Trahan
and other lawmakers on April 9.
“My promise is that our facility will be a model of cooperation and
communication,” he said. “. . . This is a learning experience for all of
us. We regard the protection, the care, and the love for our residents
as a sacred trust. Their well-being is our highest priority. And we will
make every effort to comply with all public health requirements.”
Since then, the virus has been reported at all 15 Life Care nursing
homes in Massachusetts and at dozens more facilities in other states.
Executives from Life Care have made few public comments during the
crisis. Hunter, however, has appeared on corporate videos emphasizing
moral and spiritual lessons. Just before Easter, he spoke about the
pandemic.
“These are difficult days to say the least,” he said. “Take heart. God
has your back.”
King, Mulcahy and Jacobs are graduate students in journalism at
Northwestern University’s Medill Investigative Lab. Maria Sacchetti and
Post researcher Alice Crites contributed to this report, along with
Arnab Mondal at the Medill Investigative Lab.
_________________________________________________________
Full posting guidelines at: http://www.marxmail.org/sub.htm
Set your options at:
https://lists.csbs.utah.edu/options/marxism/archive%40mail-archive.com
