January 19

Dexter nursing home death highlights bigger issues

Nursing home staff failed to follow end-of-life directives of patient to administer CPR, spurring state’s largest fine of year and raising questions about policies regarding elder care.

By Matt Hongoltz-Hetling mhhetling@centralmaine.com
Staff Writer

When the heart and lungs of Resident 11 stopped working, no one at the nursing home Dexter Health Care attempted revival with CPR.

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Nursing home comparisons available online

For the last couple of years, nursing home compliance information has been available online.

Medicare offers consumers who have Internet access an easy way to check out nursing homes at its Nursing Home Compare website, medicare.gov/nursinghomecompare.

On that site, people can enter a location or nursing home name, and get information including overall rating, which is measured by one to five stars.

Those who want to dig a bit deeper can read the star ratings in three specific categories — health inspections, quality measures and staffing levels.

They can also access the most recent health inspection reports themselves, which document every deficiency found over the past three years.

With the new inspection report factored in, Dexter Health Care’s overall rating is now two of five stars, or “below average.”

State and federal regulations, however, say CPR should have been attempted. The death led to the largest state fine against a nursing home in Maine in 2013.

Across the nation, there have been dozens of cases recently documented in which nursing home staff failed to give CPR to those who needed and wanted it.

This time it happened in Maine, even though the state statistically performs better than most others.

“It’s a serious problem,” said Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, a national organization based in Willimantic, Conn.

Edelman, who has devoted much of her 40-year career to improving nursing home conditions around the country, said the number of serious abuses documented in nursing homes is always just a small fraction of the abuses that are actually occurring.

Only six states have fewer serious documented deficiencies per nursing home than Maine. In Kentucky, with the worst ratio in the nation, there were 1.35 serious deficiencies per nursing home over the past three years, 22 times Maine’s average of 0.06.

Maine may do a good job, but when it comes to caring for a vulnerable population like the state’s elderly, a good job may not be good enough, she said. Edelman said advocacy groups are pushing for more improvements, for the sake of Resident 11 and thousands of other nursing home residents across the nation.

Resident 11 lived at Dexter Health Care, a 53-bed, for-profit nursing home in Dexter, a former mill town of fewer than 4,000 people halfway between Waterville and Bangor on the banks of the Sebasticook River. Resident 11’s personal information — name, health problems, age, even gender — were not published in the inspection report, but one important detail is included.

In the event of an emergency — if Resident 11’s heart stopped beating and lungs stopped breathing — Resident 11 wanted staff to attempt revival with cardiopulmonary resuscitation, or CPR.

But when that moment came, no one attempted to administer CPR to Resident 11.

After Resident 11’s death, Dexter Health Care was fined $5,850, the second largest such fine in the state in at least three years, for violating federal law that prohibits the mistreatment, neglect or abuse of nursing home patients.

In a statement given Friday, the nursing home’s health management team did not admit fault in the case of Resident 11’s death and said instead that it disagreed with the state’s findings.

What happened in Dexter happens with surprising regularity at nursing homes across the nation. Every year, people in nursing homes who should have received CPR die without getting it, according to an analysis by ProPublica, a watchdog journalism group that provides a searchable database of nursing home deficiencies.

Over the past three years, there have been 161 inspection reports that have included serious deficiencies related to CPR. Some are for unrelated issues, but just a sampling of the records uncovered many instances in which people with clear directives to be revived by CPR have died without receiving it.

Such elder care issues are particularly pressing in Maine, which has more elders per capita than almost any other state.

It didn’t take long for the state to identify what happened in Dexter as a serious problem. An outline of the incident is given in the state’s four-page inspection report.

On July 2 at 2:11 a.m. at Dexter Health Care, a certified nursing assistant and at least one other staff member rolled Resident 11 over on a bed, an action that is part of many routine procedures, such as dressing or cleaning people who can’t do it themselves. The nursing assistant noticed that the resident’s arm stayed on the bed, something she had never seen before.

(Continued on page 2)

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