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

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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.”

In 2013, for which only partial data has been published, similar cases resulted in deaths, not only in Dexter, but in Hornell Gardens in Hornell, N.Y., and Kenilworth Care and Rehabilitation Center in Florida, among others.

In another case, at Rockdale Resident and Rehabilitation Center in Texas in 2011, a resident requested CPR but when the time came, staff deferred to his wife, who told them not to attempt resuscitation.

In that same year, two residents at Parks Methodist Retirement Village In Odessa, Texas; two more at Woodley Manor Health and Rehabilitation in Montgomery, Ala.; and a woman at Andrus on Hudson in New York were all among those who died without receiving CPR, despite having full code status.

In 2012, similar cases resulted in deaths at Graceland Care Center of Oxford in Mississippi, Casa Morra Rehabilitation and Extended Care in Bradentown, Fla.; and Sunrise Care Center in Milwaukee, Wis.

A 2006 study from the Journal of the American Medical Directors Association found that 33 percent of nursing home residents who wanted CPR did not receive it prior to the arrival of emergency medical services.

In Maine, such elder care issues are increasingly important and will become more so in the years to come. Maine’s median age, 42.7 years, is highest in the nation, and it also has the third-highest percentage of people aged 65 or older, with 15.9 percent, according to the U.S. Census Bureau.

A first-in-the-nation 30.9 percent of Mainers are between 45 and 64 years old, which means that the next generation of those needing elder care will be even bigger.

With this in mind, a team of inspectors visits every nursing home in the state annually, or when a complaint or incident is reported. Within a week after Resident 11’s death, two complaints at Dexter Health Care prompted an inspection.

The inspectors are registered nurses, licensed social workers and health facility specialists who have all been certified to inspect long term care homes in the state. They are employees of the state, but inspect on behalf of both the state and federal governments.

Before Resident 11 died at Dexter Health Care, the home didn’t have a bad track record. During four previous state inspections, in 2011 and 2012, a handful of deficiencies, most of them minor and none resulting in fines, were found.

In its Friday statement, the Dexter nursing home touted its ratings, which include an excellence award from a national research company based on feedback ratings from patients and families.

But when the inspectors interviewed staff in July, the initial responses suggested that there was confusion, not just about Resident 11, but about the nursing home’s resuscitation policies in general.

In July, when inspectors asked the charge nurse why she didn’t attempt to revive Resident 11, she said she didn’t know the resident’s code status.

When they talked to the nursing director, the director said staff at Dexter Health Care weren’t required to give CPR unless the cardiac or respiratory failure was witnessed.

That drove the inspection team to look at Dexter Health Care’s policies, where they uncovered a second problem.

“The policy did not address what staff were to do in the event they discovered a unwitnessed cardiac or respiratory arrest on a resident with advanced directives indicating (the desire to have CPR),” according to the inspection report.

That means if a person’s heart or lungs failed while no one is in the room, then the staff didn’t have to give CPR when they discovered the body, even if the patient’s advance directives asked that they do so.

The state inspectors asked for more information. They checked a list of CPR-certified staff against payroll sheets and worker schedules.

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