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.”

That led to the discovery of a third problem.

They found that, just two days after Resident 11 died, seven other residents who also had asked to receive CPR in their advance directives were at risk of not getting it.

Why? Because no one that night at the nursing home was certified to administer CPR.

“The facility was unable to provide evidence of a system to ensure CPR trained staff were available 24 hours a day, seven days a week,” inspectors wrote. “The failure of the facility to have staff who were certified in CPR placed the residents with full code status at risk of potential harm or death.”

In response to information requests from the Morning Sentinel, Dexter Health Care’s management team issued a three-paragraph statement on the death of Resident 11 that expressed sympathy for the family, but admitted no fault.

“We can tell you that in similar situations we do not provide CPR and other lifesaving measures when doing so would be futile,” the statement reads. “While our hearts go out to the families in these types of situations, in any health care setting there will always be some circumstances when death is irreversible.”

The nursing home would not discuss Resident 11’s death or its policies any further.

But Edelman said that by not being prepared to follow the advance directives, Dexter failed to honor an agreement with its residents.

“If you have residents who want CPR and no one is qualified to do it, that’s a really serious problem,” Edelman said.

Edelman said enforcement of nursing homes can be too lax and that fines are assessed too infrequently to make much of a difference. She said federal laws only allow fines to be imposed when actual harm has occurred and that many inspectors wrongly classify serious cases as not having caused harm.

“If we read the statements of deficiency, would we agree that these are the only six with serious deficiencies?” she asked.

Addressing problems

Most nursing homes would have responded to Resident 11’s death differently.

If a resident had a full code status and was discovered without vital signs, the resident would have been given CPR at their nursing homes in Farmington, Bingham and Winthrop, Sawyer and Timberlake said.

That’s not just good elder care, officials say. It’s also the law.

In their report, the inspectors found Dexter Health Care had violated federal public health regulations that require nursing homes to “develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse of residents.”

The nursing home was also cited for violating another federal regulation, that it provide care for “the highest practicable, physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

Federal regulations also require that nursing homes have CPR-certified staff available at all times, a requirement both Timberlake and Sawyer said they comply with.

In Farmington, Orchard Park and Edgewood nurses all have up to date certification, Timberlake said.

She knows this because the date of certification of each of the two homes’ 70 staff members is tracked in a computerized system that lets administrators know when someone’s certification is nearly expired.

On a regular basis, “we bring someone from the outside in and provide training for all the folks,” Timberlake said.

Both Timberlake and Sawyer said they also encourage their certified nursing assistants to be CPR certified.

During their most recent inspections, the four nursing homes overseen by Timberlake and Sawyer had no, or minor, deficiencies.

As a group, Maine’s nursing homes have fewer serious deficiencies than most states in the country.

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