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

(Continued from page 4)

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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.”

“I think Maine overall does a pretty good job, but then once in a while you hear about something that’s horrendous,” said Linda Weare, who works as the elder abuse manager at Maine’s Elder Abuse Institute.

Weare said that, while abuses do happen in nursing homes, the institute’s focus is on residential situations, where elders who suffer abuse are often isolated from help, sometimes by the design of their abusers.

“In a nursing home, there are more people around, so the chances of people finding out are greater,” she said.

The financial penalties for violations in Maine are also less severe than those of other states. According to an analysis of the data performed by ProPublica, Maine fined its nursing homes a total of about $55,000 over three years, with an average fine of about $6,100, far below the national average of $11,300. The highest fines in the nation are assessed in Tennessee, which saw more than $5.6 million in fines, with an average amount of $72,327.

Phyllis Powell, assistant director for the Medical Facilities Unit at the state’s nursing home administrators licensing board, said it is rare for a nursing home to actually lose its license.

In fact, in the six years she’s been working in the department, she said, it hasn’t happened once.

Instead, documented deficiencies are handled with an eye toward bringing the offending business into compliance.

“If they are found in violation they have an opportunity to remedy that,” she said.

Chance at life

Would CPR have made a difference in the case of Resident 11? There’s no way to know.

CPR doesn’t guarantee survival, but it does have a chance of success. The idea is to use chest compressions and, sometimes, forced breaths into the lungs to keep oxygen-bearing blood moving through the body and into the brain until the heart can be restarted, often with a defibrillator. A 2009 study of nearly half a million patients published in the New England Journal of Medicine found that 18 percent of those who received CPR while in the hospital survived long enough to be discharged.

The 2006 study from the Journal of the American Medical Directors Association found survival rates for nursing home residents were lower, between 2 and 11 percent.

What’s often critical is how quickly CPR is administered.

In the event of cardiac arrest, the chances of survival decrease by 5 to 10 percent for every minute that CPR is not administered, according to the Centers for Disease Control.

Without a supply of oxygen, brain damage can happen in just a few minutes, and a person can die in eight to 10 minutes, according to the Mayo Clinic.

In this case, Resident 11 was alive and answering questions 12 minutes before the charge nurse entered the room and found no pulse or other vital signs.

Dexter Health Care’s statement said the state inspectors were in error when they cited the nursing home.

Dexter Health Care appealed the report’s findings to the state, and the state did modify some of the wording on the statement of deficiencies — it withdrew a sentence that said the resident died during the event and another that said two certified nursing assistants on duty were not CPR-certified. It also revised the number of nights it found without any CPR coverage from a higher number down to just one of 25 nights, July 4.

But, the main thrust of the report — that the nursing home had violated federal regulations and would be fined $5,850 — remained intact. The federal Centers for Medicare and Medicaid Services reviewed and upheld the state’s findings.

In the wake of the state inspection, things have changed at Dexter Health Care.

While it disagreed with the state findings, the nursing home did respond to the report by making changes.

“We met or exceeded the recommended corrective plan of action. We were pleased that when investigators revisited, they found Dexter to be in compliance and ruled that any deficiencies were properly corrected,” according to the statement.

Edelman said elderly residents all across the nation suffer the consequences when nursing homes fail to take care of them properly.

However, she said, the fault rarely lies with the staff members themselves.

“They’re working in difficult situations,” she said. “In many places, there aren’t enough of them to do the work.”

Instead, she said, advocates for better care focus on management decisions, particularly staffing levels, that are often made with too much of an emphasis on cost-cutting. It’s not enough to have the right policies on the books, she said. Adequate numbers of staff with proper training have to be in place to carry those policies out.

Matt Hongoltz-Hetling — 861-9287 mhhetling@centralmaine.com Twitter: @hh_matt
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