Copyright © 2018 Albuquerque Journal
At Princeton Place in Albuquerque, an unsupervised resident wandered outside the facility and was struck and killed by a vehicle, according to a 2016 federal report.
At Casa Real in Santa Fe, inspectors said in a 2016 report that eight residents were not given insulin on the schedule ordered by their doctor.
Still another report states that at Sierra Health Care Center in Truth or Consequences, a resident told inspectors in 2017 he was left unattended for hours until his colostomy bag began to leak.
“I had to hold (feces) in my hand,” said the individual, according to the report. “I finally started yelling. … I would like to get the care I feel I deserve.”
Such issues are among more than 2,217 infractions reported in New Mexico-based nursing homes in recent years, as shown by reports filed with the Centers for Medicare and Medicaid Services.
Princeton Place, Casa Real, and Sierra Health Care Center did not respond to requests for comment.
Nearly all the nursing homes in the state are Medicare- or Medicaid-certified. Reported infractions range from the relatively minor (failing to give adequate notice before switching roommates, not promptly delivering mail) to the potentially deadly (improper fire safety precautions, abuse of residents).
Of those 2,217 reported deficiencies, 115 are considered serious: rated a J, K or L on a severity scale of A to L, meaning that the problem creates an “immediate jeopardy to resident health or safety.”
An analysis by the investigative journalism organization ProPublica showed that of 74 Medicare- and Medicaid-certified homes located in New Mexico, inspectors reported serious deficiencies in 36 of them between 2015 and April 2018.
By that measure, New Mexico is the worst in the nation for serious deficiencies on a per-nursing-home basis, according to the analysis.
Nursing homes here have been fined $2.42 million between 2015 and April 2018 and had their Medicare and Medicaid payments suspended for compliance issues 44 times over the same time period.
A spokesman for the New Mexico Department of Health’s Division of Health Improvement said in a statement that the department “take(s) seriously our role to protect New Mexico’s elderly population.” There were 5,749 nursing home residents in New Mexico as of 2016, according to the Kaiser Family Foundation.
The spokesman said the state conducts inspections of nursing homes every 12 to 15 months or when a complaint is received; the findings are then reported to CMS, which determines penalties and actions.
The way some penalties are applied is likely to change soon.
As part of a Trump administration effort to relax regulations in the sector, CMS has announced it is changing an Obama-era rule. The shift will result in smaller fines for noncompliant nursing homes.
The changes have been criticized by advocates for the elderly and hailed by the industry, which argues the rules are burdensome and mean caretakers spend less time with their patients and more time on paperwork.
The industry association that represents nursing home in New Mexico claims that, in several respects, nursing homes here outperform the national average.
Jason Espinoza, the New Mexico Health Care Association’s executive director, said in a statement that New Mexico “does very well in eliminating physical restraint usage, reducing the use of antipsychotics and managing (urinary tract infections) through our infection control efforts.” He also said the association has a registered nurse on staff dedicated to working with individual facilities on quality improvement, among other initiatives focused on addressing deficiencies.
Still, a spokesman for the New Mexico Attorney General’s Office said in an email that the agency is “very concerned” about the status of resident care in the state.
The office is pursuing a civil case against two nursing home operators, Preferred Care and Cathedral Rock, who are accused of failing to provide basic services on a regular basis to residents at seven nursing homes in the state.
The AG’s Office spokesman said litigation is meant to be a deterrent against “other current operators that are not providing adequate nursing home care.”
Preferred Care and Cathedral Rock did not respond to requests for comment.
But Michael Parks, an attorney with the Albuquerque-based Senior Citizens Law Office, said that while regulators have long recognized problems within the nursing home system, they are forced to reckon with the reality of what closing any of those facilities would mean.
“In my judgment, there has long been a tension between some enforcement activities and the need to place patients in facilities,” Parks said.
It’s a tension, he said, that is only likely to get worse as the state’s population continues to age and the need for those facilities grows.
In addition to enforcement actions available to the AG’s Office, the state Department of Health can revoke a nursing home’s license.
By 2030, New Mexico will have the fourth-largest population in the country of people age 65 or older as a percentage of the overall population, according to a 2016 Legislative Finance Committee report.
A shifting landscape
In that report, the committee identifies several factors behind quality of care issues in New Mexico nursing homes, an issue it characterized then as a “growing concern.”
Specifically, the report notes that Medicaid has increasingly covered home- and community-based care options, leading to fewer nursing home residents with higher – and more expensive – needs. As a result, nursing home revenues are declining, and Medicaid and other patient revenues haven’t offset the rising costs of caring for more expensive residents, according to the report.
As of 2016, New Mexico nursing homes were also providing fewer overall staffing hours per resident compared to the national average and that of neighboring states. Higher staffing levels are correlated with better quality of care, according to the report.
Among recommendations made by the committee: Adjust the state’s Medicaid reimbursement system to account for changes in resident needs, and more closely track indicators like serious deficiencies and staffing levels.
A New Mexico Human Services Department spokeswoman said that after the legislative report was published, the agency met with the New Mexico Health Care Association and performed an analysis on the impact of a transition to a different reimbursement model, one that would weight more heavily the resource-intensive nature of caring for today’s nursing home residents.
“After considerable research, the department decided that it wasn’t fiscally possible,” said the spokeswoman in a statement.
However, she said the agency is working with managed care organizations to find ways to reward outstanding nursing homes, what she described as a “key goal” for the state’s Medicaid program, Centennial Care.
The department also implemented a 2.7 percent funding increase in the daily Medicaid reimbursement rate for nursing facilities in January, and in July they will get an additional increase of 1.84 percent.
A Department of Health spokesman said the agency has “created a strategic plan focused on improvements in the areas that will have the greatest impact on the health priorities in New Mexico.”
In an effort to improve Vida Encantada Nursing & Rehab in Las Vegas, N.M., Harvey Pelovsky, managing partner of parent company Rim Country Health, said the facility has “dramatically changed” many parts of its operation in recent years, including increasing staffing levels.
Vida Encantada has been cited by inspectors for 61 deficiencies since 2015, accord to federal data. And while Pelovsky said he’s confident those changes will mean better inspection reports in the future for the facility, he said systemwide reform will likely require a shift in state policy.
“I’d encourage people to educate themselves on the reimbursement issues, and educate their state legislators,” he said. “Nursing homes are an important part of the continuum of care. They shouldn’t be the weakest link.”
Four highly penalized
New Mexico nursing homes
Data based on reports filed with the Centers for Medicare and Medicaid Services between 2015 and April 2018 compiled by the investigative journalism organization ProPublica.
Name: Casa Arena Blanca Nursing Center
Among highest in state for: Serious deficiencies (nine). Inspectors have also found 67 total deficiencies at Casa Arena Blanca since 2015.
Response: “Though our facility has experienced challenges in the past, we are taking necessary steps to address them,” Jeffrey Adisam, Casa Arena Blanca’s administrator said in a statement. “Everyone associated with our facility remains committed to providing the highest level of compassion and care to our residents, and we look forward to improved surveys in the future.”
Name: Casa Real
Location: Santa Fe
Among highest in state for: Total deficiencies (101). Of those, inspectors found five serious deficiencies. The home was hit with $122,867 in fines and three payment suspensions from Medicaid or Medicare in the past three years. It is also a “special focus facility,” a federal designation given to nursing homes that have “a history of serious quality issues.” Casa Real is listed in a recent CMS report as a facility that has shown improvement.
Response: Casa Real directed a request for comment to its parent, Texas-based Preferred Care Group. Preferred Care did not respond to a request for comment.
Name: Good Samaritan Society — Manzano Del Sol
Among highest in state for: Fines ($220,214). Manzano Del Sol has also had two payment suspensions since 2015.
Response: A spokesman for the facility’s parent company, Good Samaritan Society, said in a statement that Manzano Del Sol is committed to “addressing issues raised by the New Mexico Department of Health surveys.” He also noted the nursing home recently received an award as part of a national program that sets “specific, measurable targets to further improve quality of care in America’s skilled nursing centers and assisted living communities.”
Name: Mission Arch Center
Among highest in state for: Payment suspensions (four). Mission Arch Center has also been fined $177,077 and was cited for seven serious deficiencies in the past three years.
Response: A Mission Arch Center spokeswoman said the facility is “committed to providing high-quality care to our patients and residents” and supports the mission and quality initiatives of the New Mexico Health Care Association, of which it is a member.
What you can do
- The Center for Medicare and Medicaid Services’ Nursing Home Compare website (www.medicare.gov/nursinghomecompare) has detailed information about Medicare- and Medicaid-certified facilities.
- ProPublica’s Nursing Home Inspect (projects.propublica.org/nursing-homes/) allows users to search through federal inspection reports by location, nursing home name, or search term.
- Michael Parks, an attorney with the Albuquerque-based Senior Citizens Law Office, says there’s no replacement for an on-site visit. “Everyone says, ‘See how it smells,’ but it’s true,” he said. He also said witnessing something like a group of residents slumped over in their wheelchairs could speak to an overuse of medications to keep an individual docile, or possibly other abuse.
- To register a complaint about a nursing home, contact the state’s long-term care ombudsman. The number is 1-866-842-9230 in Albuquerque and northwestern New Mexico; 1-866-451-2901 in Santa Fe and northeastern New Mexico; and 1-800-762-8690 in Las Cruces, Roswell and southern New Mexico.