WASHINGTON – Maryland nursing homes take an average of 60 days to correct problems that caused harm to residents, the 10th-slowest rate in the country, according to official inspection records.
A Capital News Service analysis of 582,402 deficiency records reported to Medicare by state health agencies between June 18, 1998, and Feb. 13, 2004, showed that, nationwide, nursing homes took an average of 52 days to correct problems of “actual harm” against residents.
And while Maryland facilities took 60 days to fix serious problems, they were able to correct all other deficiencies in an average of about 50 days.
Patricia Bayliss, the Maryland Department of Aging’s top ombudsman to nursing homes, said most minor deficiencies should take about two months to correct, but serious deficiencies need to be attended to a sooner — a sentiment shared by nursing home officials and advocates.
“If the deficiency is severe, the nursing home has something like 10 days to correct the problem,” Bayliss said.
But critics say the state is at least partly to blame, because of staffing shortages, and that the problem may be more severe than reported.
A 1999 report by the General Accounting Office criticized Maryland nursing homes and the Office of Health Care Quality, where it said an unidentified official “acknowledged reducing the priority of some complaints since the agency recognized that it could not meet shorter time frames because of insufficient staff.”
Sen. Paula Hollinger, D-Baltimore County, who sat on a task force formed in response to that report, said recently that there is no way of knowing if the Office of Health Care Quality is still lowering the severity of complaints it receives.
The state Health Department declined repeated requests for interviews on this story. But John Fisher, a nursing home administrator for 38 years, called it laughable to suggest that the Office of Health Care Quality had lowered the severity of incidents.
“I think the state of Maryland is in the forefront of making sure that facilities are in line with federal and state regulations,” said Fisher, whose Citizens Care Center nursing home took 148 days to correct two actual harm incidents in 2001. “I can’t imagine that Maryland would be criticized for that.”
Wendy Kronmiller, acting deputy director of the Office of Health Care Quality, said nearly all of Maryland’s 240 nursing homes have been fined for deficiencies during the last five years.
Deficiencies are classified nationally on a scale in which A is least severe and L is most severe. “Actual harm” deficiencies range from G to L. A 1999 state report said a G deficiency might be a diabetic resident who is not given insulin and goes into a coma, while a J deficiency — the most severe reported in Maryland in the period studied — might be a resident strangled by an inappropriately applied restraint.
In one J-level deficiency in April 2001, a 72-year-old man was allowed to smoke unsupervised, even though his medical record showed he suffered from psychosis and was barely strong enough to light a match. His clothes caught fire, and he suffered third-degree burns on 19 percent of his body.
Garden View Health Care Center in Baltimore, where the man was living, took 90 days to change its supervision policy after that incident. Garden View has since been sold to the Future Care nursing home chain, and neither the past nor current owners would comment on the incident.
There were 190 “actual harm” deficiencies investigated by the state from Feb. 17, 2000, to Jan. 13, 2004, inspection records show. Some of those involved more than one resident.
Fisher, the nursing home administrator, could not say why serious deficiencies take so long to correct.
“It depends on what the deficiency is,” he said. “Some things are correctible pretty quick, but other things take more time.”
But Tom Burke, a spokesman for the American Health Care Association, said corrections are often slowed down by bureaucracy. A nursing home can appeal deficiencies, he said, and even when it agrees that there is a problem, its plan of action must be approved by inspectors.
Burke, whose association represents about 10,000 of the nation’s 17,000 nursing homes, agreed that serious deficiencies should be corrected within days.
Former Sen. Arthur Dorman, D-Prince George’s, said the state deserves at least some of the blame for length of time it takes to correct nursing home problems.
“Obviously the nursing home is responsible, but the state agency has to be sure they do it,” and correct the problem, said Dorman. He was on the task force with Hollinger that was charged with studying “the quality of care in Maryland nursing facilities.”
Michael Lachance, who was Department of Aging’s legislative liaison to that task force, said there have been significant improvements made at nursing homes since then. But he and others said budget cuts have slowed that progress.
“We got about five-sixths of the way, and then the budget crisis hit about a year ago,” Lachance said.
Hollinger said that budget cuts have meant the Office of Health Care Quality is “not able to hire all the people they need to go in and investigate.”
“By not having money budgeted, it means it’s going to take longer” to complete investigations, she said. “And when it takes longer people are more in jeopardy.”
The budget of the Department of Health and Mental Hygiene, which houses the Office of Health Care Quality, was cut $84 million last year.
Bayliss said the ombudsman program — created to help the Office of Health Care Quality with inspections, even though it does not have the power to penalize nursing homes — has also suffered. The task force recommended that the program get about $1.9 million to increase the ratio of ombudsman to nursing home residents.
“We were shooting for $1.9 million,” Bayliss said. “We are now at $1.2 million.”
She was able to increase her staff of ombudsman from 29 to 53, and is hopeful of what can be accomplished. But she said resources are still a problem.
Bayliss said that residents often return to a nursing home even if they have been hospitalized because of a deficiency at that facility. They may even stay there while the investigation is going on.
“There’s really nowhere to put them,” she said. “There is no shelter or anything like that for nursing home residents.”
-30- CNS 04-27-04