July inspections reveal problems at 11 facilities, and officials are grappling with how much risk and harm are acceptable in care for the elderly.

01:00 AM EDT on Thursday, September 9, 2004

BY JENNIFER LEVITZ
Journal Staff Writer

In a grand meeting room at the State House yesterday, the Health Department presented its first monthly update of conditions at nursing homes throughout the state.

Susan Sweet, a self-described former bureaucrat who runs Rhode Island's Minority Elder Task Force, looked at the report for answers.

She found instead a list of 11 nursing homes where July inspections found problems, including one that had caused "actual harm."

She found dates when "APoC" -- plans of corrections -- were filed. "Follow-up surveys" were pending.

She didn't find clarity.

"What exactly is the problem?" she said later. "Who's being hurt and what's being done about it?"

"Let's just talk straight and move."

The Health Department made its presentation at the request of the Long Term Care Coordinating ouncil, a state agency charged with overseeing the state's policies on nursing-home and other long-term care. Its 35 members -- appointed by the governor, lieutenant governor, House speaker and Senate majority leader -- include elected officials, advocates for the elderly, representatives from the nursing-home industry and officials from various state departments.

The council's chairman, Lt. Gov. Charles J. Fogarty, asked the department to begin monthly reports after Hillside Health Center in Providence closed in May. Under Health Department policies, Hillside was given repeated chances to maintain standards of care in the two years before it shut down -- even as the department's inspectors last winter documented the dangerous worsening of an 87-year-old woman's bedsore.

Under a 1999 law, the Health Department must provide the Long Term Care Council with monthly reports of "substandard" care in the state's 101 nursing homes, where some 9,200 people live. But until yesterday, the department had never filed a report -- even though the Health Department had adopted a federal standard that "substandard care" was immediate jeopardy to a resident's health, or a pattern of widespread actual harm, or a widespread potential for more than minimal harm.

In the case of the 87-year-old woman at Hillside, the council was not notified even though the Health Department had found "immediate jeopardy," according to Fogarty.

RAYMOND RUSIN, the department's chief of facilities regulation, yesterday gave the council a list of nursing homes described as being in "noncompliance" in July inspections (see accompanying box).

The nursing homes have all submitted plans for improvement, and the Health Department is planning to reinspect them, according to the Health Department's report.

One nursing home, South Kingstown Nursing and Rehabilitation Center, was cited for "actual harm" in an incident on June 26. According to Health Department records, a nursing assistant moved a woman from her chair to her bed despite orders that she be moved by two people and an electric lift. Her ankle was broken. In its plan of correction, the nursing home said the staff assigned to the woman had been retrained, and that nursing assistants will be given instructions for using the lift at the beginning of each shift.

Yesterday's meeting illustrated the complexity of the task facing the officials who will track and regulate nursing-home care. They must decide what levels of harm and risk are acceptable.

The lieutenant governor's staff met with the Health Department two weeks ago and decided that the new standard for reporting to the council would be instances of "actual harm." Fogarty wants the reports to focus on people who need immediate help so state agencies can intervene.

Some advocates for the elderly said Fogarty's standard is not strict enough.

Roberta Hawkins, the state's ombudsman for the elderly, and a member of the Long Term Care Council, agreed that while the council may not want to see a report of all the nursing homes with deficiencies, the standard of "actual harm" means that someone was hurt.

She suggested the council be notified when inspectors find the potential for harm.

Sweet, of Rhode Island's Minority Elder Task Force, questioned whether the state is approaching elderly care with enough sense of urgency. She found it troubling that the Health Department's report showed that a nursing home with substandard care was treated similarly to nursing homes that had lesser deficiencies. The department's report showed that in each case, inspections were done, and then the nursing home had several days to respond with a plan of correction. Then the Health Department had several days to return for a another inspection.

"At some point, I don't think that any real length of time should go by," she said. "What I'm saying is if something could cause harm, we need to have it corrected in X amount of days, and if it is causing harm, we need to have someone removed immediately."

AFTER YESTERDAY'S MEETING, Fogarty said he would look at lowering the threshold for Health Department reports to the council to include the potential for harm.

He said the point of presentations such as yesterday's is to expose a home with problems earlier and also to ensure greater oversight of the Health Department. "Our first priority is the health and safety of all those folks in nursing homes," he said.

Al Santos, head of the Rhode Island Health Care Association, which represents the nursing-home industry, is also on the Long Term Care Council. He also said Rusin's report was unclear because it didn't explain the deficiencies found -- whether they were "serious or crumbs under the table."

After the meeting, Angelo S. Rotella, a council member and an officer for the American Health Care Association, the nursing-home industry's national umbrella, said the Health Department and nursing-home operators are all "after the same thing" -- good care. He said he hopes that the Health Department doesn't begin to take an adversarial approach to nursing homes. He doesn't believe there should be "more regulations, more punishments and more fines that take away from good care."

DIGITAL EXTRA: Recap a special Journal report on nursing-home care in Rhode Island, titled "Resident #1," and related stories, at:

http://projo.com/extra/2004/nursinghomes/