Pennsylvania nursing home inspectors have visited the Latrobe Regional Health and Rehabilitation Center nearly 40 times during the past two years.
They have found obese patients incapable of safe evacuation if an emergency arose. Other residents were severely dehydrated. Patients weren't being protected from their tendency to fall or pull out tracheotomy tubes. Assessments of how to help dementia patients were incomplete.
For such problems, the facility was placed on provisional licenses three times in 2006-07 by the state Department of Health, and it has been fined more than $25,000 by the state and $94,000 by the federal government.
It was banned from admitting new residents in October and November. It is one of five Special Focus Facilities in Pennsylvania, a term used by state and federal regulators to denote nursing homes in need of the most attention.
While Latrobe Regional serves as one indication of how regulators continue to find problems in nursing homes, the striking thing is how few peers it has in that regard locally. None of the other four Special Focus Facilities is in Western Pennsylvania, and no other home in the Pittsburgh region has been on a provisional license this year.
The number of penalties issued statewide by the Health Department has been far lower in recent years than in the first part of the decade, although the 43 fines totaling $342,150 this year exceeded those in 2005 and 2006. The 14 provisional licenses in 2007 were the lowest number this decade, fewer than one-fifth the number of 2003.
There has been no trend showing decline in the number of fines issued in Pennsylvania by the federal Centers for Medicare & Medicaid Services, which makes its own determinations using data provided by state inspectors. The total dollar amount of the CMS fines has dropped, however. In the 2006-07 fiscal year, CMS fined 84 homes $515,091, while fines totaled more than $1 million in both 2000 and 2002.
Latrobe Regional has absorbed the biggest recent penalties in Western Pennsylvania on both the state and federal level, with the most notable other example the Laurel Crest Rehabilitation & Special Care Center, operated by Cambria County. It has been on provisional licenses twice this year, and was fined more than $13,000 by the state and $42,000 by CMS. In its latest incident, a woman died from injuries in August after being dropped by a mechanical lift.
Reports by the U.S. Government Accountability Office have pointed out that state surveyors often miss deficiencies, even serious ones. That casts doubt about whether reduced citations actually indicate quality improvement, say GAO officials.
Many family members of nursing home patients undoubtedly have their own concerns about the places they visit, similar to Barbara Rettinger, whose father has spent three years in the West Hills Health and Rehabilitation Center in Moon.
"The weekends are very bad, very understaffed," she said. Ms. Rettinger contends the nursing home has been too slow to identify dehydration, anemia and ulcers in her father. Adam DeJulio, a dementia and Parkinson's patient, has had been hospitalized many times that his daughter believes could have been avoided.
Despite her criticisms, she keeps him at West Hills because it is so close to her home that she can visit frequently and advocate for him. When asked about her concerns, a spokeswoman for West Hills issued a statement that said "Retaining staff members in the long-term care industry as a whole remains an ongoing challenge," but it did not address Ms. Rettinger's specific concerns.
Actually, West Hills has been cited for fewer deficiencies in the past 30 months than is the average in the state, and no serious ones. The state conducts annual inspections of all homes, visits those on provisional licenses more frequently and also responds to complaints it receives. Consumers such as Ms. Rettinger end up frustrated, however, when inspectors don't confirm the faults they have identified.
William Bordner, director of the Health Department's Division of Nursing Care Facilities, expressed confidence that Pennsylvania's 729 nursing homes are better than a few years ago, with 3,433 on-site visits by inspectors this year a large factor.
Neither he nor CMS officials, however, offered an explanation for why they issued more fines in the past year than the year before, or why federal fines have far outnumbered those by the state in recent years, which wasn't the case previously.
CMS regional officials, in fact, hesitated to make the same assertions by Mr. Bordner that overall conditions are better.
Still, federal regulators say they have no reason to question Pennsylvania for finding fewer serious deficiencies and taking fewer enforcement actions than in the past. Ombudsmen who monitor long-term care for county aging agencies say they've seen no drop-off in how nursing home surveyors do their job, supporting Mr. Bordner's contention that the number of inspectors, about 130, and their approach hasn't changed.
Diane Menio, executive director of the Philadelphia-based Center for Advocacy for the Rights and Interests of the Elderly, said some of the worst-performing homes in Eastern Pennsylvania have closed.
That leaves facilities such as Latrobe Regional standing out as atypical. It even stands apart from more than 20 other nursing homes owned in the state by Milwaukee-based Extendicare Health Services Inc., since the facility in Westmoreland County has more deficiencies and recent fines than any of those.
In printed statements, the company's regional director of operations, Arlene Runzo, said Latrobe Regional is "caring for a complex population with unique requirements" compared to other nursing homes, and the staff has received new training and added a director of quality life services as a result of state-identified problems.
With such changes, she said, "we will continue to appropriately meet the needs of all the residents in this facility."
-- Gary Rotstein