Correction/Clarification (Published Feb. 5, 2002): In a story published Feb. 3, 2002, about problems at the Atrium I Nursing, Research and Rehabilitation Center in Robinson, patient Frances Poloka was incorrectly identified as the wife of Jack Poloka of McKees Rocks. She is Jack Poloka's mother.
Robbed of her ability to live on her own by Alzheimer's disease, Mabel Taylor moved into the Atrium I Nursing & Rehabilitation Center in Robinson in 1996.
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Atrium administrator Martha Bell: "Atrium I has a conscientious, dedicated administration and staff providing quality compassionate and humane care to its special needs residents." (John Beale, Post-Gazette)
Additional coverage
Family 'horrified' over care
Graphic: How Atrium compares
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Over the years, her memory and skills continued to deteriorate, but she could still converse, walk, bounce a great-grandson on her lap and sing a favorite hymn when her extended family visited and captured her on videotape in late July.
Three months later, she was dead.
After wandering into one of the nursing home's fenced-in courtyards on a night when the temperature was around 40 degrees, Taylor, 88, died on the wrong side of a locked door. County police are trying to determine if negligence or reckless conduct contributed to her death Oct. 26.
An elderly woman's death under unusual circumstances would be disturbing at any long-term care facility.
But at Atrium, an attractive, well-designed center touted as a model for dementia care when it opened in November 1995, it comes on top of a pattern of problems identified by state inspectors, federal regulators, family members and ex-employees.
In the latest indication of the facility's troubles, a federal agency yesterday cut off reimbursements for admission of new patients covered by Medicare and Medicaid. It is the second such action taken against Atrium in the past 15 months and one that could cost it substantial revenue until it returns to compliance.
In a review of the facility, the Post-Gazette also found:
Over the past 30 months, Atrium has been cited by the state Health Department for far more deficiencies than any other nursing home in Western Pennsylvania. Many citations are unrelated to direct patient care, but in a category of "actual harm" to residents, Atrium had more deficiencies than any of the state's 771 nursing homes.
From its first year of operation, Atrium has received a higher-than-usual number of punitive enforcement actions from the state and federal governments, including downgraded "provisional" licenses, nearly $68,000 in fines and a temporary ban on admissions.
Nine families have detailed to the newspaper their complaints about care, cleanliness and staffing levels affecting their relatives. Several also have relayed to county authorities their contentions that conditions at Atrium resulted in harm, prompting homicide detectives to expand the probe they began after Taylor's death.
Former employees describe a facility where the staff was disillusioned from the outset with how managers' cost concerns appeared to overshadow patient care, despite Atrium's public statements that it would offer state-of-the-art treatment for individuals with dementia.
Atrium's managers contend they have suffered from overzealous investigators, disgruntled ex-staff members and divisiveness among families. They maintain the facility is fulfilling its mission to serve a special, difficult population better than any other institution.
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Atrium administrator Martha Bell and treasurer Warren Mason in the courtyard where Mabel Taylor died. (John Beale, Post-Gazette) |
Unfairly singled out
Its administrator, Martha Fenchak Bell, has repeatedly challenged state assessments of Atrium, and says the federal government is disregarding its own regulations in the new restriction on Medicare-Medicaid reimbursements.
The ban stems from violations identified in recent inspections, which Bell says are incorrect and symbolize a pattern of unfair enforcement.
She said the facility might be penalized because it treats a particularly difficult category of patients, it lacks the clout of national for-profit chains in dealing with regulators, and initial problems brought excessive scrutiny.
"It is possible that the Department of Health's continuing microscopic scrutiny results from that bad start. Atrium I has a conscientious, dedicated administration and staff providing quality compassionate and humane care to its special needs residents," Bell said.
"We correct every well-founded deficiency cited by the department and we address all deficiencies cited regardless of the level of scope and severity or lack of a factual basis for the citation."
A former school librarian with degrees in education and nursing, Bell became a grass-roots spokeswoman on Alzheimer's disease while assisting her mother through a lengthy battle with it in the 1970s and '80s.
She helped found the national Alzheimer's Association and headed its local chapter until 1987, when she created the nonprofit Alzheimer's Disease Alliance of Western Pennsylvania, which developed and owns Atrium. She hoped to create 10 more facilities modeled on it. So far there are none.
In addition to being Atrium's administrator, Bell, 55, of West Mifflin, has been the only president of both the alliance and the Alzheimer's Disease Foundation, which has no formal affiliation with Atrium but contributes financial support to it.
Financial disclosure reports required of nonprofit organizations show she received $94,641 in 2000 to manage Atrium, a full-time job, plus $149,229 to run the fund-raising foundation, which has no staff. An industry group reports the national median salary for nursing home administrators is $62,000 plus bonuses.
Her partner in all of the organizations is Warren Mason, 73, of Natrona Heights, a former H.J. Heinz Co. engineer, who serves as treasurer and oversees financial affairs.
His compensation in 2000 was $78,488 from Atrium and $133,792 from the foundation, which generated $424,151 in revenue that year. He and Bell say they received similar compensation in 2001, and are making up for many years of unpaid volunteer service.
Their tenacious teamwork in the late 1980s and early 1990s cobbled together the $13.6 million in bank and government loans, private donations and other funds to open Atrium.
Perched on a hillside overlooking the Parkway West off Campbells Run Road, the 170-bed red-brick and cream-framed facility resembles a townhouse retirement village. Its dementia-specific design includes courtyards landscaped with winding paths that contain no frustrating dead ends for wandering patients and a special alarm system on doors leading outside.
Wrong side of the door
It was in one of those courtyards that Mabel Taylor died in the middle of the night.
Atrium workers found her around 4:30 a.m., sprawled on a concrete sidewalk outside the nursing home's ground-floor B nursing unit. An autopsy later determined that she had died of heart disease aggravated by exposure to cold. Her death was ruled accidental.
The door through which Taylor walked was equipped with an alarm that should have rung when she opened it. But workers later conceded to investigators that employees often propped doors open to deactivate alarms, which is against nursing home policy and state safety requirements, while they went outside for cigarettes.
One of Taylor's six children, Jane Baczewski of Hopewell, said an Atrium employee called her that morning and told her that her mother had died "peacefully in bed." But when Baczewski and her husband arrived, they were puzzled to find Taylor's still-icy body in a room where the heat had been turned up stiflingly high.
An aide, Rose Beasley, soon told them where Taylor really died. Police and the coroner were summoned, and an inquest was convened in December to examine the circumstances of her death.
Although Taylor's family knew she was nearing the end of her life, they were still heartsick over the way she died, Baczewski said.
"She was not a vegetable," she said. "At night, when she couldn't sleep, she would slip into all the rooms and cover up the other people. She was still a mother, and she was a functioning human being who enjoyed her life."
Testimony during the inquest indicated that Atrium employees disobeyed nursing-home policy by moving her body indoors without notifying the coroner's office.
Aides also testified that they heard a supervisor, nurse Kathryn Galati, say she'd called Bell and that Bell wanted them to make it appear that Taylor died in bed. Bell has since denied that and maintains that the aides had clocked out of the facility by the time Galati telephoned her at home.
Since the inquest, which is to be reconvened for additional testimony and an eventual recommendation to county District Attorney Stephen A. Zappala Jr., other families and current and former employees have provided their own stories to both the newspaper and county police.
Some relatives say Atrium looks pretty on the outside, but loses its luster for those residing in or visiting its rooms, where daily charges start at $90 for personal care services and $127 for basic nursing care. Such charges are not high compared with similar facilities.
"It was a beautiful building. But I didn't care about the beautiful furniture, the beautiful drapes. I wanted it clean," said Jackie Weinstein of Kennedy, whose mother, Mary Petrelli, spent about three weeks in a skilled nursing unit at Atrium last year before dying in a hospital.
Weinstein said she and her siblings usually had to feed her mother and tend to her hygiene because there weren't enough workers on duty. Nurses and aides were kind, she said, but were badly overtaxed and often couldn't respond promptly when patients needed them.
Bell acknowledges Atrium has suffered from some of the same difficulties in retaining and recruiting staff as the rest of the long-term care industry, but said that through overtime and temporary help, it has consistently met its regulatory requirements.
A mission unrealized?
The state Health Department and Public Welfare Department separately monitor Atrium on the nursing home side and in its personal-care home, where residents are higher functioning.
Their inspectors follow up on public complaints in addition to performing annual inspections. The inspections turn up deficiencies in most facilities, but not usually severe enough to prevent renewal of regular licenses.
Atrium has been cited for 99 deficiencies in the past 30 months, more than four times as many as the average among facilities its size, according to the Health Department.
The department divides the deficiencies into different levels of severity. The category of "actual harm" to residents, in which Atrium led the state, includes problems such as bed sores, dehydration and failure to receive prescribed medication or treatment.
For its violations, Atrium has received five provisional licenses in just more than six years from the Welfare Department and four provisional licenses from the Health Department, a sanction that brings tighter scrutiny.
Susan Getgen, director of the Health Department's division of nursing-care facilities, said Atrium and other facilities were typically given a chance to correct deficiencies and wipe their slates clean. She said the department tried to avoid closing facilities and disrupting the lives of residents.
"They have some problems and some concerns, but any place can have those problems," Getgen said of Atrium. "They just have to be more consistent."
While Atrium has never been threatened with closure, the Health Department has fined it four times and slapped it with a two-month ban on admissions in March 1996, four months after opening. An inspection at that time found inadequate care plans for residents, insufficient staff training, failures to carry out doctors' orders and numerous other problems.
The most serious action since then was the denial of government reimbursements for Medicare and Medicaid patients from November 2000 to January 2001. Bell said the facility lost hundreds of thousands of dollars because it couldn't admit new residents covered by the programs during that period.
The federal Centers for Medicare & Medicaid Services accompanied the payment denial with a $37,700 fine. Those actions followed an Oct. 25, 2000, inspection in which the facility was cited for failure to prevent pressure sores, failure to give medications properly, poor administrative oversight and other problems.
Dr. John Prendergast, medical director of Atrium since its opening, said he was uncertain why the facility has had so many negative findings. He has suggested to Bell and Mason multiple times, he said, that they hire an outside firm experienced in managing such facilities to run Atrium.
"I think all of us are frustrated by the fact that the potential is here for a facility that could be excellent in many respects, that could be a leader in many respects, could be a model for other facilities ... and we have not realized the potential," said Prendergast, who is Mercy Hospital's chief of geriatric services and spends a minority of his time at Atrium.
Bell used a management firm, now out of business, in the first months of operation, but severed the contract because it wasn't doing a good job, she said. She has not replaced it because the cost of using such firms diverts funds from other needs.
A number of former employees, some of whom had bitter disputes with Bell and Mason upon leaving, believe that while the vision for Atrium was admirable at the outset, its managers' financial concerns became obsessive and took precedence over providing quality care.
"Martha Bell was caring and she wanted to do some good," said Joanne Kraynak, 54, of Coraopolis, who was Atrium's original admissions director, returned later as personal-care coordinator, and left last year after a dispute. "That's why it bothers me, what's going on in that building. They had good staff, but they destroyed them and drove them out of there. They're different than they were five years ago."
The facility also has fallen short of its mission to assist in Alzheimer's breakthroughs since the departure of its research director, Dr. Mahmood Usman, just five months after opening. His dispute with the Atrium managers is still in litigation.
Even with its problems, Prendergast and some staff and relatives of residents join Bell and Mason in maintaining that Atrium provides a caring and knowledgeable environment.
Several current staff members said they'd worked at other long-term care facilities that were substandard to Atrium. Bell said several employees whose relatives live at Atrium wouldn't permit the facility to provide poor care.
Some people with no obligation to Atrium say it compares favorably to other places where loved ones stayed.
"Every time I ask the staff for something, they always do it without hesitation," said Jack Poloka of McKees Rocks, whose mother, Frances, 87, has been at Atrium since September. He is satisfied she "has a clean, safe, nice place and gets treated with dignity, and gets her meals and medication."
