Newly released federal information reveals five Vermont nursing homes that are shortlisted candidates for heightened governmental supervision.
A request from two U.S. senators has made public the names of five elder care facilities that have been identified as prospects for higher levels of scrutiny under the national Special Focus Facility program, which is run by the Centers for Medicare and Medicaid Services (CMS).
A review of records from the shortlisted facilities reveal forgotten medications, residents abusing other residents, and dirty facilities. Observers in the field, however, say the records only capture part of the picture.
The five homes are all candidates for Vermont’s single spot in the SFF program, which targets facilities with a “history of serious quality issues” by doubling the number of inspections a home receives. When a given nursing home either graduates from the program or loses its federal funding, a state body — here, the Vermont Division of Licensing and Protection — will choose one of the candidates to take its place.
The Vermont nursing homes currently shortlisted are Ludlow’s Gill Odd Fellows Home, St. Johnsbury Health and Rehab, the Burlington Health and Rehab Center, Newport Health Care, and Colchester’s Green Mountain Nursing Home.
The sole Vermont nursing home currently enrolled in the program is the Pines Rehab and Health Center in Lyndon, which was listed as having “shown improvement” within the program as of May 2019.
While facilities enrolled in the SFF program have always been publicly identified, those shortlisted for the program have not. But after two senators requested the information, CMS compiled a list revealing over 400 additional nursing homes that are candidates for governmental oversight. The senators argue that the publicization of struggling nursing homes will help families make more informed care decisions.
Pam Cota, the licensing chief for the Vermont Division of Licensing and Protection, said that “this allegedly secret list” is something that her division receives every month. While Cota noted that she supports transparency, she also said that the health records and CMS rankings have always been public.
The state does not perform any extra inspections for SFF candidates. According to Cota, however, they visit certain facilities “multiple times a year” to perform complaint investigations, and the division is in regular contact with nursing homes statewide.
“If there’s a lot of problems at a facility, we typically hear about it from residents, family, and staff,” Cota said.
But despite statewide supervision, the Medicare nursing home directory provides troubling details on the five Vermont SFF candidates.
At the Gill Odd Fellows Home in Ludlow, a report states that a licensed nurse assistant “yank[ed]” a resident into a bed, then removed their cap and shoes in an “aggressive” manner.
At St. Johnsbury Health and Rehab, a resident was sent to the emergency room because staff did not comply with their stated dietary needs. “The resident choked on the meat after the first bite, and was unable to clear their airway,” the report reads.
A resident at the Burlington Health and Rehab Center was left on the toilet for 15 or 20 minutes despite calling out for help. They finally “self-transferred” to their walker, something they should not have been required to do. According to the report, the resident said, “I know I’m supposed to wait for someone to help, but I just couldn’t sit there any longer.”
For each of the Vermont nursing homes, the health inspection rating was the lowest segment of the home’s overall rank. The St. Johnsbury facility has 16 total health citations, compared to a Vermont average of 6.1. The Gill Odd Fellows Home’s long-term resident hospitalization rate is 3.25 times greater than the Vermont average.
Vermont has 36 nursing homes listed on the Medicare website. Of the 36, 24 receive rankings of “average” or better. Only five receive the worst rating, ”much below average,” and all of them are candidates for SFF.
Two of the homes, the St. Johnsbury and Burlington Health and Rehab centers, are owned by the same parent company, an organization called Genesis. Genesis oversees approximately 400 nursing homes in 29 different states, including nine in Vermont.
Lori Mayer, a Genesis spokesperson for the St. Johnsbury and Burlington locations, wrote in an emailed statement that both centers are committed to providing quality care. She also noted that because past surveys are not removed from CMS’s calculations for three years, the data is not always “an accurate reflection of the care provided.”
“We support making relevant, transparent information available to patients, residents and their families to make informed care decisions,” she wrote.
The other nursing homes did not respond to multiple requests for comment.
Like Mayer, Cota emphasized that the surveys might not accurately reflect current quality. She called SFF candidacy a “moving target”: as violations age out of inclusion in the rankings, facilities may make it off of the candidate list without ever participating in the SFF program.
“They may have had a bad year three years ago, but maybe they changed their practices or had a leadership change, and now they’re stellar,” Cota said. “But they’re still on that list because of the findings of years ago. So it really is just one piece of the puzzle.”
According to Laura Pelosi, who oversees policy at the Vermont Healthcare Association, the association is working to combat broader systemic issues that might lead to poor care. She cited low Medicaid reimbursement and a lack of an available workforce as problems that “raise concerns about the sustainability of the system.”
Cota, however, said that CMS’s rankings do not necessarily indicate a deeper problem for the state’s elder care network.
“I think that the public should have every decision making tool possible at their fingertips when they’re trying to decide on a nursing home for themselves or a loved one,” she added. “This is just one piece of the picture. It’s not the whole picture.”
