The Good, The Bad and The Elderly

Area Nursing Homes Fall Hard on Both Sides of New Federal Ratings

By David Anderson Jr.
Published December 30, 2008

One Dunn nursing home received a stellar score in a recent Medicare listing of skilled-care facilities, while two other area nursing homes fared among the worst in the state.

Britthaven of Harnett, nestled on Lucas Road halfway between Dunn and Erwin, was the only nursing home within 25 miles of Dunn to receive five out of five stars — the best score possible — from a new online rating system the federal agency introduced earlier this month. In contrast, Liberty Commons Nursing and Rehabilitation in Benson and Magnolia Living Center in Dunn were the lowest ranking in the area, with one- and two-star ratings, respectively.

Eda Currie, left, and Delissa Bledsoe, nurses at Liberty Commons Nursing and Rehabilitation in Benson, review patient care information in the nursing home's recently expanded assisted living wing. Liberty Commons was given the worst rank possible in a new Medicare rating system, despite having received a perfect state inspection just two months ago, leading staff to wonder how accurate the federal ratings are.

Eda Currie, left, and Delissa Bledsoe, nurses at Liberty Commons Nursing and Rehabilitation in Benson, review patient care information in the nursing home's recently expanded assisted living wing. Liberty Commons was given the worst rank possible in a new Medicare rating system, despite having received a perfect state inspection just two months ago, leading staff to wonder how accurate the federal ratings are.

Medicare officials said the online system should make it easier for people to compare the quality of nursing homes within each state. The database compiles existing information about each facility — state health inspection reports, safety records, staff records and patient care history — and assigns a score based on the overall quality of the facility. Because inspection standards vary between states, the agency doesn’t recommend using the database to compare nursing homes in different regions or selecting a nursing home to care for a loved one without first visiting the facility.

Although the rating system was unveiled just two weeks ago, some of the information used to evaluate nursing homes is already outdated. State inspectors gave Liberty Commons a flawless review in October after spending three days picking over every detail at the nursing home, but the Medicare database lists a poor report from 2007 as the most recent health inspection.

Serious Errors
In November 2007, Liberty Commons was penalized for nine different areas the facility was failing in — an improvement from 39 deficiencies earlier that year.

According to the report, staff failed to keep residents’ personal records confidential; did not ensure each patient’s nutritional needs were met; and slacked off on making sure the nursing home area was free of dangers. More troubling citations included exposing residents to serious medication errors; failing to mark drugs properly; and not having a pharmacist check over medications on a monthly basis.

According to the report, at least 10 percent of Liberty Commons’ long-term residents were physically restrained during the past year — more than twice the average for other facilities in the state.

To read more detailed information about these nursing homes or to compare other facilities, visit http://www.medicare.gov/NHCompare.

A January 2007 report that claims the company hired someone with a legal history of abusing patients; didn’t help residents who couldn’t feed or bathe themselves; and failed to provide three meals a day in regular intervals also contributed to Liberty Commons’ low score.

In at least one case in 2007, actual harm was done to a patient when staff failed to notify family members or a physician when a resident was injured, there was a major change in the resident’s health or there was a need to change the resident’s treatment significantly.

Brian Joiner took over as administrator at Liberty Commons in April, several months after the last detailed inspection recorded by Medicare. He said he couldn’t comment on problems before his tenure, but points to the 2008 report — the one not included in Medicare’s ratings — as evidence that earlier issues have been corrected.

“We changed management here and obviously we’re moving in the right direction for having a deficiency-free survey,” he said. “If you’re deficiency free, obviously the care being provided, with them spending three days here, obviously we’re doing a good job.”

Mr. Joiner said officials have explained the rating process to him and there is nothing he can do about it now. He said all he could do was continue pushing Liberty Commons forward in a positive way.

“I don’t know how accurate it really is,” he said of the Medicare database. “I think the best way to choose a nursing home is to actually go out and see what a facility is like.”

Magnolia Living Center in Dunn was also among the worst rated in the area with two out of five stars.

Magnolia Living Center in Dunn was also among the worst rated in the area with two out of five stars.

Magnolia Living Center in Dunn fared only slightly better with eight deficiencies cited, but statistics show a cause for concern when comparing the condition of patients in the nursing home to those at other facilities in the state. At Magnolia, 44 percent of the long-term residents need more help with daily activities than when they entered the facility, compared with just 22 percent of patients at other centers across North Carolina.

Administrator Shelley Tinsley says that difference is because her nursing home treats very few rehab patients; most of their customers move in looking for a permanent home.

“I think one thing that happens here is we get residents who stay here long-term and they are going to decline once they come in,” she said. “At some point you are going to decline, and eventually expire, in the facility.”

Inspectors also noted some residents at Magnolia Living Center were given catheters unnecessarily; residents on medication were given too many doses or kept on drugs for too long; and management failed to keep an available supply of common drugs used every day and during emergencies.

“Some of this is misleading,” Ms. Tinsley said of the statistics. “It really depends on how they do the data and sometimes that’s in our favor and sometimes it’s not. Unfortunately, that’s just one of those things.”

Ida Trogdon, administrator at Britthaven of Harnett, was able to steer her nursing home to the top of the pack. Britthaven was the only area nursing home to receive a perfect five-star rating from Medicare.

Ida Trogdon, administrator at Britthaven of Harnett, was able to steer her nursing home to the top of the pack. Britthaven was the only area nursing home to receive a perfect five-star rating from Medicare.

Top of the Class
Britthaven and Golden Years Nursing Home in Falcon received the most favorable inspections among facilities in the area, with five- and four-star ratings, respectively.

Britthaven’s most recent health inspection was filed without a single problem noted against the nursing home. While Golden Years was cited with three administrative errors, it still fared better than the state average of five problems per nursing home and far above the national average of nine deficiencies per facility.

Ida Trogdon, a veteran nurse who worked her way up to the administrator post at Britthaven, said finding and keeping qualified, caring nurses is the key to success in her industry.

“I’ve been in this building almost 10 years now,” she said. “I think a lot of it is keeping consistent staff and dependable staff.”

“The director of nursing has a tremendous job, trying to keep staff hired and staff on the hall to look after the patients,” she said.

Ms. Trogdon said nursing homes with a high rate of staff turnover often have the toughest time, not just with health inspections, but with providing quality care to patients because the staff doesn’t get to know the individual patients as well.

“Our overall goal is quality care for the residents. It’s all about them and taking care of them and making it as much like home as we can,” she said. “I still have residents here that were here when I came to work in 1999.”

Ms. Trogdon said while she was pleased with her high ratings, she understands the difficult time other facilities have keeping pace with volumes of rules and regulations. While enforcing good practices and following government guidelines everyday usually results in positive inspections and good patient care, she said bad luck or accidents on the day of an inspection can hurt an otherwise good facility.

“A lot of it’s just circumstances and stuff that works against you,” she said. “There’s close to 500 things that they can give us a deficiency in. We’ve been real fortunate here over the years that we’ve never had a real bad survey.

“It’s just good management,” she added. “But then you have to have good staff to care for the patients.”

 

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Text and images copyright 2008 by The Record Publishing Company.
Used with permission.


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