Residents in nearly a third of Kansas nursing homes face possible harm or are in immediate jeopardy, according to citations issued this year — the fourth highest percentage among all states.
Nationwide, 13.4 percent of nursing homes have had such citations this year, according to data compiled by the state of Wisconsin.
An advocate for the elderly says older adults face harm in nursing homes. But the nursing home industry contends that government has been overzealous in enforcement of regulations. The industry wants the Kansas Department for Aging and Disability Services, which conducts inspections, to end what it calls “extreme treatment.”
Mitzi McFatrich, director of Kansas Advocates for Better Care, said changing the inspection process, also called a survey, would undercut the welfare of the state’s most vulnerable older adults.
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“What it seems like to me is a full-frontal attack on the health and safety of frail elderly that are in nursing facilities. The survey process is really the only outside, objective health and safety check on nursing homes that exists,” McFatrich said.
Cara Sloan-Ramos, a spokeswoman for the Kansas Department for Aging and Disability Services, which conducts the inspections, said: “We are proud of our nursing facility surveyors and believe these numbers reflect what a good job they are doing.” She directed a reporter to McFatrich for further comment.
The number of immediate jeopardy citations against Kansas nursing homes has soared. Immediate jeopardy represents the most serious citation possible, and means a situation at a facility has caused or is likely to cause serious injury, harm, impairment or death. Examples might include unexplained injuries to residents that haven't been investigated, or failures to carry out the orders of doctors.
According to LeadingAge Kansas, an association representing nursing homes and other aging services, the number of immediate jeopardy citations in Kansas rose from nine in 2012 to 134 in 2016. The number rose gradually each year through 2015, when the state issued 60 citations, before jumping in 2016.
In 2017, inspectors have issued 99 citations. The state inspects nursing homes on behalf of the federal government.
Federal fines of Kansas nursing home also jumped. In 2012, the federal government assessed nursing homes $52,275. In 2016, the amount of fines was $4.6 million.
Like the number of citations, the amount of fines also rose gradually until spiking in 2016 – jumping from $1.5 million in 2015.
LeadingAge said the fines cripple nursing homes financially. “There is no possible justification for a 9,000 percent increase in Kansas nursing home fines over the last five years,” said Rachel Monger, the organization’s vice president of government affairs.
Aldersgate Village, a nursing home based in Topeka, said it faced a ban on new Medicaid and Medicare admissions earlier this year because of a deficiency. A survey report from March shows the facility failed to notify a physician about abnormal lab results for a resident who required hospitalization for an infected wound.
The ban lasted nearly three months and led to $411,000 in claims being held, said president and CEO Jerry Ney.
“It is choking the facilities to death. You’re killing the goose that lays the golden egg,” Ney said.
So why has the amount of fines and number of citations risen so sharply?
No one had a firm answer. LeadingAge called on KDADS to conduct an analysis to find out why.
McFatrich, an advocate for the elderly, had a few suggestions. She said the Affordable Care Act required nursing homes for the first time to report serious incidents.
She also said federal inspector general reports show that in the past citations have been issued at levels not as severe as the potential harm that was actually present.
An Aug. 24 report from the federal Health and Human Services Office of Inspector General found that the Centers for Medicare and Medicaid Services has inadequate procedures at skilled nursing facilities nationwide to ensure that potential incidents of abuse or neglect are reported. A separate September report from the Office of Inspector General found that in Kansas, the state’s nursing home inspectors didn’t follow up on about half of the problems they found in 2014.
“The state agency’s practice was to accept the nursing homes’ correction plans as confirmation of substantial compliance without obtaining the required evidence of correction for less serious deficiencies,” the report said.
Codi Thurness, the survey, certification and credentialing commissioner for the state agency, said expectations for enforcement from CMS began shifting in 2016. As citations rose, the state sought a federal check of its actions.
“We had CMS in Chicago and Baltimore both review our (immediate jeopardy citations) to determine if we were citing things incorrectly,” Thurness said. CMS backed them up, she said.
In August this year, however, KDADS received new guidance from CMS. Thurness said the new expectations have led to yet another shift and resulted in fewer citations.
Two weeks ago, the chairman of the House health committee, Rep. Dan Hawkins, KDADS Secretary Tim Keck and nursing home representatives huddled in Wichita to discuss the issue, multiple attendees said.
“They (KDADS) understand that they may need to do some re-training and really look closely at what their inspectors are doing,” said Hawkins, R-Wichita.
Kansas faces a shortage of inspectors. Of about 60 surveyor positions, Thurness said KDADS has 20 openings right now. The inspectors take about a year to certify, and are a “hot commodity” recruited by nursing homes after they’re trained, she said.