How peo­ple end up in un­li­censed as­sisted liv­ing homes


COL­LEGE PARK — Vonda Wag­ner and An­drew Ed­wards said they were kicked out of their li­censed nurs­ing homes and wound up in an un­li­censed as­sisted liv­ing fa­cil­ity. Here’s how that hap­pens in Mary­land...

1. Staffing short­falls pre­vent the state from ad­e­quately mon­i­tor­ing as­sisted liv­ing and nurs­ing homes

The Of­fice of Health Care Qual­ity reg­u­lates nurs­ing homes in Mary­land and it doesn’t have enough peo­ple to do the job. At the end of last year, about 1 in 5 po­si­tions in the OHCQ was va­cant, ac­cord­ing to an anal­y­sis of its 2017 fis­cal year bud­get.

The staffing shortage af­fects OHCQ’s mon­i­tor­ing of li­censed as­sisted liv­ing homes, as well as how it keeps tabs on the net­work of those op­er­at­ing with­out a li­cense. Ac­cord­ing to a state leg­isla­tive bud­get anal­y­sis, OHCQ “has faced chronic staffing short­ages over the past few years due to the com­bi­na­tion of an in­creased work­load, a struc­tural de­fi­ciency in po­si­tions al­lot­ted for sur­vey and in­spec­tion ac­tiv­i­ties, and chronic va­can­cies among sur­veyor po­si­tions.”

It has also af­fected OHCQ’s abil­ity to mon­i­tor skilled nurs­ing homes. Last year, it took the of­fice 34 days on av­er­age to ini­ti­ate nurs­ing home com­plaint in­ves­ti­ga­tions, though fed­eral reg­u­la­tions re­quire that they are ini­ti­ated in 10 days or fewer. That can widen the door for abuse and ne­glect in the dis­charge process and be­yond.

For its part, the OHCQ said it is per­form­ing the re­quired in­spec­tions and sur­veys to make sure nurs­ing home and as­sisted liv­ing pa­tients are treated prop­erly, said Christo­pher Gar­rett, spokesman for the Mary­land De­part­ment of Health and Men­tal Hy­giene.

2. Tech­ni­cal jar­gon and buried in­for­ma­tion makes re­search­ing nurs­ing homes ex­tremely dif­fi­cult

For those look­ing to en­ter a nurs­ing home, dig­ging out in­for­ma­tion is no easy task. While the Medi­care. gov nurs­ing home com­pare tool is prob­a­bly the most use­ful due to its one- to fives­tar rat­ing sys­tem, it doesn’t guar­an­tee a speedy re­search process.

“It’s not per­fect, but it sure is a good start­ing point,” said Alice Hedt, for­mer Mary­land state long-term care om­buds­man.

The prob­lem stems from OHCQ not keep­ing records on all peo­ple dis­charged from nurs­ing homes. It only tracks cases where res­i­dents have filed com­plaints.

That means that a per­son would have to ob­tain OHCQ’s an­nual or semi­an­nual sur­veys of the state’s nearly 230 skilled nurs­ing fa­cil­i­ties — which are packed with tech­ni­cal jar­gon — to find this in­for­ma­tion. This poses a po­ten­tial prob­lem for con­sumers, who could other­wise rec­og­nize sites with ab­nor­mally high dis­charge rates and steer clear of them.

The end re­sult can be a self-per­pet­u­at­ing prob­lem: Res­i­dents could un­know­ingly en­ter fa­cil­i­ties with ques­tion­able records.

3. All this leads to a greater chance of wind­ing up in an un­li­censed as­sisted liv­ing fa­cil­ity

Nurs­ing res­i­dents face sig­nif­i­cant prob­lems when it comes to as­sisted liv­ing homes. Cap­i­tal News Ser­vice has ex­am­ined three cases where res­i­dents were dis­charged to un­li­censed as­sisted liv­ing fa­cil­i­ties with dan­ger­ous out­comes.

One of the ways this hap­pens is that site man­agers op­er­ate both li­censed and un­li­censed homes at the same time and move res­i­dents to fa­cil­i­ties un­reg­u­lated by the state.

“They bring peo­ple in through the li­censed fa­cil­ity,” said Anne Hur­ley, for­mer di­rec­tor of Mary­land Le­gal Aid’s Long-Term Care As­sis­tance Project. “And then a lot of times they shut­tle them to un­li­censed fa­cil­i­ties.”

As­sisted liv­ing homes may net­work and use place­ment agen­cies to find res­i­dents be­ing dis­charged from nurs­ing homes, other con­sumer ad­vo­cates say. OHCQ, hav­ing in­ves­ti­gated cases in which this prac­tice ended with el­derly abuse or ne­glect, has ex­pressed con­cern over the po­ten­tial for prob­lems.

Be­cause there is no com­pre­hen­sive as­sisted liv­ing home rat­ing sys­tem in Mary­land, the best a dis­charged res­i­dent need­ing daily care can do is make sure his or her as­sisted liv­ing home is li­censed with the state by check­ing the state-up­loaded PDF file, where all li­censees are com­piled.

4. An over­whelm­ing nurs­ing home ad­mit­tance process com­pli­cates un­der­stand­ing of rights

What hap­pens when a per­son en­ters a nurs­ing home is gen­er­ally re­ferred to as dis­ori­ent­ing, com­plete with a stack of pa­per and a “sign here … sign here” ur­gency.

As re­quired by law, nurs­ing fa­cil­i­ties must present a con­tract con­sis­tent with Mary­land’s skilled nurs­ing care rights. But the om­buds­man re­ported that due to the vol­ume of pa­pers and gen­eral stress of the ad­mit­tance process, many res­i­dents are un­aware of their le­gal re­sources un­til they’re is­sued a dis­charge no­tice and need le­gal coun­sel.

Ad­di­tion­ally, many com­pa­nies ask in­com­ing pa­tients to sign ar­bi­tra­tion clauses, which re­quire that if a com­plaint comes up, the pa­tient will set­tle with the nurs­ing home through a third party rather than seek pub­lic lit­i­ga­tion.

Ar­bi­tra­tion clauses are fairly stan­dard prac­tice in the in­dustr y, of­fi­cials said, but Ben­nett added a cau­tion that con­sumers should ask about it when be­ing ad­mit­ted.

“The les­son to the con­sumer is, if you’re an older adult like I am, don’t wait to learn about nurs­ing homes and as­sisted liv­ing,” Hedt said. “Try to learn about it even be­fore you need it, so that you can make de­ci­sions in an emer­gency if you have to.”

Cap­i­tal News Ser­vice re­porters Car­los Al­faro, Zoe Sa­ga­low, Camille Chrysos­tom and Julz Har­vey contributed to this story.

Vonda Wag­ner, 59, said she was as­saulted by the owner of an un­li­censed as­sisted liv­ing fa­cil­ity after be­ing in­vol­un­tar­ily dis­charged from a nurs­ing home. CAP­I­TAL NEWS SER­VICE

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