Two sides to nursing home
Staff earned praise, but state inspectors faulted facility
When families needed a safe place for their seniors, The Rehabilitation Center at Hollywood Hills promised to be a caring home away from home — located directly across the street from Hollywood’s Memorial Regional Hospital.
But when Hurricane Irma knocked out the power to the nursing home’s air conditioning, authorities say vulnerable residents sweltered in oppressive heat for days and nobody on staff walked across the street to the hospital to make it clear that patients’ lives were endangered.
In just 12 hours and 14 minutes on Wednesday, eight of the nursing home’s residents died. The first, a 99-year-old woman, was found dead in the home shortly before 3 a.m. The last, an 84-year-old woman, died in the hospital shortly after 3 p.m.
A criminal investigation is underway. And officials from the nursing home, FPL and Broward County have been pointing fingers at each other about who is to blame
for letting a troublesome incident turn into a mass tragedy.
Some relatives of the victims say they blame the owners and staff at the nursing home. Others jumped to the defense of workers who, they say, went out of their way to be kind and compassionate. They blame FPL and Broward County for not having a proper plan to restore power to nursing homes quickly.
Nursing home officials said staff did everything they could after the air conditioning stopped working. But one of the most perplexing unanswered questions: Why didn’t they evacuate patients to the neighboring hospital?
Before the hurricane, many families considered the home a welcoming sanctuary — despite its history of below-average state and federal reviews and inspections. It had a two-star ranking on a five-star government scale.
The current owner, Dr. Jack Michel, bought the home in a bankruptcy auction in the summer of 2015, after the prior operators went to prison for a $67 million Medicare fraud. Michel had his own legal problems: He and three others paid $15.4 million in 2006 to settle federal allegations that they received kickbacks for sending patients for unnecessary medical treatment at a Miami hospital in the late 1990s.
Linda Harmon, of Dania Beach, said her 78-year-old husband, who suffers from mild dementia, lived in the center for the past 18 months. She was satisfied with his care and said the aides were terrific. She, like some other family members, found this deadly lapse uncharacteristic of the care at the home.
“They treated him like he was family,” she said. “If it would have been atrocious, I would have moved him out of there.”
But when the air conditioning failed, Harmon became alarmed. Her husband was on the second floor where patients were placed in wheelchairs or beds in the hallway near fans and small portable air cooler units.
Workers opened the windows on the first floor, but the second-floor windows remained closed, she said.
“I was very concerned with the other patients. They had them in the hallways with fans and portable air units connected to the ducts,” she said. “The ones that were complaining the most they had the vents pointed at them. … [Staff] told me they were doing everything they can and they were sorry for the inconvenience.”
One of the patients on a bed in the same hallway that Tuesday night was Betty Hibbard.
Harmon said Hibbard was in distress and complained about the heat, saying she couldn’t breathe well. Harmon gave the 84-year-old woman a cup of ice.
“It didn’t seem to be helping her. I thought she should have been sent to the hospital,” Harmon said. “She was the one I was the most concerned about.”
Hibbard was the last of the eight victims to die on Wednesday.
Patients at the nursing home ranged from those who were able to walk, those who used wheelchairs, and bedridden residents, some of whom used feeding tubes.
Staff said there were some private rooms, but most residents had roommates, sometimes four people to a room.
When Judith Susana went to the home after the hurricane on Monday morning, she found her 80-year-old mother soaked in sweat but still wearing a heavy North Face sweater. She suspects her mom, who has been paralyzed on the left side of her body since a stroke 10 years ago, was dressed that way when the air conditioning was functioning and nobody took it off when the cooling system failed.
“The heat was unbearable,” Susana said. “I had a fit and changed her into a Tshirt.” “They had [the seniors] in the halls outside their bedrooms, many of them without clothes, some in their diapers with hospital gowns,” Susana said.
The nursing home appeared understaffed, she said, as workers who had spent the weekend shuttered in during the hurricane began to leave before their replacements arrived.
William Dean, a South Florida attorney who has been suing nursing homes on behalf of patients and their families for 20 years, says he’s somewhat jaded but thinks the 152-bed Hollywood Hills center was pretty average.
“I’ve seen worse, I’ve also seen better,” said Dean, who has filed lawsuits against the center alleging negligence that resulted in patients suffering falls, a broken hip, stroke, bedsores, hypothermia or low temperature, dehydration and infections.
One family affected by the most recent incident has already hired him. Two other families have hired other lawyers who have already filed court papers on their behalf. Even if families prevail in civil lawsuits against the nursing home, Dean said the center’s insurance coverage would be unlikely to provide for large amounts of compensation.
The cost of living at the center was average or below average, he said.
State records show the center’s posted rate as $280 a day or $8,400 a month. Medicaid or Medicare generally pays about $4,000 a month per resident, Dean said.
One family told the Sun Sentinel their portion came to $2,400 a month after the government payments.
About half of the center’s residents had conditions including dementia and Alzheimer’s disease that would have left them with significant cognitive issues, Dean said. About a quarter would have been relatively active and the rest would not, he said.
Dean said he wasn’t surprised that workers at the center apparently didn’t make the decision to move patients. He said he has seen many nursing homes discourage lower-level employees from reporting problems and asking for help when things go wrong.
The Centers for Medicare and Medicaid Services, which regulates nursing homes, gives the Hollywood center a below-average rating, two out of five stars. But the most recent state inspection reports showed no deficiencies in the area of emergency plans.
However, they documented other concerns.
After an unannounced inspection in early 2016, state regulators threatened to revoke the center’s Medicare agreement and fine the facility if officials did not improve their medication dispensing practices. Investigators said they observed two mistakes as they watched 25 medications being dispensed, putting the facility outside regulatory error limits. Records show the deficiencies were corrected by the next month.
Nursing home regulators, during an inspection in 2016, also cited Hollywood Hills for violating regulations regarding generator maintenance and testing, along with fire safety code issues. Those violations were also corrected.
Regulators said the center had an above average number of violations on its regulatory inspections in the last two years. There were 11 violations in its March health inspection. The state average was six violations.
In the February 2016 life and safety inspection, there were 17 violations compared with a 6.8 state average.
None of the violations, however, involved patient mistreatment; three — all in 2016 — involved quality of care.
During a February 2016 inspection, state records show the home was cited for not providing proper treatments to prevent new bedsores and not respecting residents’ dignity.
State investigators said they saw one man who looked like he had not been shaved in several days and had long fingernails, according to the report.
In March, the home was cited for not honoring residents’ choices when it came to daily activities and care. Regulators said they interviewed 40 residents. One said she had not showered that morning because her aide was too busy but promised to help her the next day. The resident said she been given only two showers in the past 15 days; her aide told investigators the woman often was sleeping and she did not want to wake her.
Inspectors also saw food being improperly prepared for people who, on their doctors’ orders, needed special diets. Some 44 people living there required special meals. The inspectors said the patients were improperly fed sausage and pork that was cut into strips rather than finely ground, something that could cause them to choke.
Despite the violations, family members like Vendetta Craig said they were content with the care their loved ones received.
“The ones that dealt with my mom, they treated her like family,” Craig said.
Craig’s 87-year-old mother Edna Jefferson, who survived the aftermath of the hurricane but wound up at Memorial dehydrated and with a temperature of 102 degrees, moved to Hollywood Hills in late January. A hospice company helped the family place her after they struggled to find a center that didn’t have a waiting list of a year or more, Craig said.
Craig said she visited her mother a couple of days before Hurricane Irma and happened upon a staff meeting about hurricane plans for the nursing home.
Craig overheard workers she said were “extremely upset” about not having enough time to prepare their homes for the storm. The mood was tense and she said she overheard a supervisor threaten to report a worker and try to get their state license revoked.
“What happened over those few days? Maybe they didn’t have the best people there, maybe they didn’t have enough people there,” Craig said. “Maybe they were understaffed, and at a nursing facility you cannot be understaffed.”
Elie Pina, whose 96-year-old mother, Mirelle Pina, developed pneumonia during the ordeal and is hospitalized, doesn’t fault the nursing home staff at all.
Pina was harshly critical of FPL, politicians and emergency dispatchers, and said staff at the nursing home did their best to care for patients.
“I was there every day for hours. They were cared for,” Pina said. “If the power would have been turned on this wouldn’t happen.
“We should have started screaming in the street to get help before it happened,” Pina added. “They should have put everybody out and started screaming in the middle of the street.”