Official: Oversight of nursing homes lacking
HARRISBURG >> The Pennsylvania Department of Health has drastically reduced its use of provisional licenses as penalties for nursing home facilities, and increased its use of fines.
That is one of the findings detailed in a report on Pennsylvania nursing homes released by state Auditor General Eugene DePasquale.
In 2017, the ratio of fines to provisional licenses was 3:1, or, 100 fines and 33 provisional licenses. In 2018, that ratio was 55:1, or 165 fines and three provisional licenses.
DePasquale is not convinced that fines are the best way to get nursing homes to improve care.
“Any punitive tool must align with business realities in order to be effective. Many stakeholders contend that fines do not work, as they rarely impact a facility’s ability to operate,” his report said. By contrast, provisional licenses are a licensing downgrade and can motivate a nursing home’s leaders to make the changes necessary to earn the right to operate on a standard license.
While it is rare for a facility to lose its license altogether, a downgrade to provisional sends a clear message and is an important oversight tool, the report said.
Provisional Licenses
Nursing homes are issued a new regular license annually, but some are given provisional licenses, which indicate a facility that needs closer monitoring. The provisional license allows a facility to operate for just six months.
“A provisional license is a serious red flag to members of the public and others that the facility has problems it must fix in short order,” the report said.
The report recommends the Department of Health avoid defaulting to civil monetary penalties and use its oversight tools to respond to violations with appropriate severity and with the goal of seeking improvements.
Provisional licenses are an important tool and Department of Health should use them, the report said.
In Berks County, Spruce Manor Nursing and Rehabilitation Center in West Reading is the only nursing facility currently operating under a provisional license.
The facility has had multiple instances in the last year of one resident abusing another. On April 25, a female resident woke up to find a male resident touching her inappropriately.
He was ultimately sent to prison, charged with sexually assaulting another resident while she slept.
Another resident was physically combative at least four times before he was found on Christmas 2018 on the floor in the hallway straddling another resident and punching him with closed fists. Local police were notified, and the resident was issued a citation for disorderly conduct.
After the altercation, the facility implemented increased supervision, which meant it would monitor the resident every 15 minutes, state reports show.
But on Feb. 2, a nurse heard a resident screaming in the second floor dining room. The resident who was supposed to be under increased supervision said another resident struck him with a cane so he punched him in the face. The resident he punched was transferred to a hospital, treated for a laceration to his left eye and a broken hip.
Greg Nicoluzakis, an Ohio attorney for Saber Health Care Group, which operates Spruce Manor, offered an emailed statement about the incidents and the provisional license.
“The facility is in compliance with state licensure regulations. At all times the facility has acted in the best interests of its resident population and promotes their health, safety, and welfare,” Nicoluzakis said. “Unfortunately, it is difficult to predict how certain residents will conduct themselves in a long term care environment.”
Workforce shortage predicted
The report also advised that Pennsylvania has a looming health care workforce crisis that must be addressed or it will leave older adults without care.
Nearly 90,000 Pennsylvanians, many of them age 85 and older, live in more than 700 nursing homes throughout Pennsylvania, and they represent just a fraction of the aging population.
The U.S. Department of Labor projects that by 2022 the nation will need 1.1 million new registered nurses to replace retiring RNs and avoid a nursing shortage. Pennsylvania could be short over 4,000 RNs by 2030, the report says.
Wages are low relative to the physical and emotional demands of providing direct care.
In Pennsylvania nursing homes offer an entry wage of $23,000 per year.
The report recommends employers raise wages and increase benefits such as tuition reimbursement, and gas cards. The departments of State and Health should work together to clarify and consolidate titles, certifications and licenses for nursing and health care professionals, including adding certified nursing assistants, and they should ease licensing restrictions for medical professionals, the auditor general’s office said.
In the report, DePasquale also makes recommendations to improve quality of care; expand access to care and prevent abuse, fraud, waste and erosion of civil rights.
The findings are based on conversations with more then 50 people connected to the nursing home industry. Interviewers heard of shortages of equipment such as lifts to help get residents out of bed, and of supplies such as blankets and diapers.
“We need to do a better job of caring for our older adults in Pennsylvania,” DePasquale said.