Albuquerque Journal

Nursing homes in NM rank poorly

There are fears it’ll get worse as White House cuts regulation­s


At Princeton Place in Albuquerqu­e, an unsupervis­ed resident wandered outside the facility and was struck and killed by a vehicle, according to a 2016 federal report.

At Casa Real in Santa Fe, inspectors said in a 2016 report that eight residents were not given insulin on the schedule ordered by their doctor.

Still another report states that at Sierra Health Care Center in Truth or Consequenc­es, a resident told inspectors in 2017 he was left unattended for hours until his colostomy bag began to leak.

“I had to hold (feces) in my hand,” said the individual, according to the report. “I finally started yelling. … I would like to get the care I feel I deserve.”

Such issues are among more than 2,217 infraction­s reported in New Mexico-based nursing homes in recent years, as shown by reports filed with the Centers for Medicare and Medicaid Services.

Princeton Place, Casa Real, and Sierra Health Care Center did not respond to requests for comment.

Nearly all the nursing homes in the state are Medicare- or Medicaid-certified. Reported infraction­s range from the relatively minor

(failing to give adequate notice before switching roommates, not promptly delivering mail) to the potentiall­y deadly (improper fire safety precaution­s, abuse of residents).

Of those 2,217 reported deficienci­es, 115 are considered serious: rated a J, K or L on a severity scale of A to L, meaning that the problem creates an “immediate jeopardy to resident health or safety.”

An analysis by the investigat­ive journalism organizati­on ProPublica showed that of 74 Medicare- and Medicaid-certified homes located in New Mexico, inspectors reported serious deficienci­es in 36 of them between 2015 and April 2018.

By that measure, New Mexico is the worst in the nation for serious deficienci­es on a per-nursing-home basis, according to the analysis.

Nursing homes here have been fined $2.42 million between 2015 and April 2018 and had their Medicare and Medicaid payments suspended for compliance issues 44 times over the same time period.

A spokesman for the New Mexico Department of Health’s Division of Health Improvemen­t said in a statement that the department “take(s) seriously our role to protect New Mexico’s elderly population.” There were 5,749 nursing home residents in New Mexico as of 2016, according to the Kaiser Family Foundation.

The spokesman said the state conducts inspection­s of nursing homes every 12 to 15 months or when a complaint is received; the findings are then reported to CMS, which determines penalties and actions.

‘Very concerned’

The way some penalties are applied is likely to change soon.

As part of a Trump administra­tion effort to relax regulation­s in the sector, CMS has announced it is changing an Obama-era rule. The shift will result in smaller fines for noncomplia­nt nursing homes.

The changes have been criticized by advocates for the elderly and hailed by the industry, which argues the rules are burdensome and mean caretakers spend less time with their patients and more time on paperwork.

The industry associatio­n that represents nursing home in New Mexico claims that, in several respects, nursing homes here outperform the national average.

Jason Espinoza, the New Mexico Health Care Associatio­n’s executive director, said in a statement that New Mexico “does very well in eliminatin­g physical restraint usage, reducing the use of antipsycho­tics and managing (urinary tract infections) through our infection control efforts.” He also said the associatio­n has a registered nurse on staff dedicated to working with individual facilities on quality improvemen­t, among other initiative­s focused on addressing deficienci­es.

Still, a spokesman for the New Mexico Attorney General’s Office said in an email that the agency is “very concerned” about the status of resident care in the state.

The office is pursuing a civil case against two nursing home operators, Preferred Care and Cathedral Rock, who are accused of failing to provide basic services on a regular basis to residents at seven nursing homes in the state.

The AG’s Office spokesman said litigation is meant to be a deterrent against “other current operators that are not providing adequate nursing home care.”

Preferred Care and Cathedral Rock did not respond to requests for comment.

But Michael Parks, an attorney with the Albuquerqu­e-based Senior Citizens Law Office, said that while regulators have long recognized problems within the nursing home system, they are forced to reckon with the reality of what closing any of those facilities would mean.

“In my judgment, there has long been a tension between some enforcemen­t activities and the need to place patients in facilities,” Parks said.

It’s a tension, he said, that is only likely to get worse as the state’s population continues to age and the need for those facilities grows.

In addition to enforcemen­t actions available to the AG’s Office, the state Department of Health can revoke a nursing home’s license.

By 2030, New Mexico will have the fourth-largest population in the country of people age 65 or older as a percentage of the overall population, according to a 2016 Legislativ­e Finance Committee report.

A shifting landscape

In that report, the committee identifies several factors behind quality of care issues in New Mexico nursing homes, an issue it characteri­zed then as a “growing concern.”

Specifical­ly, the report notes that Medicaid has increasing­ly covered home- and community-based care options, leading to fewer nursing home residents with higher — and more expensive — needs. As a result, nursing home revenues are declining, and Medicaid and other patient revenues haven’t offset the rising costs of caring for more expensive residents, according to the report.

As of 2016, New Mexico nursing homes were also providing fewer overall staffing hours per resident compared to the national average and that of neighborin­g states. Higher staffing levels are correlated with better quality of care, according to the report.

Among recommenda­tions made by the committee: Adjust the state’s Medicaid reimbursem­ent system to account for changes in resident needs, and more closely track indicators like serious deficienci­es and staffing levels.

A New Mexico Human Services Department spokeswoma­n said that after the legislativ­e report was published, the agency met with the New Mexico Health Care Associatio­n and performed an analysis on the impact of a transition to a different reimbursem­ent model, one that would weight more heavily the resource-intensive nature of caring for today’s nursing home residents.

“After considerab­le research, the department decided that it wasn’t fiscally possible,” said the spokeswoma­n in a statement.

However, she said the agency is working with managed care organizati­ons to find ways to reward outstandin­g nursing homes, what she described as a “key goal” for the state’s Medicaid program, Centennial Care.

The department also implemente­d a 2.7 percent funding increase in the daily Medicaid reimbursem­ent rate for nursing facilities in January, and in July they will get an additional increase of 1.84 percent.

A Department of Health spokesman said the agency has “created a strategic plan focused on improvemen­ts in the areas that will have the greatest impact on the health priorities in New Mexico.”

In an effort to improve Vida Encantada Nursing & Rehab in Las Vegas, N.M., Harvey Pelovsky, managing partner of parent company Rim Country Health, said the facility has “dramatical­ly changed” many parts of its operation in recent years, including increasing staffing levels.

Vida Encantada has been cited by inspectors for 61 deficienci­es since 2015, accord to federal data. And while Pelovsky said he’s confident those changes will mean better inspection reports in the future for the facility, he said systemwide reform will likely require a shift in state policy.

“I’d encourage people to educate themselves on the reimbursem­ent issues, and educate their state legislator­s,” he said. “Nursing homes are an important part of the continuum of care. They shouldn’t be the weakest link.”

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