Report: Every nursing home in Nevada cited by inspectors

Abuse, neglect and mistreatment of nursing home residents is widespread in Nevada, according to a report issued by a nursing home resident advocacy group.

“Nevada represents what’s terribly wrong with nursing home care and oversight in America,” said Brian Lee, executive director of Families for Better Care. “State officials and industry representatives should be ashamed of their abysmal nursing home record.”

Bed sores are frequently found on residents, Lee said, and they also are found to suffer from dehydration, malnutrition and injuries from falls.

The report found that Nevada is one of two states where every nursing home was cited with one or more deficiencies by state health inspectors, and one in three nursing homes was cited for a severe deficiency, meaning a resident suffered actual harm or was in imminent danger.

Findings of the report are based on 2012 reports from state health inspectors to the federal Centers for Medicare and Medicaid Services.

State inspection reports last year showed that one patient was discharged who still needed skilled nursing care. That patient, who suffered from breathing problems, later was taken by ambulance from her home to a hospital, where reports said she became “clinically brain dead.”

Another nursing home resident died after not having a bowel movement for days.

Marla McDade Williams, the deputy administrator for the Nevada Division of Public and Behavioral Health, said Monday that her agency holds facilities accountable when there are serious deficiencies. But Mary Woods, state spokeswoman for the Nevada Department of Health and Human Services, said specific disciplinary information for the nursing homes listed in the report is not immediately available.

“Unfortunately, Nevada did not levy one monetary penalty against a nursing home with severe deficiencies in 2012 although it did deny payment for new resident admissions to one nursing home,” Lee said. “If you don’t have a regulatory system enforcing the laws, then it doesn’t incentivize the nursing homes to operate better for residents in cases of abuse and neglect.”

Facilities are inspected at least once a year and when complaints are filed, Williams said. When deficiencies are identified, nursing homes are required to submit a plan of correction and a follow-up inspection is conducted to ensure they are in compliance.

Disciplinary actions for those that fail to address serious concerns can range from preventing the facility from admitting patients to expelling the current ownership of the facility to revoking the facility’s CMS certification, Williams said.

Lee noted that Clearview Health and Rehabilitation in Henderson is currently on the “Special Focus Facility List,” which means it is being closely monitored by federal authorities. Lee called the list the “Federal Hall of Shame.” In 2012 inspectors found that several devices including a catheter and feeding tube were managed incorrectly on a resident and doctor’s orders were not followed.

“Injuries from neglect are rampant in Nevada,” Lee said, stressing that nursing home residents in the state receive fewer than two hours and 10 minutes of care daily.

If direct care staffing levels could be ramped up to around three hours daily, Lee said, there would be a rapid turn- around in nursing home quality.

Direct care involves the work of front-line caregivers, which includes responding to call lights, assisting residents with eating, helping residents go to the bathroom, and helping them get dressed daily.

“It’s where the rubber meets the road in nursing home quality,” Lee said.

Darren Liu, assistant professor in the University of Nevada Las Vegas Department of Health Care Administration and Policy, said he wasn’t surprised with the poor ranking of nursing homes in Nevada.

“Their performance is not too good,” he said.

Liu said the first steps that the state’s nursing homes need to take to improve quality of care is to look at their staffing levels and their facility’s environment to determine whether it’s a safe place for patients.

“Staffing issues have been a longtime issue in nursing homes, no matter where the nursing homes are,” he said.

Alaska which finished best in the first-ever, state-by-state nursing home report card received an A, as did nine other states, including Utah, Oregon, Idaho, New Hampshire, Rhode Island, Maine and Hawaii.

Nearby California and Arizona had C’s. Nevada, which received an F, the worst state in the Pacific region, scored the region’s worst grades in five of eight measures. Those below average measures are direct care staffing, direct care staffing hours, health inspections, percentage of facilities with deficiences and percentage of facilities with severe deficiencies.

In registered nurse hours at nursing homes, Nevada received a C, translating to 50 minutes of professional nursing service per day.

According to the report, registered nurse staffing was above average, and given a B grade, meaning that 71 percent of the nursing homes staffed above recommended levels.

The worst state listed in the report was Texas, followed by Louisiana, Indiana, Oklahoma and Missouri. Nevada ranked 43rd.

For the past 10 years, Lee noted, publicly traded nursing home stock prices increased an average of 415 percent, outpacing the stock market by a 2-to-1 margin.

“This shows that for the owners of nursing homes it’s all about profits over people,” he said. “They could open the staffing spigot tomorrow. The question is will they?”

The 2013 Nursing Home Report Card is available for download at http://www.nursinghomereportcards.com.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908 and Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440.

Examples unearthed by inspectors last year of severe deficiencies in Nevada nursing homes included:
-- Care Meridian nursing home, 7690 Carmen Boulevard, Las Vegas: A physical therapist failed to conduct a comprehennive assessment which resulted in braces being misapplied to a resident’s leg. The resident had to be taken to the hospital for pain and injury.

-- Torrey Pines Rehabilitation Hospital, 1701 S. Torrey Pines Dr.: A nurse’s aide who went on break left a resident unattended on the commode even though the resident had been identified as a fall risk. The resident suffered an arm injury and "bleeding from the right side of his ear."

-- The Heights of Summerlin, 10550 Park Run Drive: A resident who had to be hospitalized on several occasions because of weight loss. The resident’s weight, which optimally was 133 pounds, was 110 pounds upon hospital admission and later dropped to as low as 77.2 pounds.

-- TLC Care Center, 1500 W. Warm Springs Road, Henderson: Resident was in imminent danger of harm when he wandered from the facility and later was found to have traveled on a bus. Another resident fell three times, having to be taken to the hospital on one occasion.

-- College Park Rehabilitation Center, 2856 E. Cheyenne Ave., North Las Vegas: Failed to properly administer medications which endangered a resident’s breathing, and also failed to notify the physician or family of the episode. Nutritional and medication administration guidelines were not followed for another resident, which may have resulted in a bowel "impaction."

-- Silver Ridge Health Care Center, 1151 Torrey Pines Drive, Las Vegas: A resident’s welfare was endangered after she refused medication for three days. The physician who was supposed to be notifed wasn’t.

-- El Jen Convalescent Hospital and Retirement Center, 5538 W. Duncan Drive, Las Vegas: In one instance, a woman assessed at high risk of falling did so while a nursing assistant watched her take her own diaper down. She suffered a large skin tear on her right elbow and a large skin tear on her left forearm. In another instance, a woman was found on the floor after an unwitnessed fall.

-- Clearview Heath and Rehabilitation, 1180 E. Lake Meade Drive, Hendeerson: A number of devices, including a catheter and feeding tube, were managed incorrectly on residents. Doctor’s orders were not followed.

-- Life Care Center-Paradise Valley, 2325 E. Harmon Ave., Las Vegas: Residents were discharged who still required skilled nursing care. One resident then had to be taken to a hospital where she was first short of breath and intubated, and later found to be "clinically brain dead."

-- Horizon Health and Rehabilitation Cener, 660 Desert Lane, Las Vegas: A resident died after not having a bowel movement in four days. According to a state report filed with the federal government, "the resident was holding his stomach and saying this is not right."

-- Highland Manor of Mesquite, 272 Pioneer Blvd., Mesquite: A resident was left unattended in bed and the nursing assistant told inspectors that "I forgot to put the bed down when I went to answer an ... alarm." When she came back, the resident was on the floor. Crying, she had a large bruise on her right forearm and bruising to her lower extemities.