Senate report reveals nearly 400 troubled nursing homes, including 2 on LI

The federal government has for years kept under wraps the names of hundreds of nursing homes around the country found by inspectors to have serious health, safety or sanitary problems.

Nearly 400 facilities nationwide, including two on Long Island, had a “persistent record of poor care” as of April, but they were not included along with a shorter list of homes that get increased federal scrutiny and do have warning labels, according to a Senate report released Monday.

The two on Long Island are Medford Multicare Center in Medford, which previously ran afoul of regulators, and Townhouse Center for Rehabilitation & Nursing in Uniondale, which is listed as a candidate for the special federal program.

However, the monitor the state attorney general appointed for Medford, which years ago agreed to reforms as part of a $28 million settlement, provided a copy of a March 13 letter from the state Department of Health saying the federal agency had removed it from the list because it “has achieved and sustained progress in survey results.”

In a statement, a Department of Health spokesman said Medford is no longer listed as a special focus facility, the formal term. 

Michael Fragin, a spokesman for Townhouse, issued a statement: “Townhouse Center for Rehab serves some of the most vulnerable patients on Long Island in our highly specialized units and we are committed to providing the finest in long term care to our residents. Our administrators and staff treat every issue and complaint very seriously, and as the information contained in the Senate report is at this time, dated, corrective action has already been taken and completed.”

Townhouse, he added, improved its supervision of nurses and training and invested in equipment.

“Townhouse’s annual inspections in 2019 and 2017 show that it has minimal deficiencies and operates far better than the national, and New York, averages for skilled nursing facility,” Fragin said by email.

Further, the nursing home, though placed on the pending list by the U.S. Centers for Medicare and Medicaid Services, never was put on the formal focus list, he said.

Referring to the federal agency and the state Department of Health, he continued: “Townhouse has been notified that it is in substantial compliance with CMS and DOH.” 

The Department of Health said Townhouse is not on the list.

“When the Department of Health identifies a persistent pattern of poor care at a nursing home, over three consecutive inspections, we recommend that federal regulators designate it a Special Focus Facility," the department said. "DOH inspects ‎Nursing homes designated Special Focus Facilities twice as often as other nursing homes and these facilities face additional enforcement actions if significant improvement is not made.”

The U.S. Centers for Medicare and Medicaid Services and the Medford Multicare Center did not comment. 

As part of the state settlement, the Medford nursing home returned $10 million to Medicaid. Nine employees either pleaded guilty or were convicted of charges stemming from the death of a resident, a 72-year-old woman who relied on a ventilator. Those workers are: the former administrator, who falsified business records and violated health laws, three nurses, two respiratory therapists, and three aides.

Budget cuts appear to be contributing to the problem, reducing money available for the focused inspections that are required for nursing homes on the shorter list, according to documents and interviews.

The secrecy undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified, according to two senators who released the report on Monday.

“We’ve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis,” said Sen. Bob Casey (D-Pa.), who along with Sen. Pat Toomey (R-Pa.), issued the report.

“When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings,” said Toomey.

The senators released a list provided to them by the Centers for Medicare and Medicaid Services, or CMS, of nursing homes with documented problems whose names were not publicly disclosed by the government.

About 1.3 million Americans are nursing home residents, cared for in more than 15,700 facilities. The senators’ report noted that problem nursing homes on both lists account for about 3 percent.

CMS does publicly disclose names of a smaller group of about 80 nursing homes that are getting special scrutiny to help them resolve documented quality problems. They’re in what’s called the Special Focus Facility program. Nursing homes that don’t improve can be cut off by Medicare and Medicaid.

Consumers can identify special focus facilities on the government’s Nursing Home Compare website by looking for an icon shaped like a small yellow triangle that resembles a traffic “caution” sign. The website does not display starred quality ratings for the special focus facilities. Usually, nursing homes receive from a low of one star to the highest quality score of five stars.

The nearly 400 facilities that are candidates for the shorter list “qualify for the program because they are identified as having a ‘persistent record of poor care’ but are not selected for participation as a result of limited resources at (CMS),” said the report from Casey and Toomey.

“Despite being indistinguishable from (special focus nursing homes) in terms of their qualifications, candidates are not publicly disclosed,” the report added.

In a letter last month to Casey, CMS Administrator Seema Verma singled out federal budget problems as a factor.

“The total number of (special focus) slots and total number of (special focus) candidates nationally are based on the availability of federal resources,” Verma wrote. She added that as recently as 2010, there was room for 167 nursing homes in the special focus program and 835 candidates. That’s now down to as many as 88 special focus slots and about 440 candidates.

She said federal budget cuts in 2014 reduced the number of available slots.

Verma said her agency is evaluating whether it can publicly release the list of “candidate” nursing homes. The Trump administration has asked Congress for more money for health care inspections, but the final amount and how it will be distributed remain unclear.

In a statement, CMS said its starred ratings on the Nursing Home Compare website are already the best yardstick “for consumers to understand and use.” About 2,900 nursing homes have the lowest one-star overall rating.

But consumer groups say such ratings are not enough, and greater disclosure is overdue.

“It might help (consumers) avoid facilities that the government is acknowledging are very, very troubled,” said Toby Edelman, a senior policy lawyer with the nonprofit Center for Medicare Advocacy.

A nursing home industry group says it generally supports transparency and takes no position on release of the list. David Gifford, vice president for quality with the American Health Care Association, said the inspection reports on which the CMS lists are based are only one measure, and people should also consider other factors, such as staffing levels and clinical outcomes.