State Raises Financial Penalties For Nursing Homes

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Last summer, the state Department of Public Health fined a Danielson nursing home $580 after a resident whose feet were not properly secured to a wheelchair suffered a hip fracture.

This January, a Waterbury nursing home was fined double that amount — $1,160 — after an incident in which a resident sustained a cut on the forehead during a fall, while being transferred to a toilet without proper precautions.

Similarly, the Lutheran Home of Southbury paid a $615 state fine last spring, after a resident who was supposed to be served a “soft diet” was instead served a meal of ham and carrots and choked to death. Then more recently, in February, the state fined the Paradigm Healthcare Center of Norwalk double that amount — $1,230 — in connection with the death of a resident who choked on food that had been left on a tray at a nursing station.

Why the differences in penalties?

According to a spokesman for the DPH, the department’s licensing and investigations unit “recently reviewed and updated the financial penalties it levies against nursing homes for the various classes of violations it issues.” The fines were generally doubled.

The spokesman, William Gerrish, said the review “happens periodically, and is not based on a change of law, policy, staff, or other factors.”

DPH officials could not say how long it had been since the last update was done, except that it was at least “several years.”

Gerrish said the recent decision to boost fines was not influenced by increased media coverage of DPH’s penalties against nursing homes by the Connecticut Health I-Team (C-HIT), which has routinely been reporting on regulatory actions against nursing homes and other health-care providers for the past two years. C-HIT stories have stirred criticism from some elder-care advocates and nursing home family members that the state fines were too low.

Gerrish said the federal Centers for Medicare & Medicaid Services (CMS) recently updated their civil penalties, and “we felt it was also appropriate for us to review and update the penalties we had been levying under our state jurisdiction . . .”

“Because the fines had remained at the same level for many years, DPH felt it was time to increase their level to bring them into alignment with today’s economy and make them a more effective regulatory tool,” he said.

Under state law, DPH is empowered to cite nursing homes for two classes of violations – Class A, which is deemed to present “an immediate danger of death or serious harm to any patient” in a facility, and Class B, a less serious violation. DPH has the authority to impose fines of up to $3,000 for each lesser violation, and up to $5,000 for each more serious violation.

Until recently, fines for Class B violations rarely exceeded $700, with average fines at about $500 to $600. In the past several months, DPH has imposed civil fines exceeding $1,000 on 18 homes cited for Class B violations.

State statutes give the DPH latitude in setting penalties, which can be influenced by factors such as the degree that the violation impacts the health and safety of patients; the conduct of the home’s leadership in taking steps to comply or to correct the violation; and prior violations by the nursing home.

Gerrish said financial penalties are “one tool among many (that) the department uses to bring licensed facilities into compliance after violations have been identified. “ The DPH also can order homes to submit corrective action plans for serious violations, or may issue consent orders mandating significant changes in a facility’s operations.

Matthew Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes, said members have not complained about the increased fines, which come as many homes face falling Medicare reimbursements. He said he believes the increases are an effort by DPH “to increase its revenue capability” – a claim that Gerrish denied.

Nursing homes rarely contest the fines and citations that result from state inspections, which also are recorded on CMS’ Nursing Home Compare website.