Three years ago, Meredith Phillips’ mother, Georgia Svolos, fell and broke her kneecap, setting off a downward spiral that landed her in nursing homes on and off for a year. In one facility, she fell and broke her knee again, necessitating more surgery. All of the facilities were noisy and chaotic, and one smelled of feces. So, when Phillips learned recently about moves by the Trump administration to ease regulations and fines on nursing homes, she was alarmed. “I’m horrified and frightened,” says Phillips, who lives in Westbrook.
At the Fresh River Healthcare nursing home in East Windsor, the chance that a short-stay patient will end up back in the hospital within 30 days of arriving at the facility is less than eight percent. Meanwhile, 12 miles away at the Greensprings Healthcare and Rehabilitation nursing home in East Hartford, more than a third of patients who came from hospitals will be readmitted in 30 days. The wide swing in nursing home patients’ re-hospitalization rates has a lot to do with the condition patients are in when they are discharged from inpatient stays, as well as the planning that goes into the transition to other care. The federal government has been penalizing hospitals since 2012 for high rates of patients returning within 30 days of discharge. But now, nursing homes (or skilled nursing facilities) also are being held accountable for hospital readmissions.
Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 21.6 percent since 2011 – more than the national average — new government data show. The data, released Friday by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut – many with dementia — are still more likely to be given antipsychotics than their counterparts in 33 other states. But the state’s usage rate has declined more than the national average drop of 17.1 percent. “While quality improvement in the area of reducing off-label antipsychotic drug usage needs to be an ongoing effort, Connecticut’s skilled nursing facilities have achieved very positive change,” said Matt Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes. He said the state’s homes are making ongoing changes in “behavioral and health care practice” to further reduce reliance on antipsychotics.
A bill requiring for-profit nursing homes that receive state funding to report their profits and losses from related businesses won legislative approval early Tuesday – a win for the union representing nursing home workers, which had the Malloy administration’s backing. The state Senate voted 24 to 11 to approve the bill, which also empowers a Nursing Home Financial Advisory Committee to examine quality of care, staffing levels and the financial solvency of nursing homes. The bill passed the House last week. The legislation requires nursing homes to disclose the financial status of any “related party” businesses that contract with the homes – such as associated companies that own the facility properties, or spinoff businesses that provide rehabilitation or management services. The original proposal required that the nursing homes report profits and losses for any related businesses that receive more than $10,000 a year, but that dollar amount was upped to $50,000 in the final proposal.
At the Governor’s House Rehabilitation & Nursing Center in Simsbury, 17 of the nursing home’s 73 beds sat empty this spring – a 23-percent vacancy rate that would have been unlikely five years ago. The home’s occupancy has fallen despite its above-average health care quality scores in the federal government’s rating system. “There are a lot of factors – a lot of initiatives out there now to keep people out of nursing homes,” said Keith Brown, the home’s administrator. “And with the increase in home care, we’re seeing a more frail resident population. So we have fewer residents, with higher acuity.”
The Simsbury home is not unique: Nearly a third of Connecticut’s nursing homes are less than 90 percent occupied, with Litchfield and Tolland counties bearing the highest vacancy rates, an analysis of state data shows.
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?