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.
Is it any wonder that the Nursing Home Corporate Representative quoted in this article claims that Nursing Homes have no problem with the increased fines? -They are so miniscule, even when doubled that they amount to nothing. The state spokesman who announced the fines should be embarrassed since the penalties respond to human death and suffering, and his own agency (CT DPH) will fine a cosmetician 1800. for cutting hair illegally. The state of Connecticut apparently takes animal welfare more seriously with a $5000. sanction for repeat instances of animal neglect and abuse.
Compare: Five Connecticut long term care residents with dementia have choked to death in the last year when care plans were not followed, meaning they were given the wrong food or didn’t have proper supervision. The fines? On average less than a thousand dollars. In California last month (March) a dementia patient choked to death and the state fined the San Diego facility $100,000. An industry spokesman from the same CT LTC organization as the gentlemen quoted here spoke in September 2012 told a local NBC TV reporter: (Note the casual tone) “We had a couple of incidents of choking and the industry at large, with the help of the Department of Health, has been all over it like a lawnmower on grass” ( At the time there had been 4 choking deaths with one fine was as low as $615.)
Item: Maggots. Maggots developed in the wound of a Nursing Home resident in a highly rated New Milford facility. The Connecticut fine? $1020. In 2010 a Sanford Maine nursing home resident suffered maggots when care was neglected, and those state regulators issued a fine of 10,000. In 2009, a Florida West Palm Beach Nursing home was fined $16,000 when a resident developed maggots.
A 2012 Journal of the American Medical Association study considered the use of the Appeal Process (Informal Dispute Resolution) available to nursing facilities for state sanctions. It found that in states where there was a low regulatory environment, facilities who were cited didn’t bother to appeal. Is Connecticut a low regulatory environment? According to this article facilities here rarely contest the fines. Connecticut’s eldercare ecosystem has among highest rates for hospital readmissions, the lowest nursing home staffing requirements in the country, and the highest use of dangerous anti-psychotic drugs on dementia patients. Yet none of these measures are reported in Medicare’s Nursing Home Compare rating system. Some of the most critical adverse events take place in highly rated facilites, and it doesn’t appear to diminish their quality ratings. As the industry spokesman quoted in this article described facilities “aren’t complaining” about the new fines, but maybe they don’t have to. Is there anyone looking out for our elders?