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Part-Timer Harbors Troubling Memories of Brooklyn Nursing Home


 

Hopkins Nursing Home

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the fourth of five parts. 

As a college student working as a part-time security guard at the Hopkins Center for Rehabilitation and Healthcare, Victor Ayala formed some disturbing impressions of repressive administrators and dour residents.

"The majority of the residents who could walk and talk on their own would tell me, ‘Help me escape. Help me leave,'" recalled Ayala, who worked at the home in Brooklyn for six months in 2012. “It broke my heart.” 

One resident said he chain-smoked because he saw death as his only escape from Hopkins, Ayala said.

“I would never put anyone in a nursing home after that,” he said.

Hopkins is rated as a one-star facility by the federal Centers for Medicare and Medicaid Services (CMS), which evaluates nursing homes nationwide. A single star means the nursing home performs “much below average.”

Low-quality care afflicts nursing homes across the city. Of the 175 nursing homes in the five boroughs, 61 percent are rated by the CMS as below average or much below average.

Hopkins Director Susan Rice didn’t respond to an interview request. But Director of Admissions Janet Cikana said the facility’s one-star rating is undeserved.

“I’ve seen bad nursing homes,” she said. “There are some I wouldn’t put my dog in.”

Cikana suggested that Hopkins’ one-star rating is a residual effect of a 2011 incident in which an 85-year-old female resident with dementia walked out of the 288-bed nursing home and was missing for four hours.

A state Department of Health investigation at the time determined that security guards and a receptionist failed to respond to an alarm triggered by a “wander guard” worn on the woman’s wrist. A family member found the missing woman in her former home and returned her to Hopkins.

Hopkins has fared better in federal inspections since the incident. Inspectors found no deficiencies during a 2012 certification survey and minor deficiencies cited last year have since been corrected.

Still, the CMS gave Hopkins the lowest possible rating in a staffing category, which is largely based on the amount of time that nurses spend with residents. CMS records show that:

  • A Hopkins registered nurse (RN) spends an average of 26 minutes a day with a resident. The state average is 42 minutes.
  • A nurse aide, who performs such tasks as feeding, bathing and dressing residents, spends an average of one hour and 51 minutes a day with a Hopkins resident. The state average is two hours and 22 minutes.
  • On average, a Hopkins resident receives care from all certified nurses, which includes RNs, licensed practical nurses, and licensed vocational nurses, for one hour and four minutes each day. The state average is one hour and 32 minutes.

An apparent shortage of staff at Hopkins led to another unsettling experience for Ayala. During an overnight shift, nurses summoned Ayala, though he wasn’t supposed to leave his security desk. They needed his help. He went upstairs and found them wrapping blankets around a resident who had died. Ayala carried the resident to the basement morgue. He had never seen a dead body before.

A few weeks later, the night nurses again asked Ayala to carry a deceased resident to the morgue.

Sometime after Ayala left in September 2012, it dawned on him that a part-time guard was probably not supposed to leave the entrance unmanned to transport dead residents.

He was right. State law stipulates that qualified nursing staff members are responsible for all direct care, which includes dealing with residents’ bodies after death.

St. Vincent’s Hospital operated the nursing home under the name Bishop Mugavero Center for Geriatric Care until the hospital filed for bankruptcy. KFG Operating, a trio of businessmen who own other nursing homes, bought the facility in 2011. Staffing has been an issue since the ownership change. 

Cikana, the Hopkins’ admissions director, acknowledged that the new owners changed the business model, but said she regarded the changes as improvements. Rather than hire in-house physical therapists, for example, Hopkins uses contractors. Some of the nurses are contract employees as well, she said.

Advocates for the elderly oppose the employment of outside contractors in nursing homes. Furthermore, Medicare and Medicaid will pull funding from facility that use independent contractors for patient care, according to accountants and nursing experts.

Deborah Truhowsky, an attorney whose firm practices in the area of elder neglect and abuse, suggests that administrators understaff nursing homes for business purposes.

“They’re not hiring more people, but still taking in new residents,” she said. “It’s difficult to imagine, what with the low number of staff members, how they could do what they need to do—take care of patients and train staff properly.”

State regulations require facilities to have “adequate” staffing but set no specific standard for adequacy. Though seven states have passed laws that define staffing standards, the New York legislature has repeatedly struck down similar bills.

Nursing homes with staffing problems identified by the CMS frequently fail to ensure the health of their residents. A high incidence of pressure ulcers, commonly called bedsores, is often noted in such facilities .

Nearly 14 percent of long-term residents at Hopkins developed the painful and unsightly wounds. The state average is 8 percent and the national average is 6 percent.

Hopkins also is home to an above-average number of residents who exhibit signs of depression. Medicare records show that 23.7 percent of Hopkins long-term residents exhibit symptoms of depression—twice the state average and more than three times the national average.

Security measures taken after the 85-year-old resident went missing in 2011 might be contributing to some residents’ depression. To prevent confused residents from straying, Hopkins erected an enclosure around the building’s patio, the only outdoor space. Some residents and their families complained that the patio took on a jail-like atmosphere.

A former recreation leader at Hopkins, who asked that his name be withheld because he doesn't want to jeopardize his future employment, said he felt conditions worsened at the nursing home under the new owners.

“The people that are now running it are very much not in the interest of having it be something other than to make them money. Period. End of Story,” he said.

The recreation leader, who had organized activities and musical performances, has worked at other nursing homes in the city, but said the environment at Hopkins was palpably different than anywhere else.

 “Anyone who walked in there could tell that everyone was on edge,” he said. “I don’t remember anybody—staff or visitors, or family members or whoeverfeeling as good about it as they did before the changeover, in terms of care, general feeling of the place, and every possible permutation of the business.”

Theresa Fisher filed this report while attending the CUNY Graduate School of Journalism.

Bed-Stuy Nursing Home: 'Much Below Average' in Staff Care


generic for Hucles

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the last of five parts.

When Harold Beer entered Bishop Henry Hucles Nursing Home, he gave his prosthetic leg to an aide while being fitted for a wheelchair. He says they never returned it.

“They also won’t tell me when they’re letting me go,” complained the 73-year-old Beer. “I can’t get a straight answer around here.”

Complaints about Bishop Henry Hucles are not uncommon. The facility, located in the Bedford-Stuyvesant neighborhood of Brooklyn, ranks as one of the lowest-rated nursing homes in the city, according to state inspections and Medicare records.

Bob DeVito, administrator of the 240-bed nursing home, rejects the findings of state inspectors who assigned the facility several poor scores in categories used to measure its performance.

“Those scores must be either outdated or wrong,” he said. “This nursing home takes great care of its residents.”

300 pie chartThe Centers for Medicare & Medicaid Services (CMS), which evaluates nursing homes, gave Bishop Henry Hucles an overall rating of two stars, which the CMS assigns to nursing homes that provide a “below average” level of care.

DeVito would not allow a Gotham Gazette reporter to tour the facility, citing instructions from new owner, Michael Melnicke, whose company operates several nursing homes. Meinicke didn’t respond to requests for an interview.

The CMS gave Bishop Henry Hucles a one-star rating in the all-important staffing category. The CMS equates a one-star rating with a “much below average” level of care. The rating is based largely on the amount of time nurses and certified nurse aides spend each day with residents.

Arthur Edey, a former employee, claims that staffing problems began in 2011 when Episcopal Health Services, the non-profit that operated the nursing home, transferred ownership of Bishop Henry Hucles to Melnicke. The nursing home reduced staff to three certified nurse aides (CNA) for every floor, which have as many as 40 residents, he said. 

“That’s a lot of people to cover, and some of them need lots of help,” Edey said. “It also means people have to wait longer to get the help they need.”

Staff also was asked to clean two floors per person, which “is an impossible thing to ask one person to do,” he added.

Bishop Henry Hucles admits many residents who need long term care and suffer from Alzheimer’s disease and dementia. A nurse who asked that her name be withheld because she feared that she could lose her job for commenting, said that when staff gets squeezed, “the care of the patients sometimes suffers.”

A typical nursing home needs an average of 4.4 hours of direct care staff time per resident per day to see positive outcomes, said Richard Mollot, a consumer advocate for nursing homes.

“If you dig into how CMS computes data, 4.4 hours translates to a high four- or a five-star rating,” Mollot said. “Three stars is significantly below average, and one star means you’re one of the worst in the country.”

At Bishop Henry Hucles, registered nurses spend an average of 18 minutes per day per resident, less than half the state average of 42 minutes and national average of 48 minutes. The facility’s licensed nurses spent an average of 59 minutes a day per resident, nearly 35 minutes less than the state average.

Unlike other states, New York does not have a mandated minimum staff ratio or a minimum amount of hours that nursing staff is required to devote to nursing home residents (although there is a proposed bill that aims to change that), Mollot said.  

Staffing deficiencies can lead to patient neglect. For example, a resident walked out of Bishop Henry Hucles undetected on Dec. 18, 2012, according to a state inspection report. The resident typically strolled inside the facility at about 7:30 p.m. and nursing aides assumed she was on the first floor, the report says. It is unclear how long it took the home to locate the resident, but she wasn’t reported missing until 11:20 p.m., according to the report.

The facility scored low in several care categories. There has been a 41-percent increase in the number of long-term residents who need help with daily activities, according to CMS data. The statewide average is 15 percent. Nearly 36 percent of the residents exhibit symptoms of depression – three times the state average of 11.7 percent, the CMS data show. 

Health violations have also been a problem at the home. Inspectors cited Bishop Henry Hucles for 12 health deficiencies last year, more than double the 5.3 state average. For example, a licensed practice nurse (LPN) left medications unattended in a hallway while she went to the medication room. The LPN left the cart unattended again 10 minutes later. In another case, a resident with a skin rash was ordered to see a dermatologist, but didn’t see one until 16 weeks later because of multiple miscommunications among staff. 

On a recent visit to Bishop Henry Hucles, residents were dressed in tattered clothing. A few residents said the home’s food was extremely poor and wished there was more variety. 

“All they ever give us is gravy, gravy, gravy,” said Sally Norman, a longtime resident. “It’s not good for us.”

Some staff members at the home are also unhappy. Edey, a 15-year employee at Bishop Henry Hucles, complained that Melnicke instituted a few unwelcome changes when he took ownership of the facility.

“They had added changes to our union contracts,” he said. “And they weren’t good.”

The changes included fewer overtime hours and lower disability benefits, Edey said. Melnicke was unwilling to compromise on the changes, said Edey, who was the union representative.

“We voted the changes down,” Edey said. “But Melnicke said no one had ever voted against him, and we had to vote over.”

The next vote was an even more resounding no.

Edey, 61, had spent six months on disability after spraining an ankle and tearing an ACL on the job. He said that after the union vote Melnicke went to his supervisor and said he didn’t think Edey was healthy enough to continue working, even though Edey’s doctor had advised him to go back to work.

“I’ve been on disability ever since,” he said.

Alex Eidman filed this report while attending the CUNY Graduate School of Journalism.

The "Quality of Staffing" pie chart uses data obtained from the Centers for Medicare and Medicaid Services.

'Tax Dollars are Paying for This'


Marcus Garvey

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the third of five parts. 

Citing a pattern of serious problems, federal regulators placed Marcus Garvey Nursing Home on an exclusive watch list of the worst nursing homes in the country in 2009 and again in 2011.

Those actions occurred while the state attorney general’s office pursued a civil lawsuit accusing Ruby Weston, the facility’s owner, of using money intended for resident care to enrich herself and her family. A 2012 settlement of the lawsuit required Weston to forfeit $821,000 in deferred compensation and pay $50,000 to cover the cost of the AG’s investigation.

The 295-bed nursing home in Brooklyn’s Crown Heights neighborhood is now named the Marcus Garvey Residential Rehab Pavilion and operated by new owners. Yet it remains one of the worst in the country.

Current administrators say they are working to solve the problems but seem to have a lot to overcome.

In 2009, the federal oversight agency for Medicaid and Medicare designated Marcus Garvey a Special Focus Facility (SFF) after an investigation found that its staff was failing to properly administer patients’ medications. The nursing home was fined nearly $55,000.

The facility landed on the SFF list the following year after regulators found that Marcus Garvey staff failed to report a resident’s high potassium levels, body numbness, and trouble breathing. The resident was hospitalized and died. Soon after that, the state fined the facility $20,000 for delivering sub-standard care.

When Marcus Garvey was placed on the SFF watch list, its administrators were told they need to make significant improvements to continue to receive Medicare funds. They needed to hire more competent staff, for example, and make clear policies to ensure patients receive the proper medications, according to Medicare documents. But the problems persisted.

“People are suffering and our tax dollars are paying for this,” said Richard Mollot, leader of the advocacy group Long Term Care Community Coalition.

Substandard nursing homes such as Marcus Garvey are supposed to lose their Medicare and Medicaid money if they fail to correct serious problems, Mollot said. Government agencies are failing to enforce their regulations, he said.

Quality of care measures

Despite the fines and additional oversight, Marcus Garvey remains among the lowest ranking nursing homes in the city. One of the most troubling problems fueling its poor ratings is the large number of patients on antipsychotic drugs.

Aproximately 40 percent of the long-term patients at Marcus Garvey receive antipsychotics — more than twice the state average, according to state Health Department records. And 4.6 percent of the facility’s short-term patients take the drugs, well above the 2.7 percent state average.

Elder care advocates and doctors have said antipsychotic drugs, which include powerful tranquilizers such as Risperdal and Seroquel, are often overused in nursing homes as chemical restraints.

Marcus Garvey Medical Director Pierre Brutus said he is trying to reduce the number of patients on antipsychotics. However, doing so is difficult because the nursing home receives many patients from Gracie Square Hospital, a psychiatric and substance abuse facility in Manhattan, he said.

Hospital adminstration said it could not provide information about the number of patients transferred to Marcus Garvey.

Two-thirds of Marcus Garvey’s long-term residents display symptoms of severe depression, federal records show. That’s nearly six times higher than the state average and 11 times higher than the national average. Brutus said that for many of these patients, there is nothing the facility can do.

“Some have major depression, and we cannot reverse that,” he said.

Federal inspectors routinely found problems at Marcus Garvey that could be reversed. A Gotham Gazette review of federal inspection reportds from 2011 to 2012 found many other violations, including the failure to:

  • Properly administer medications (one insulin-dependent resident’s chart showed no evidence that she had received insulin for three days in a row);
  • Provide proper dental services (during the state inspection, a resident told an inspector that she was missing her front teeth because of a fall and hadn’t seen a dentist during her year-long stay at the facility);
  • Address “critical and aberrant” lab results;
  • Do an accurate assessment of each patient and keep each resident — along with his or her doctor and family — apprised of any changes in health status (one resident’s health care manager told inspectors that the facility “does not always inform him about changes in the resident's medication or treatment”).

Yoga instructor Daniela Bella discovered how frustrating it could be to try to improve conditions at Marcus Garvey. Once a week, she guided a classroom of residents in “chair yoga,” in which the elderly participants go through a series of stretches and poses while seated in chairs.

“They were happy, they loved the music and they loved me,” Bella recalled. “I got close with a lot of them,” she said.

Despite the patients’ enthusiasm, Marcus Garvey administrators often forgot to tell residents about scheduled classes or failed to clear the classroom of furniture, she said. It simply wasn’t a priority, she said.

“You could tell they had just forgotten,” Bella said.

The Marcus Garvey website prominently features a photo of the facility’s visitor lounge. “Visitors welcomed and encouraged everyday,” reads the photo caption. But a visit by the Gotham Gazette was clearly unwelcome; its reporter was escorted out of the building.

An apologetic Gloria Gasper, director of social work at the home, said a few days later that interviews with residents and staff are not allowed.

 “I just think this is a place that has its own culture,” she said. “I would suggest you not waste your time here.”

Erin Brodwin filed this report while attending the CUNY Graduate School of Journalism. 



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