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Nursing-Home Laws Evaluated

Public hearings this week examine oversight and enforcement efforts

Apr 20, 2003 | The News Journal

Seated in the dining room of the Franciscan Care Center in Wilmington, 74-year-old Lorraine Valandingham chats with state Sen. Robert Marshall, D-Wilmington West, about how much she likes the nurses and food at the nursing home.

Valandingham, who has lived in the facility for three years, is one of about 4,300 people residing in 42 nursing homes throughout the state, officials said.

Her positive comments about her stay are what Marshall said he wants to hear from more nursing-home residents.

The senator's visit Wednesday was prompted by upcoming public hearings this week about the state's nursing-home reform laws.

The two-day hearing is aimed at assessing whether existing state laws are enough to ensure residents receive quality care free from abuse and neglect. The hearing also will gauge the performance of the agency charged with the oversight and enforcement of the facilities, and judge how well the state Attorney General's Office plays its part in prosecuting cases of abuse and neglect referred to them.

The hearings are scheduled for 1 to 5 p.m. Wednesday and Thursday in the Alcoholic Beverage Control Commission conference room of the Carvel State Office Building, 820 N. French St.

"Do we need more legislation, or do we simply need the agencies charged with the existing legislation to do their jobs?" Marshall said. "If you don't have the proper leadership at the top, the residents suffer."

Officials from the state's Division of Long-Term Care Residents Protection, the division's Ombudsman, the state Attorney General's Office and U.S. Department of Justice's Medicaid fraud units will appear before the panel.

Marshall said his visit brought back memories of when his 87-year-old father, Ignatius "Eagle" Marchlewicz, was a resident at Franciscan Care Center. His father, who suffered a stroke in 1997, was a resident there for six months before his death.

Marshall said the experience gave him a unique perspective on the shortfalls in nursing-home care and staffing. It pushed him to reform laws in the state, which resulted in the passage of Eagle's Law in 2000. The law, named after his father, requires that nursing-home patients receive a minimum 3.28 hours of one-on-one care from a nurse or certified nursing assistant each day.

"I was an eyewitness to the deficiencies and weaknesses in the system," Marshall said. "There were systemic problems dealing with inadequate staffing, criminal background checks and issues of enforcement of laws and regulations."

Criticisms arise

Nursing-home owners have been critical of the law, saying the national nursing shortage has forced them to use temporary agencies to supply nurses at increased costs to comply with the state's minimum-staffing requirement.

The Division of Long-Term Care Residents Protection, created under the legislation, has been charged with monitoring the quality of care that facilities provide to residents. The division also has the authority to hold nursing homes accountable for violations by imposing fines, bans on admissions or closures.

Now, three years after the reforms went into effect, Marshall wants to know whether the state's watchdog agency has been enforcing violations discovered through complaints and from annual and random inspections.

Last year, the division imposed $187,000 in civil penalties against 19 nursing homes and other health-care agencies, said Allison Taylor Levine, spokeswoman for Delaware Health and Social Services.

According to statistics released by the division, it handled 47,781 complaints between 1999 and 2002. Of the complaints, 5,046 of them sparked investigations of possible harm to the residents or problems with staff or with the operations of the facility.

Of those complaints investigated, 1,234 were substantiated. The majority of those complaints have been about patient abuse.

Levine said the problem with substantiating more of the complaints is that it has been difficult "to find sufficient evidence, witnesses, etc., to prove something inappropriate happened."

Yet the numbers have more than quadrupled in the past three years from 118 in 2000 to 630 substantiated claims in 2002.

Levine said the majority of complaints include reports of bumps, bruises or minor falls, all of which have to be reported. But they also include more serious accusations such as thefts from patients, mistreatment, neglect or abuse by staff. One case investigated last year included a strangulation death that occurred when no one was around.

Deaths investigated

In October, 82-year-old Edgar Anderson was found hanged from the seat belt of his wheelchair at Harbor Healthcare and Rehabilitation Center in Lewes.

In January, a 60-year-old Lewes woman died of complications suffered when she was trapped in a freezer for five hours at Lewes Convalescent Center.

Both death investigations pointed to a general failure in staff accountability, officials said. Action was taken against a kitchen worker at the Lewes Convalescent Center. The worker's name was placed on the state's Adult Abuse Registry, one of 260 names currently on the list.

Both nursing-home death cases remain under investigation by the state Attorney General's Office.

Spokeswoman Lori Sitler said 58 patient-abuse cases - half of them involving thefts were referred last year by the Division of Long-Term Care Residents Protection to the Attorney General's Medicaid Fraud Unit for review. Anderson's death was referred by the state Medical Examiner's Office.

Although the state Attorney General's Office said it had 170 patient-abuse referrals last year that resulted in 60 investigations, officials did not indicate what, if any, specific action or resolution was reached in the cases referred by the Long-Term Care Residents Protection division.

Nurse Pat Engelhardt, who is a member of the state's Nursing Home Quality Assurance Commission, said a lot has been accomplished in the past five years. But she said there is still a long way to go.

"I just want to see residents protected against long-standing problems of abuse and neglect," Engelhardt said. "It's not perfect yet, and we just want it to get better."

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