Report: Violations Widespread In Nursing HomesApr 29, 2003 | AP When Dorothy Moss, an 85-year-old Alzheimer's patient, entered a nursing home in November 1999, she was walking, talking and feeding herself. A year later, she lay dying in a pool of blood.
Her family moved her to three different homes, after she was hospitalized twice when she developed severe malnutrition, dehydration and pneumonia, and, after six months in a second home, when she had multiple infected bedsores.
While in the third home, medical records show, Moss began bleeding where a feeding tube entered her body. She died in bed, awaiting a blood transfusion.
"She pretty much lay there and bled to death," said Dottie Merinar of Portsmouth, Moss' daughter.
Nursing-home operators say their patients receive good care from conscientious professionals and that stories like Moss' are rare.
However, government reports, lawsuits and a review of state nursing-home inspection records by The Virginian-Pilot newspaper reveal that dozens of nursing homes throughout the state have incurred stacks of safety and health-care violations.
A legislative study in 2000 found that more than half of Virginia's 275 nursing homes failed to meet federal quality standards. The problems were most severe in eastern Virginia, where three-quarters of the homes were found to be out of compliance.
Several local nursing homes have been sued for patient neglect or abuse.
Government regulators allow poorly performing nursing homes to continue operating because they say closing them would traumatize their residents and possibly leave them with nowhere else to go, the newspaper reported Sunday. No Virginia nursing home has ever been shuttered by regulators.
Most of the shortcomings of Virginia nursing homes can be traced to inadequate staffing, poor funding by the state and the lack of any minimum legal standard for the amount of nursing care each patient must receive, the newspaper said.
Virginia ranks near the bottom among states in the amount it contributes to Medicaid, the federal-state medical program for low-income people, which is the primary source of payment to nursing homes. Low Medicaid payments translate into low pay and high turnover for the nurse aides who provide most of the patient care.
Some nurse aides complain of having to care for as many as three dozen patients in one night shift. State inspectors have found up to 60 patients being cared for by a single nurse and an aide.
Nursing home patients need, on average, about four hours of care daily, according to a federal study. Recognizing this, most states have set minimum staffing levels. Virginia is among 13 states that have not.
Moreover, because Virginia restricts Medicaid coverage to the most frail patients, it has the sickest nursing-home population in the country, the newspaper found. That means nursing homes in Virginia must meet the greatest demand for services in the nation with one of the smallest pots of government money.
These and other problems with nursing homes could multiply as the bulk of the huge baby-boom generation moves into its retirement years.
Statewide, 27,000 Virginians now live in nursing homes. By 2020, Virginia's over-65 population is projected to grow by 75 percent.
Yet, Virginia lawmakers continue to underfund nursing homes and do not pass reforms requiring better care, the newspaper said.
"We're going to have more abuse, more neglect, more bedsores, because we don't have the staff we need to take care of people," said state Sen. Leslie Byrne, D-Fairfax, who sponsored one of two unsuccessful nursing-home staffing bills in this year's General Assembly. "We're dumping millions of dollars into nursing homes and we're not getting what we're paying for. We're not getting good care."
Nursing home operators say that despite staffing and funding shortages, most patients get high-quality, caring treatment.
"There are a few negative stories that can taint the industry," said Mary Blunt, president of Sentara Life Care Corp., which operates seven nursing homes in Hampton Roads. "But there's a lot of good work that's being done in long-term care today."
Lack of money often is pointed to as the principal cause of staffing shortages and other problems plaguing nursing homes. In Virginia, nearly 70 percent of nursing-home residents are covered by Medicaid. Ten percent are covered by Medicare, the federal health-insurance program for the elderly.
Virginia ranked 47th in per capita Medicaid nursing-home spending in 2001. Virginia's average daily reimbursement rate is $102.50. Rates in neighboring states range from $108 in North Carolina to $162.49 in Maryland.
At the current reimbursement rate, Virginia nursing homes lose, on average, $10 to $12 a day for each Medicaid patient they take, according to the Virginia Health Care Association, a Richmond-based industry group.
Without bigger state contributions, nursing homes can't afford to provide the level of patient care recommended by industry experts, government officials and patient advocates say.
"Common sense says that if we're that low nationally in Medicaid reimbursement, we're probably not able to deliver the quality of care that we want to deliver," said Joani Latimer, the state's long-term-care ombudsman.