‘It’s a crisis under our feet’: Valley nursing homes putting the elderly at risk

Valley nursing homes putting the elderly at risk

HUNTSVILLE, Ala. (WAFF) - Nursing homes in the Valley house parents, spouses and loved ones.

They can also the be the scene of practices that put residents in harm’s way.

During the reporting on alleged abuse, understaffing and investigations at the Floyd E. Tut Fann Veterans Home, a number of sources said conditions at other nursing homes in the valley were just as bad, if not worse.

WAFF 48 News spoke with the people who see it on a daily basis, looked through state and federal reports, and reached out to the departments responsible for protecting some of the most vulnerable in our community.

An attorney’s take

Huntsville attorney Tommy Siniard said he’s been representing clients against nursing homes for the last 25 years.

He said the conditions his clients live in have recently worsened, and described it as a “crisis under our feet.”

“If it was small children at a daycare and this was going on, it would be a march on Washington,” he said.

He said his clients often suffer from basic neglect, where nursing homes fail to ensure they’re hydrated, not developing bed sores or getting the assistance they need when moving around.

Siniard said his office is currently working three Grade 4 bedsore cases, where the wounds go down to the bone.

Warning: the following images have been blurred but can still be described as graphic.

“It’s not that people that work at nursing homes are evil, contrary to that, it is that it’s a for-profit business and the less people and the less trained they are, and the less you pay them, the more profit you make,” he said.

“So when we say nursing home you expect the place to be swarming with nurses, there may be a nurse for an entire shift that covers 30, 40, 50 beds.”

He said he fears the ratio will only get worse as the Baby Boomer generation transitions into nursing homes.

Siniard said he thinks the recent backslide in conditions is also the result of confidentiality agreements from previous lawsuits, the perception of reduced policing at the homes, and a lack of options for elderly care.

“These victims and the press, there’s a lack of will or knowledge to shine a light on it,” he said.

Three family members say under-staffing is the root of the issue

Dinah Porch: Daughter of a former resident

Through an independent source, WAFF 48 News contacted Huntsville resident Dinah Porch.

Her mother resided at a north Alabama nursing home for a one week period in 2017 before Porch removed her from the facility.

She now pays for a health care professionals to care for her mother at home.

Porch requested WAFF 48 News keep the nursing home name private in order to protect her mother’s privacy.

She said the issues began on the first day, when staff failed to respond to her mother’s call light for two hours.

“I had to go to the front of the building, I couldn’t find anyone at the nurses’ station. I had to go to the very reception at the front of the building and get them to call the nursing supervisor to get someone to come in,” she said.

“Most of the people, were just being ignored. They only had one nurse for I’m guessing 30 patients."

She said issues with an under-responsive staff continued until Porch’s brother found her mother with a bruised arm later in the week.

She said they took her mother to the hospital and discovered she had a broken hip.

Porch said she does not know how her mother fell, but decided to take her mother out of the home following the hospital visit.

She said she pays for an at-home service which is cheaper than the nursing home was, and encourages others to keep their loved ones away from homes if possible.

“If you get your loved one into a facility and you have a bad feeling when you get there or bad experiences, go ahead and make a change then. Don’t wait,” she said.

Family member #2: Wife of a current resident

Through a separate independent source, WAFF 48 News contacted the wife of a current resident at another north Alabama nursing home.

The woman was able to provide documentation showing her husbands’ current residence.

WAFF 48 News agreed to keep her name and likeness private in order to prevent retaliation toward her husband at the home.

She said her husband has lived at the facility for two years, and she visits him on a regular basis.

The woman said a lack of staffing is leaving resident call lights unattended for up to 45 minutes.

“If you’re having a heart attack, or if you’re having any type of seizure or any type of medical issue, five minutes is crucial for a life or death situation,” she said.

“That makes me worry that I’m going to get a phone call in the middle of the night, and get that call that nobody wants, that your loved one has passed away. That’s nerve wracking.”

She said under-staffing often results in residents being unattended in public areas as well.

“You see neglect, you see people sitting in feces, you see feces sitting in wheelchairs, you see bathrooms that are unkept, because they’re not cleaned but once every other day,” she said.

The wife said she would like to move her husband, but she’s facing two challenges.

She said she is not physically capable of taking care of her husband at home. Other nursing homes are an option, but cost and an extended wait list present challenges.

“This is across the board, it’s not just one nursing home or one facility. I’ve had two other people in different nursing homes and have encountered almost the similar things."

She said Alabama needs to re-evaluate the standards it holds its nursing homes to.

Family member #3: Daughter of a current resident

The daughter of a current north Alabama nursing home resident reached out to WAFF 48 News to share her family’s experience with two different nursing homes.

She was able to provide documentation of her father’s residence at both facilities.

WAFF 48 News agreed to keep her name private because she expressed concern her father would be retaliated against at the nursing home he currently resides in.

She said her father suffers from memory loss, and is wheelchair bound.

She admitted him into the first facility in 2016, and visited him regularly. She said the staff did its’ best to care for him, but under-staffing appeared to be an issue.

She said staff would tell her they’d work double shifts to keep the residents cared for.

She described one scenario where she found her father unresponsive, and the staff wasn’t aware.

“They said he had been laying there pretty much all day, but did not realize he was slow to respond,” she said.

“We tried everything and could not even get him to open his eyes.”

The daughter is a health professional and was ultimately able to get him to respond by applying painful pressure on her father’s sternum.

“They say he did have breakfast that morning, but then had basically been in the bed the rest of the day."

She said she had found her father unresponsive around 5:30 p.m.

“Somebody should have said ‘hey, he’s not waking up. He’s not talking to us,” she said.

In late 2018, she moved her father to a second facility that was less cost prohibitive.

He still resides at the second facility, and she said the issue of under-staffing remains.

“The employee did talk to us, and she was very frustrated, worked 16 hour days, multiple days in a row," she said.

“[The employees] appear just overwhelmed out on the floor with the responsibilities, and their frustration shows.”

She said it results in staff being “short” with residents, and not always acting in their best interest.

She said she found her father “restrained" by his wheel chair. He was positioned so that he was unable to lift himself up.

She said she sternly told the staff on hand to never put her father in that position again, but her options are limited.

She said her family cannot adequately care for him at their home, and the cost of moving him remains a challenge.

“I just want him, in the final years, days and years of his life, I want him to be well provided for and taken care of," she said.

The Alabama Department of Public Health’s take

The ADPH declined an interview for this story, but answered to questions via email.

The department regulates and licenses nursing homes to ensure compliance with the Alabama State Board of Health Rules.

When a violation is cited, the nursing homes are required to complete a corrective action plan.

Director of Long Term Care Lisa Pezent said the department follows up on those plans at the next survey, to ensure they’re being followed.

She said “surveys of nursing facilities are conducted at various times including weekends, 24 hours a day," and it is illegal for homes to have prior notice.

WAFF asked how the department would describe the current state of north Alabama’s nursing homes.

Pezent responded with a link to the deficiencies web page.

In prior reporting the ADPH stated “There is no minimum number of required staff in nursing homes,” but state guidelines only require staffing levels to be “sufficient.”

Alabama nursing homes are required to follow the following procedures for staffing:

“Nursing Services. (1) The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. (2) Sufficient staff. The facility must provide services by sufficient numbers of licensed nurses and other nursing personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: (a) The facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. (b) The facility must designate a registered nurse to serve as the director of nursing on a full time basis. (c) The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.”

When asked if the ADPH found under-staffing to be a reoccurring issue, Pezent responded “no.”

She said the department monitors staffing through observations of care and interviews with residents and their families.

Pezent said each facility has its own procedures for documenting when and how often staff members are in contact with patients.

Alabama Nursing Home Association: Concerns over staffing are “wrong”

The Alabama Nursing Home Association is a Montgomery-based “network of professionals” that claims to represent “approximately 95% of Alabama’s long-term health care.”

That translates to almost 220 nursing homes (the majority of which are privately owned) and 26,000 nursing home beds.

Spokesman John Matson said the concerns that privately owned nursing homes are keeping their staffing levels low to keep profits high is “simply not true."

“Right now, we could probably hire 500 or 600 LPN’s (licensed practical nurses) across the state, if they were available. We’re always looking to hire more employees,” he said.

Matson said the 2.6% unemployment in Madison, Limestone, and Morgan counties and the high levels of training needed limits the applicants.

“As a nursing home, we can’t just hire any person to work there. It has to a person who can pass a criminal background check, has no criminal history, has to go through a drug screening," he said.

“What you have, especially in your part of the state, and the most all the state right now is a very tight labor market.”

Matson said the ANHA “welcomes” the scrutiny brought by ADPH, as the cited deficiencies allows the homes to improve their care.

“If we’re doing something wrong, we want to know it, so we can correct it as soon as possible,” he said.

Matson said when people are considering a nursing home, they should speak to the physician on staff, visit the home, and do their homework with reports on the home.

Federal and state reports on local nursing homes

The following is a list of every nursing home in Madison, Morgan and Limestone Counties.

WAFF 48 News is only looking at CMS and ADPH deficiencies that were cited since January 1, 2017.

The ADPH conducts surveys roughly once a year and upon the receipt of a complaint.

The CMS operates within the Department of Health and Human Services, and monitors nursing home conditions and deficiencies.

Part of its monitoring involves analyzing the ADPH reports.

The CMS star rating is a overall assessment of health inspections, staffing and quality measures.

The following list of includes some, but not all, of the deficiencies the homes were cited for since January 1, 2017.

Madison County nursing homes

Brookshire Nursing Home

CMS Rating: 4/5 stars “Above average”

  • The nursing home did not have a care plan for a patients’ catheter, risking infection for the resident.
  • The nursing home failed to report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities in the necessary time frame.
  • The nursing home failed to provide and implement an infection prevention and control program.
  • The nursing home failed to give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible
  • The nursing home failed to keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.

Diversicare of Big Springs

CMS Rating: 2/5 stars “Below average”

  • The nursing home failed to provide and implement an infection prevention and control program.
  • The nursing home failed to maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.

Fairview at Redstone Village

  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

Floyd E. Tut Fann Nursing Home

CMS Rating: n/a

  • “The facility failed to ensure RI (Resident Identifier) #7′s bathroom floor was free of a brown substance. This was observed three of three days of the survey." The facility’s director of environmental services later said it was related to water damage issues, and the “brown substance” had been there a month.
  • “The facility failed to ensure Resident Identifier (RI) #5 was care planned for refusal of the Ensure supplement at meal times.” The ‘Ensure’ supplement was part of the resident′s diet per physician’s orders. A licensed practical nurse later said the nurses responsible for RI #5′s supplements failed to provide it to him, due to his refusal. The licensed practical nurse said she did not make “anyone aware of the resident’s refusing ensure," and said to the surveyor “I don’t know what to tell you.”
  • “The facility failed to ensure a Certified Nursing Assistant (CNA), Employee Identifier (EI) #6, did not touch the water faucet handles with soiled gloves while performing colostomy care.”

Huntsville Health and Rehabilitation, LLC

  • An employee improperly cleaned a resident’s stool toward the urinary opening, risking infection for the resident.
  • The nursing home failed to ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietitian, and meet the needs of the resident.
  • The nursing home failed to make sure that each resident who enters the nursing home without a catheter is not given a catheter, and receive proper services to prevent urinary tract infections and restore normal bladder function.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

Madison Manor Nursing Home

CMS Rating: 4/5 stars “Above average”

  • The nursing home failed to ensure each resident’s drug regimen was free from unnecessary drugs.

Millenium Nursing and Rehabilitation Center, INC

  • The nursing home failed to follow a physicians’ orders, inappropriately administering tube feeding.
  • A nursing home employee left a patients wound open and visible to staff and residents passing by the room.
  • A nursing home employee failed to clean a resident’s wound properly, risking infection.
  • The nursing home administered unregulated tube feeding to a patient.
  • The nursing home failed to publish its second shift staffing log, making it unclear who is responsible for resident care during that time.

Regency Health Care and Rehabilitation Center

CMS Rating: 3/5 stars “Average”

  • The nursing home failed to store, cook, and serve food in a safe and clean way.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

Signature Healthcare of Whitesburg Gardens

  • The nursing home failed to administer doctor-mandated medicine to a resident, but recorded that it had been given.
  • The nursing home failed to re-position a resident in his nursing chair, resulting in bruising.

South Hampton Nursing and Rehabilitation Center

CMS Rating: 3/5 Stars “Average”

  • The nursing home failed to provide and implement an infection prevention and control program.
  • The nursing home failed to make sure each resident receives an accurate assessment by a qualified health professional.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

Valley View Health and Rehabilitation

  • A nursing home employee failed to clean her hands after cleaning a bowel movement from a resident, risking urinary tract infection for the resident.
  • The nursing home failed to keep each resident’s personal and medical records private and confidential.

Willowbrooke Court Skilled Care Center at Magnolia Trace

CMS Rating: 5/5 Stars “Much above average”

  • The nursing home failed to give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
  • The nursing home failed to set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action.

Windsor House

  • The nursing home failed to inform the state agency of an unexplained injury within 24 hours. The report states the injury involved bruising on the left side of the face. The resident said it was not from a fall, but did not know how it happened.
  • The facility failed to provide and implement an infection prevention and control program.

Morgan and Limestone County nursing homes

Decatur Health and Rehab Center

CMS Rating: 3/5 stars “Average”

  • The nursing home failed to properly document a resident was hard of hearing, leaving an employee responsible for his care unaware.
  • The nursing home failed to provide safe and appropriate respiratory care for a resident when needed.
  • The nursing home failed to give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
  • The nursing home failed to properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

Falkville Health Care Center

CMS Rating: 4/5 stars “Above average”

  • The nursing home failed to provide and implement an infection prevention and control program.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.

River City Center

CMS Rating: 2/5 stars “Below average”

  • The nursing home substantiated an incident of physical abuse from an employee to a resident. The employee in question allegedly threw the resident into bed, and was fired the next week. It sent the following statement in regards to the incident:
  • “The care, safety and well-being of our patients and residents is our priority at River City Center. The Center has a zero tolerance policy with regard to abuse and when we receive a report from any source, be it patient, family or another employee, we contact the authorities immediately. We do not hesitate to terminate any employee if warranted after an investigation is completed. We conduct pre-employment background checks on all employees and no issues were uncovered. We cooperated with the local authorities in an investigation of an alleged incident that took place more than a year ago. We will not discuss the specifics of that investigation. "
  • The nursing home kept a vial of influenza vaccine in the fridge with no date, making it unclear if it’s viable or not.

Summerford Nursing Home Inc.

  • The nursing home failed to 1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.
  • The nursing home had hired a registered sex offender. The state was notified via an anonymous complaint. The state investigated, and the employee was fired. The nursing home sent the following statement in regards to the incident:
  • Summerford Nursing Home is a family-owned and operated facility that has been meeting the rehabilitation and long term care needs of the citizens of Morgan and surrounding counties for 54 years. We take the care of our residents very seriously and strive to meet or exceed the regulatory requirements. In fact, our most recent survey by the Alabama Department of Public Health found us to be deficiency free, satisfying all state and federal requirements. Any past deficiencies from two years ago were immediately addressed by the facility, and the facility was promptly found to be back in compliance.

Senior Rehab and Recovery at Limestone Health Facility

CMS Rating: 3/5 stars “Average”

  • A nursing home employee failed to clean a wound properly, risking infection
  • The nursing home failed to allow residents to self-administer drugs if determined clinically appropriate.
  • The nursing home failed to provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Athens Health and Rehabilitation, LLC

  • The nursing home failed to provide emergency testing and training documentation.
  • The nursing home failed to provide and implement an infection prevention and control program.
  • The nursing home failed to have a program that investigates, controls and keeps infection from spreading.
  • The nursing home failed to provide appropriate foot care.

How do I get help for a loved one?

If you or a loved one is concerned about a patient being mistreated at any home, the Alabama Department of Public Health can be contacted via:

  • The complaint hotline (1-800-356-9596)
  • By mail (P.O. Box 303017, Montgomery, AL 36130-3017)
  • Or its website

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