THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, August 22, 1996 TAG: 9608220361
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
DATELINE: PORTSMOUTH LENGTH: 185 lines
The federal government is threatening to stop paying for all Medicaid and Medicare patients at the region's largest nursing home, Manning Convalescent Home, because of repeated violations that could affect the health and safety of its 176 residents.
More than 95 percent of the nursing home's patients are covered by Medicaid. The termination of payments would force the transfer of all of those patients to other nursing homes, according to Joseph M. Teefey, state Medicaid director. Only a handful of patients would be allowed to remain at the facility.
By Wednesday afternoon, Robert T. Manning, the nursing home's administrator, said residents and their families had not been notified about the situation.
The federal government's warning comes after the home was cited for problems found in inspections conducted in April, May and July. During the inspections, which are not announced to the nursing home, state health department officials found problems ranging from cold food to inadequate care, according to their reports.
In one case, a patient experienced breathing problems and distress, due to failure to obtain a nebulizer machine for the patient, according to the report. The machine sprays medication into the lungs.
The third and most recent inspection in July - which included two problems that had appeared on previous reports, as well as several new problems - triggered the termination process.
The nursing home was notified by the United States Health Care Financing Administration on Aug. 13 that it would end the nursing home's Medicaid/Medicare participation on Sept. 1 unless the nursing home has a nearly flawless upcoming inspection. The nursing home is allowed to appeal the federal government's decision, but the termination can take effect even during the appeals process.
The agency also imposed a $500-a-day fine on the nursing home, effective July 19. The fines accumulate until the home is found to be in complete compliance. The nursing home doesn't have to start paying the fines immediately.
State inspectors are expected to visit the home once more by Sept. 1, Teefey said. If additional problems are found, the state has 30 days to move Medicaid patients to other nursing homes.
State health department officials could not be reached for comment.
It is extremely rare for the federal government to take this action.
In the past 10 years, Manning recalled, only three of Virginia's 258 nursing homes have lost their Medicare/Medicaid contracts.
Manning, the nursing home's administrator, said Wednesday that the facility is in complete compliance with all regulations, and is prepared for another inspection.
``We're expecting (inspectors) today or tomorrow,'' said his father, Thurman W. Manning, who owns the 60-year-old facility.
Robert Manning blamed the problems cited in the recent reports on changes in the inspection process. In July 1995, the federal government implemented a tough new enforcement policy for nursing homes that consistently exhibit problems.
It sets specific penalties for homes exhibiting certain problems, including fines and restriction of admissions, and requires that those penalties be automatically implemented. The federal government contracts with the state health department to conduct the inspections.
Before July 1995, it was up to the states to impose any penalties, and Virginia rarely did.
Manning called the new enforcement policy a ``zero-tolerance'' approach. Those new rules, he said, coupled with the low payments the home receives for its Medicaid patients, resulted in the problems cited in recent reports.
``They demand perfection, and if you don't give it to them they cut off your admissions and eventually take your license away,'' he said.
Perfection is nearly impossible, he said, given the range of services the home has to provide to its patients, many of whom have feeding tubes or are on ventilators.
But perfection in the next inspection is what it will take to stop the termination process, said Timothy Hock, of the Health Care Financing Administration's regional office in Philadelphia. That office is charged with overseeing nursing homes in several states, including Virginia.
Even one deficiency on its re-inspection that poses ``greater than minimal risk'' to patients would keep Manning on the termination track, he said. Nearly all the violations listed on Manning's previous inspections have been in that category or more severe.
If the home loses its Medicare/Medicaid funding, then the state Department of Medical Assistance Services will transfer patients to other nursing homes.
``We go down and contact the patients, their families, and we will make them aware that we have to place them in other facilities,'' Teefey said.
He said it is likely that residents at Manning would find spots at other nursing homes in Hampton Roads. ``There are a fair number of empty beds in that area,'' he said.
Although the federal government has set a Sept. 1 deadline to terminate Manning's contracts, the state wants a one-month extension on that deadline.
In a similar situation in Richmond, Forest Hill Nursing Home, also facing a Medicaid/Medicare contract termination by the federal government, failed its final re-inspection last week. Nearly 150 patients may have to be moved to other nursing homes.
But ``most facilities that have problems bring the facilities into compliance,'' said Teefey. He said 10 homes in Virginia have been threatened with loss of Medicaid/Medicare funding since July 1995, he said. Only Forest Hill has failed to correct its problems.
State long-term care ombudsman Mark C. Miller urged Manning family members not to panic. ``They should contact the facility first, and find out what the contingency plan is, and how they're working with the state.''
Robert Manning predicted that the home would pass the next inspection, and declined to discuss a contingency plan.
Nearly all the home's 176 patients have their care paid for by Medicaid, the state insurance program for the poor. ``We're a welfare facility,'' Robert Manning said.
The home has the highest percentage of Medicaid patients of any adult nursing home in South Hampton Roads. Statewide, the average Medicaid participation in nursing homes is 66 percent.
The state pays the nursing home $55.64 a day for each Medicaid patient, Robert Manning said, which is not enough to provide quality care.
``There is a direct correlation between a high Medicaid population and the deficiencies,'' he said.
On the home's annual inspection in April, the state health department cited the home for numerous deficiencies, many of them serious. These included:
Failure to serve a resident's breakfast on time. The patient, who suffers from diabetes and malnutrition, became so angry he refused to eat.
Failure to help a resident get consent for surgery, which delayed the insertion of a feeding tube for over four months, and delayed amputation of a gangrenous foot for 30 days. The delays ``placed the resident in a life-threatening position,'' according to the report.
Failure to supervise a resident, who crawled away from the facility in freezing weather. The resident hurt his knees, hands and feet, and was hospitalized for hypothermia.
During a follow-up inspection in May, inspectors found continued problems in nine areas, and some new problems.
These included:
Failure to remove a patient's surgical staples on time, which had the potential to cause the staples to stick to the skin and ``caused the resident unnecessary discomfort when removed,'' according to the report.
Failing to ensure that a resident received the ordered amount of tube-feeding formula, which could have caused this resident to lose weight.
During the third and most recent inspection in mid-July, inspectors found more problems. After this inspection, the federal government said it would not pay for any new Medicaid/Medicare admissions.
Every inspection cited Manning's administration for failing to ``use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident.''
Robert Manning said the nursing home staff has gone through ``loops and hoops'' to correct all deficiencies. In at least one case, they fired a nurse who was cited in one of the reports. The home has also hired a new director of nursing, he said.
The nursing home has not told most residents and their families about the current situation, he said.
One family member, Linda Zakaria, whose mother, Alma Twigg, has been at Manning for two years, was surprised to hear about the home's problems.
``I've had my problems, but they've tried to work with me,'' the Chesapeake woman said. ``I have no major concerns. But a nursing home is a nursing home. You're never really totally satisfied with the care provided away from home.''
ILLUSTRATION: Color photo by Vicki Cronis\The Virginian-Pilot
Manning, owned by Thurman W. Manning, below, is the largest nursing
home in South Hampton Roads, with 258 beds. It has 176 residents,
nearly all covered by Medicaid.
Color photo by Jim walker/The Virginian-Pilot
[Manning Nursing Home]
Graphic
What happened? The federal government is warning it will stop
paying for Medicare/Medicaid residents at Manning Convalescent Home
in Portsmouth on Sept. 1, due to violations that could harm
patients.
What were the problems?
State officials conducted inspections in April, May and July.
They cited problems that included: - Failure to supervise a
resident who crawled out of the building in freezing weather. The
resident was hospitalized for hypothermia.
- A staff member failed to follow proper procedures while
cleaning a patient's tracheostomy tube, causing severe breathing
difficulty.
- Failure to help a resident get consent for surgery.
Other problems concerned administration of the facility and
management of residents' money.
Most problems found in earlier reports have been corrected.
What happens next?
The state Health Department will conduct one more unannounced
inspection by Sept. 1. The home must pass this inspection with no
serious citations.
If it doesn't, patients must be moved. The state will help
residents and their families find other nursing homes, and assist
with transferring them. Only a handful of patients who are not
covered by Medicaid/Medicare would be able to stay.
KEYWORDS: NURSING HOME VIOLATIONS FEDERAL FUNDING by CNB