THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, August 23, 1996 TAG: 9608230068
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON AND MARIE JOYCE, STAFF WRITERS
DATELINE: PORTSMOUTH LENGTH: 160 lines
State Health Department officials came to Manning Convalescent Home on Thursday to begin an inspection that will determine whether nearly all of the nursing home's 176 residents will be transferred.
The federal government notified the home in an Aug. 13 letter that it would lose its Medicaid/Medicare certification on Sept. 1 because of repeated violations that could affect residents' health and safety.
The government's action came after numerous problems were found during inspections in April, May and July.
How the home fares on this inspection, expected to end today, will determine whether the residents, nearly all of them receiving Medicaid, will have to be transferred to other nursing homes.
Even one deficiency on its reinspection that poses ``greater than minimal risk'' to patients would keep Manning on the termination track, said Timothy Hock of the U.S. Health Care Financing Administration's regional office in Philadelphia. Nearly all the violations listed on Manning's previous inspections have been in that category or more severe.
It may be at least a week after inspectors finish at Manning before residents and their families learn whether they can stay, said Mark C. Miller, the state's long-term care ombudsman.
``More than likely the staff on site isn't going to give them a thumbs-up or down,'' he said. The state has 10 days to submit its final report.
If residents do have to be transferred, some officials who work with the elderly in Hampton Roads questioned whether the region's nursing homes have enough empty beds to accommodate them.
They were also concerned about the physical and emotional toll such a move might take on the residents, most of them frail or disabled.
But state officials said talk of transferring patients is premature while the current inspection is continuing.
``It's certainly our hope that they will be in compliance,'' said Nancy Hofheimer, director of the Health Department's Office of Health Facilities Regulation, which inspects and licenses nursing homes.
After the July inspection, Manning submitted a plan to correct its problems, she said. ``So we take that on good faith that they have corrected their problems.''
Inspectors will be checking whether the home followed that plan, which, among other issues, addressed problems with the care provided to ventilator-dependent residents and with meeting other needs of residents.
``We're not asking for perfection, but they must be in substantial compliance,'' Hofheimer said. ``The regulations do not tolerate substandard quality of care.''
Robert Manning, the nursing home's administrator, has said that the state's ``zero tolerance'' for any problems, coupled with the low reimbursement the nursing home receives for most of its patients, resulted in the problems cited during the April, May and July inspections.
But, noted Hofheimer, ``There are facilities who have been deficiency-free, so it can be accomplished.''
Sixty-eight percent of Virginia's 257 nursing homes are in substantial compliance with federal and state regulations, she said. Only about 9 percent have serious deficiencies like those found at Manning.
Robert Manning predicted Wednesday that when state inspectors returned to his nursing home they would find that all violations had been corrected. ``We are going to be successful,'' he said.
If the report shows continued problems, Miller said, then the issue of transferring patients becomes a reality.
The state does have the option of putting a temporary manager on site at Manning to try to fix problems, Miller said. It's an option the state is considering with a Richmond nursing home that has already lost its Medicaid/Medicare contracts.
The other alternative is to move Medicaid residents - nearly all the home's patients - to other area nursing homes. But local health care official Paul M. Boynton said, ``I think it's going to be a little tougher than they believe to place people that need to be placed.''
Boynton is executive director of the Eastern Virginia Health Systems Agency, a state-appointed group that regulates nursing home expansion.
``I don't believe for a minute that they're going to move those folks out of there,'' he said.
That's because the region's nursing homes operate close to capacity.
``Right now I have a full house, thank the Lord,'' said Audrey Butler, administrator of Hillhaven Nansemond Rehabilitation and Nursing Center in Suffolk, which has 160 beds.
Sentara Life Care Corp., which has 771 beds in six nursing homes in Hampton Roads and northeastern North Carolina, had only 19 empty spots Thursday.
Based on numbers supplied by the State Health Department, approximately 260 empty beds in South Hampton Roads are empty at any given time.
That may sound like enough, but there are restrictions on how those beds can be used, Boynton said.
For instance, a woman can't be placed in a room already occupied by a man. No one can share a room with someone with an infectious illness, say home administrators.
And many of Manning's patients - those on ventilators or with feeding tubes - require a higher level of care than some nursing homes can provide, said Bill Miller, spokesman for Sentara Life Care Corp.
Beyond that, many nursing homes are reluctant to take too many Medicaid patients because their care generally isn't reimbursed as well as that of patients with private insurance, Boynton said.
The low reimbursement - $55.64 a day for Manning patients - directly affected the quality of care at Manning, Robert Manning said Wednesday.
His nursing home has the highest percentage of Medicaid patients - about 96 percent - of any adult nursing home in Hampton Roads.
Most nursing homes in Virginia maintain no more than a 70 percent Medicaid occupancy, said Stephen Morrisette, president of the Virginia Health Care Association, a nursing-home industry trade organization based in Richmond.
``The other 30 percent is where they make their profit.''
Medicaid, the state health insurance program for the poor, pays for nearly 70 percent of care provided in the state's nursing homes.
``Most nursing home facilities could not survive completely on Medicaid patients,'' said David B. Tate, Jr., president and chief executive officer of Lake Taylor Hospital, a Norfolk nursing home.
There is another reason why the state hopes it won't have to transfer Manning residents - the toll such a move takes on the residents.
``Any time you put an extremely frail resident into an ambulance and transport them, there's always a risk,'' Miller.
``It's like being moved from your home,'' Morrisette said. ``You make friends there, know the staff, know the routine. . . . I'm sure the state will go to great lengths to try and avoid moving them, but they have to respond to HCFA.''
ILLUSTRATION: Color photo
Manning is the largest nursing home in South Hampton Roads, with 258
beds. It has 176 residents, nearly all covered by Medicaid.
Graphic
MANNING CONVALESCENT HOME
State Health Department officials began an inspection Thursday of
the Manning Convalescent Home in Portsmouth. Prior inspections cited
repeated health and safety violations. Final inspection is expected
to end today.
The inspection results will determine whether residents will be
transferred to other Hampton Roads nursing homes. There are concerns
that there are not enough appropriate beds in the area to
accommodate the Manning residents.
Manning submitted a plan to correct its problems, and says all
violations have been corrected. Inspection officials say if the
report shows continued problems, then the issue of transferring
patients will become a reality.
GETTING THE FACTS
Family members and residents can see for themselves how a nursing
home has done on a state inspection.
Nursing homes are required under federal law to have their most
recent state inspection report available. Just ask at the front
desk, said Mark Miller, the state's long-term care ombudsman.
He also recommended contacting the State Health Department or his
office for additional information on individual nursing homes.
If there are problems at a nursing home, he suggests family
members and residents talk to the home's administrators first.
``I hear administrators say `If I knew it was a problem, we would
have fixed it.' On the one hand, they ought to be looking
themselves at the quality of care, but the family should also raise
questions.''
Some useful contacts:
State Health Department, Office of Health Facilities Regulation:
804-367-2100.
Long-term Care Ombudsman: 1-800-552-3402.
Local Social Services Departments also investigate some nursing
home complaints. Contact your city's Adult Protective Services
division.
KEYWORDS: NURSING HOMES FEDERAL FUNDING VIOLATIONS by CNB