Originally created 10/18/98

Nursing homes cleaning up image



Walking the halls of Westwood Nursing Home on University Drive in Evans, Mike Gibson bends down to pick up a piece of trash from the floor just outside the door to the Alzheimer's wing.

Placing the trash in a nearby bin, he said that everyone in his facility, even himself, has to pitch in to keep the 70,000-square-foot nursing home clean because visits by state surveyors are unpredictable.

"If (state surveyors) find one bug on your floor, it looks like you got a place crawling with roaches," he said.

This is the new face of nursing homes in the Augusta-Aiken area, according to Mr. Gibson and many local administrators: friendlier, cleaner and more in line with federal regulations.

State survey reports back them up. Only 38 deficiencies were reported among the 20 area nursing homes in 1998, an average of 1.9 deficiencies per facility. That is a sharp decline from the 10.29 deficiencies per facility per year during 1991 to 1997.

Of those 38, half were from one home alone. Eight local facilities were deficiency-free in 1998.

A deficiency represents a violation of one of the more than 530 federal regulations inspectors check for during home surveys. Each deficiency must be fixed within a time stipulated by state regulators.

It would appear local nursing homes are in good shape, just as nursing homes nationwide are bracing for the most sweeping industry crackdown since 1987, industry officials said.

President Clinton announced July 21 a series of sanctions and new rules for providers, making facilities and states more accountable for the care of nursing home residents.

"They are looking for the facilities that have had problems in the past, the recent past," Mr. Gibson said.

Officials at the National Care Coalition on Nursing Home Reform said the new sanctions are responding to a lack of enforcement of nursing home regulations, as witnessed by a decrease in the number of deficiencies cited at nursing homes and an increase of deficiency-free nursing homes.

Eight of the 20 local nursing homes have not received any deficiencies in 1998, but Sarah Greene-Burger, executive director of the NCCNHR, said she worries when so many facilities are passing surveys with little or no deficiencies.

"Since 1995, when the enforcement regulations came into being, there had been a diluting of the enforcement procedures so that there had been enormous pressure to lay off the heavy-handed enforcement," Ms. Greene-Burger said.

She said residents will benefit from the sanctions if the president's initiatives are implemented.

Locally, there has been a drop in the number of deficiencies cited at most nursing homes. For example, Forrest Lake Health Care, which averaged more than six deficiencies per year between 1991 and 1997, hasn't received any deficiencies this year through Sept. 29. Likewise, Magnolia Hill of Augusta, which averaged more than 20 deficiencies during the same seven-year period, has not received any deficiencies so far in 1998.

Administrators at local nursing homes say the decrease in deficiencies is a result of their efforts to increase the quality of care they give. Despite the decreasing number of deficiencies at local nursing homes, some nursing home administrators say that sanctions already are tough enough and a few sayregulations are too severe.

"Sometimes I feel it is a little unrealistic," said Carolyn Brentnell, administrator of Salem Nursing and Rehabilitation Center, which has been cited for 19 deficiencies so far this year, the most among the 20 local facilities. "I have problems that once you get to be a poor performance facility, where there is a problem, they nitpick you to death."

David Dunbar said surveyors usually are nurses but also include pharmacists, dietitians and social workers that go through an extensive pre-survey briefing. He said he understands that facilities with unfavorable surveys may complain of unfairness but doesn't believe the state's surveyors go in to any facility with biases.

Deficiencies at local nursing homes have been decreasing since 1995, when some categories of regulations were merged together, thereby reducing the total number of possible deficiencies a nursing home could receive, said Mr. Dunbar.

Remedies that state regulators offer nursing homes with deficiencies begin with a plan of correction, which is a detailed list of actions for how the facility will correct problems. If the plan of correction is not sufficient, state regulators can impose a directed plan of action, whereby regulators direct the facility to do specific corrective steps.

When problems persist, the state may impose a civil monetary penalty if inspectors say residents are in jeopardy, if the facility has a substandard quality of care and has had substandard surveys within the past survey, or if the facility's plan of correction does not correct problems within a given time. As a last resort and in very rare instances, regulators can impose temporary bans on admission, which typically last 30 to 45 days.

Under the president's proposed sanctions, instead of requiring a plan of correction, nursing homes may face quicker monetary penalties, Ms. Greene-Burger said.

"Hitting them in the pocketbook seems to the only thing they understand," she said.

When residents are believed to be in jeopardy, Georgia regulators can impose fines of $3,050 to $10,000 per day. For substandard quality of care or if a plan of correction does not correct a problem in a set time, fines can fall between $50 and $3,000 per day.

As of Aug. 30, only one Augusta-Aiken area nursing home had received a fine since the first of the year. Salem Nursing and Rehabilitation Center was ordered to pay $27,852 after a May 20 survey in which surveyors found the facility didn't correct a problem that resulted in a resident's death.

The resident died May 12 from cardiac arrest and aspiration after choking while eating unsupervised. On Aug. 8, 1997, the same resident had been evaluated by a speech therapist, who warned that the resident should be supervised constantly during meals to prevent aspiration.

"I knew we had staff present, but I couldn't tell them which staff members," said Ms. Brentnell, adding that she doesn't think residents at Salem are in jeopardy.

However, the home was cited May 20 during a complaint investigation for allowing residents with swallowing difficulties to eat unsupervised.

In its plan of correction, Salem officials reported a dining room monitoring plan had been developed to ensure appropriate supervision in the dining area during meal service.

"We have staff there, and they have to sign in now that they were in the dining room," Ms. Brentnell said.

In July, Salem received a survey citing 16 certification deficiencies, with an additional eight life safety code violations cited by Keith Bryant of the State Fire Marshal's Office. Life safety codes include regulations pertaining to fire safety.

Mr. Dunbar said only four of 349 Georgia nursing homes in the current survey cycle, which would include some surveys as old as 15 months, had more than the 16 federal deficiencies Salem received on its annual survey in July. Salem also received three deficiencies during a complaint investigation in May, for a total of 19 deficiencies.

Ms. Brentnell said the nursing home received a subsequent survey in August that cleared all deficiencies from the July survey. According to records from the Office or Regulatory Services, no deficiencies were found at Salem on Aug. 25 during a follow-up visit and complaint investigation.

In North Augusta, Mark Feltham, administrator of Anne Marie Rehabilitation and Nursing Center echoed complaints about investigations. He said if an inspector has never been to a particular home, he will be unfamiliar with that home's track record and won't know where to look for improvement or a lack of it.

"It all depends on the team you get," Mr. Feltham said. "Once they find several things, it's like a snowball effect."

In a survey completed Dec. 17, 1997, Anne Marie received 23 deficiencies, including not providing a comfortable and homelike environment, failing to investigate injuries with unknown origins, failing to ensure that nurses' aides were able to demonstrate competency in skills and techniques to care for residents' needs, and failing to offer residents snacks at bedtime.

Mr. Feltham said he requested that the Department of Health and Environmental Control disregard the survey because of the unprofessional manner in which it was done. However, his request was denied by officials at DHEC.

Mr. Feltham, who became administrator at Anne Marie last year, said surveyors took advantage of his inexperience and that only a fraction of the deficiencies had any foundation.

"There were some, about seven or eight, that were warranted, but there were some that they just went on and on with," he said.

Nursing home information

AIKEN COUNTY

  • Anne Marie Nursing Home
  • Owned by: Fane Management, part of F&E Enterprises

    1200 Talisman Drive

    North Augusta, SC 29841

    Cost per day: Private $78; semiprivate $75; deluxe $125

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 132

  • Beverly Health and Rehabilitation Center
  • Owned by: Beverly Enterprises

    123 DuPont Drive

    Aiken, SC 29801

    Cost per day: Private $101; semiprivate $95; ward $93

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 30

  • Carriage Hills Plantation (formerly New Ellenton Nursing Center)
  • Owned by: Health Management Resources

    550 E. Gate Drive

    Aiken, SC 29803

    Cost per day: Semiprivate with half-bath, $112; semiprivate with full bath, $120; private, $127; large suite with half-bath, $150; large suite with full bath, $160

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 51

  • Mattie C. Hall Health Care Center
  • Owned by: Aiken County, managed by National Health Corporation

    830 Laurens St. N.

    Aiken, SC 29802

    Cost per day: Private $89-$91; semiprivate $86

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 45

  • National Healthcare Center of North Augusta
  • Owned by: National Health Corporation

    200 Frontage Road

    North Augusta, SC 29841

    Cost per day: Private, $116; semiprivate, $98

    Number of certification deficiencies in 1998: 5

    Number of deficiencies from 1991-97: 31

  • Pepper Hill Nursing Center Inc.
  • Owned by: Wade Jones Jr.

    3525 Augusta Road

    Aiken, SC 29802

    Cost per day: Medicare private, $131.25; Medicare semiprivate, $110.25; non-Medicare private in skilled wing, $94.50; non-Medicare semiprivate in skilled wing, $88.20

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 69

    COLUMBIA COUNTY

  • Brandon Wilde Pavilion
  • Owned by: Augusta Resource Center in Aging Inc.

    4275 Owens Road

    Evans, GA 30809

    Cost per day: Private, $147; semiprivate, $119; dementia special care, $130

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 31

  • Lake Crossing Health Center
  • Owned by: Sunrise Medical Services

    6698 Washington Road North

    Appling, GA 30802

    Cost per day: Private, $125; semiprivate, $100

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 57

  • Westwood/University Extended Care
  • Owned by: University Health Services Inc.

    561 University Drive

    Evans, GA 30809

    Cost per day: Skilled private, $95; skilled semiprivate, $90

    Number of certification deficiencies in 1998: 3

    Number of deficiencies from 1991-97: 62

    RICHMOND COUNTY

  • Beverly Manor Convalescent Home
  • Owned by: Beverly Enterprises

    1600 Anthony Road

    Augusta, GA 30904

    Cost per month: Private, $2382-3190

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 54

  • Blair House Convalescent Center
  • Owned by: F&E Enterprises

    2541 Milledgeville Road

    Augusta, GA 30904

    Cost per day: Would not release prices

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 83

  • Forrest Lake Health Care
  • Owned by: Forrest Lake Health Care Inc., part of Allgood Health Care

    409 Pleasant Home Road

    Martinez, GA 30907

    Cost per day: Private, $99; semiprivate, $90

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 49

  • Georgia War Veterans Nursing Home
  • Owned by: Georgia Department of Veterans Services

    1101 15th St.

    Augusta, GA 30901-1599

    Cost per day: Veterans aren't required to pay

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 9

  • Gracewood Nursing Facility (Unit 9)
  • Owned by: Georgia Department of Human Resources

    Building 76, Ward 1-2

    Gracewood, GA 30812

    Cost per day: Intermediate care $237; skilled $218

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 28

  • Jennings Health Care Inc.
  • Owned by: Allgood Health Care

    2335 Deans Bridge Road

    Augusta, GA 30906

    Cost per day: Not available

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 54

  • Kentwood
  • Owned by: University Extended Care

    1227 West Wheeler Parkway

    Augusta, GA 30909-1899

    Cost per day: Skilled private, $130; skilled semiprivate, $120

    Number of certification deficiencies in 1998: 3

    Number of deficiencies from 1991-97: 32

  • Magnolia Hill of Augusta
  • Owned by: Southern Care Corporation

    2122 Cumming Road

    Augusta, GA 30914

    Cost per day: Private, $79; semiprivate, $75; ward room, $68

    Number of certification deficiencies in 1998: 0

    Number of deficiencies from 1991-97: 172

  • Salem Nursing and Rehabilitation Center of Augusta
  • Owned by: Salem Nursing Corporation

    2021 Scott Road

    Augusta, GA 30906

    Cost per day: Private, $102.50; semiprivate, $95 intermediate care; semiprivate in skilled area, $205

    Number of certification deficiencies in 1998: 19

    Number of deficiencies from 1991-97: 110

  • West Lake Manor Health Care Center
  • Owned by: Allgood Health Care

    820 Stevens Creek Road

    Augusta, GA 30907

    Cost per day: Not available

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 81

  • Windermere
  • Owned by: Beverly Enterprises

    3618 J. Dewey Gray Circle

    Augusta, GA 30909

    Cost per day: Private, $106; semiprivate, $101

    Number of certification deficiencies in 1998: 1

    Number of deficiencies from 1991-97: 55