Even after a resident was raped and murdered earlier this year, inadequate staff and poor care continued to put residents at risk at Homestead Healthcare Center, according to a recently released health inspection report.
Failures in the weeks following the murder sent at least two of the nursing home residents to the emergency room with life-threatening conditions. Others languished in urine-soaked beds and soiled bandages. A resident lost more than 40 pounds after the facility failed to provide nutritional supplements as recommended, inspectors found.
In total, the Indiana Department of Health cited Homestead for 20 violations of federal and state regulations during a mid-March inspection. The quotes show that even amid scrutiny following the murder, deeply concerning issues persist at the troubled Indianapolis facility.
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Many of the issues found by inspectors are similar to those identified in an IndyStar investigation into the nursing home’s troubled history. Reporters found that understaffing, rampant drug abuse, mishandling of medications and substandard care had plagued the facility long before the death of 80-year-old resident Patricia Newnum on February 2.
Police say a nursing assistant found another resident, Dwayne Freeman, 60, above Newnum with a pillow over his face and a bottle of liquor nearby. Freeman faces charges of rape and murder.
Freeman threatened at least two other female residents with sexual assault or violence shortly before the murder, but Homestead failed to take action to protect its vulnerable residents, according to a state health inspection conducted in the days that followed. immediately followed the homicide.
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The new 76-page inspection report shows that problems continue to abound in Homestead.
Dangerous conditions persist
Facility failures sent at least two residents to the emergency room with life-threatening conditions, according to the report.
In one case, Homestead failed to take care of a resident’s urinary catheter, resulting in a urinary tract infection. The resident had a fever, became confused and agitated and asked to go to the hospital.
A nurse practitioner wrote an order to send the resident to the emergency room, but Homestead did not follow the order.
Two days later, the resident was found unconscious and taken to hospital with sepsis and respiratory failure. A discharge summary from the hospital indicated “comfort measures only” and that “resident’s breathing has ceased”.
In another case, a hypoglycemic resident began having seizures, but could not be treated because Homestead did not ensure that drugs to reverse the hypoglycemia were available, the report said.
Instead, the facility had to call 911. By the time an ambulance arrived, the resident’s blood sugar had dropped to 36 – an extremely low and dangerous level.
Inspectors found another Homestead resident had lost more than 40 pounds in 6 weeks when the facility failed to give the resident nutritional supplements recommended by a dietitian.
Another resident fell and fractured his neck. Inspectors cited Homestead for failing to report the incident to state health officials.
Homestead has pledged to correct deficiencies identified in the inspection report, but it is asking state regulators to reduce the scope and severity of the most serious citations in the report, which found the facility was putting the health and safety of residents in “immediate peril”. or caused “actual harm”.
A spokesperson for Cincinnati-based CommuniCare, the company that operates Homestead, did not respond to questions from IndyStar about the report. The head of Adams County Memorial Hospital, which owns Homestead, also declined to answer questions.
Basic needs are not met
Inspectors also found that Homestead had failed to meet residents’ basic needs.
Residents with soiled bandages told inspectors they sometimes went days without being changed. A resident has not received wound treatment prescribed by a doctor for more than three weeks.
In one case, inspectors noticed a “strong smell of urine” coming from a resident’s bedroom. They found “a large wet brownish colored area” that covered a third of the bed and had “soaked through the blanket, fitted sheet and mattress”. The bed remained dirty for four hours.
Two days later, inspectors found the same resident again lying in his own urine for at least two hours. The resident’s pillow “was resting on the brownish-yellow tinted bottom sheet,” the report said.
The problems at Homestead are not new. Some of the infractions found by inspectors are similar to those identified during previous inspections.
For example, inspectors cited Homestead for failing to properly care for an IV in a resident’s arm. It’s especially alarming because the facility was cited and fined more than $87,000 last year after a resident’s IV went unattended for eight days, leaving him led to septic shock and death.
The new inspection report also shows that Homestead continues to improperly store and manage drugs. Loose pills were found strewn about in medicine carts. Some drugs and supplies were outdated. Opioids were checked, but never marked as administered.
Inspectors found similar issues in August when they cited Homestead for leaving a medicine cart “unlocked with no personnel in sight”.
Repeated medication failures are concerning as drug addiction is rampant in Homestead. Police have conducted several narcotics investigations at the facility since the beginning of last year. The problem got so bad that overdose medication was issued to residents. Two nurses have been arrested for stealing opioids from residents.
More than two years into the COVID-19 pandemic, inspectors also cited Homestead for failing to implement infection control measures. They were cited for the same last year in May.
Insufficient staff identified
Inspectors linked many of the facility’s problems to low staffing levels.
The finding comes after an IndyStar analysis of federal data showed Homestead has some of the lowest total nursing staff hours in America.
IndyStar also found that state health inspectors have not cited Homestead in the past, even though the facility has repeatedly violated a requirement that nursing homes employ at least one registered nurse for eight years. hours per day. In fact, the state allowed Homestead to expand capacity in January.
This time, however, inspectors cited the establishment for violating this requirement on 9 of the 28 days examined.
Homestead also failed to meet its own staffing recommendations.
An assessment of the facility’s facilities in 2021 identified a need for 3 or 4 nurses for day and evening shifts, and 2 nurses for night shifts, the report said. Inspectors reviewed two weeks of nursing schedules and found that the facility had never met this standard. For seven days, there was only one nurse per shift.
Lack of sufficient nursing staff resulted in surgical dressing changes not being made, care not being provided for a feeding tube, intravenous dressings not being changed, that medication was left in a resident’s room, that a resident was given unnecessary medication, that there was no urinary catheter care and nutritional supplements are not being provided, the report says .
What else can we do?
On Tuesday, IndyStar asked the Indiana Department of Health and the US Department of Health and Human Services what actions they plan to take in response to the new inspection report.
Federal officials did not provide a response Wednesday afternoon, and state officials did not discuss specifics.
“The Indiana Department of Health is working within its authority to address issues in long-term care facilities, but cannot comment further while enforcement actions are pending,” said Jeni O’Malley, Deputy Chief of Staff at IDOH.
Regulators have the power to fine nursing homes and withhold payments for new admissions, but these tools have so far failed to deter trouble. Federal data shows Homestead has been fined nearly $300,000 since the start of 2021 and federal payments have been suspended twice.
More severe enforcement measures are available.
State health officials can place a nursing home’s license on probation or revoke it altogether. The state has placed at least nine nursing homes on probation since 2010, but closed only one during that time.
Federal officials can impose a temporary manager or terminate a facility’s agreement to provide Medicare and Medicaid services. The latter would have the effect of closing the installation.
So far, state and federal authorities have resisted calls for these more drastic enforcement actions.
O’Malley said the state generally follows a “phased” action plan to “hold vendors accountable and provide an opportunity to return to compliance and remain in compliance.”
Closing a nursing home is usually an option of last resort due to the risks associated with transferring vulnerable residents to a new facility. Homestead had 75 residents at the time of its last inspection.
At some point, the question becomes who poses the greater danger: closing a facility or letting its residents stay?
Contact IndyStar reporter Tony Cook at 317-444-6081 or firstname.lastname@example.org. Follow him on Twitter: @IndyStarTony.