Although the Colorado Department of Health and Environment has been criticized for its lax enforcement of nursing-home standards ("Dying for Dollars," October 15, 1998), recently it seems to have stepped up its efforts. And the action taken against the O'Hara Regional Center for Rehabilitation is the most stringent in years.
In late November, a department surveyor cited O'Hara for 26 violations of federal care requirements, including chronic understaffing and potentially life-threatening danger from unsanitary conditions. The survey fills hundreds of pages and goes into exhaustive detail about O'Hara's failings.
O'Hara is designed to care for patients with special needs, including brain damage and spinal-cord injuries. During the survey period, the home's approximately fifty residents included ten who were hooked up to a life-support ventilator, seventeen in a vegetative state, and twenty-two who had to be fed through a gastrostomy tube; a surveyor also found six residents who were sick enough to require intravenous antibiotics. Because O'Hara's population is highly vulnerable, O'Hara is designated as a "class five" institution, which means the federal Medicaid program pays the home $214 per day to care for each patient, more than twice the standard Medicaid rate.
Judging from the survey, that money doesn't buy much. The state inspector found numerous instances of poor care, including catheters going unchanged, residents lying for hours in their own urine and feces, tracheotomy tubes being inserted incorrectly and residents with lice.
One surveyor asked a staff nurse why so many residents had urinary-tract infections. "If you lay in poop and your catheter gets poop on it, you're going to get an infection," she replied, adding that the facility had inadequate supplies of soap and towels for staffers to use in washing their hands.
The most critical finding, though, was that O'Hara was consistently short-staffed. Relatives of several residents told department inspectors that staffing was "horrendous." A surveyor interviewed those residents who were able to talk. One woman said she would sometimes lie wet in bed for three hours before a staffer came to change her. A man who is dependent on a ventilator said that the staff took almost half an hour to answer call lights and that O'Hara was "scary at night" since he could never be sure the staff would answer calls for help. "Two minutes not being able to breathe is scary," he added.
Another resident was able to communicate with the surveyor only through a computer and by nodding his head. He cannot move without assistance and said he frequently lies in the same position all night long. (Not being moved is dangerous for nursing-home residents, since they can develop bedsores.) The man told the interviewer that he tried not to ask for help since he knew there were others who also needed assistance. "He was asked if he knew of anyone on the second or third floor that didn't get the help they needed," wrote the surveyor. "He hesitated and looked away. When asked if he would rather not answer that question, he nodded and added by computer, 'Because all I know of is what I hear from my room. But when I hear somebody crying, I feel they aren't being cared for.'"
As a result of the survey, the health department found that O'Hara posed an immediate danger to its residents' health and safety, ordered continuous state oversight and imposed a $7,000-a-day fine. The size of the fine was later reduced to $1,700.
O'Hara is owned by investors Ari Krausz and David Sebbag, who also have three nursing homes in Lakewood (Allison Nursing Care, Cambridge Nursing Center and Lakeridge Village Care Center) and two in Denver (Rocky Mountain Health Care Center and Brentwood Health Center). O'Hara is managed by a Denver-based contractor, Solomon Health Services.
Under federal law, nursing homes have the right to appeal survey results. O'Hara has done just that, notifying the health department that it will contest the findings; O'Hara's attorneys have already indicated that they'll challenge multiple items in the survey. Their appeal will be considered by a review committee including health-department staffers, nursing-home owners and residents' representatives.
Under the survey process, each failing (known as a "deficiency") cited by the health department is given a rating based on severity. "The people on the committee have the opportunity to review the deficiencies and the documentation asking that the deficiencies be downgraded or eliminated," says Jackie Starr-Bocian, spokeswoman for the department's Health Facilities Division.
Although Solomon officials say they cannot comment in detail about O'Hara's survey, they provided this statement: "It is our belief, however, that the deficiencies cited in these surveys were not as serious as implied in the survey document. Furthermore, all the original deficiencies have been subsequently found corrected. Our number one concern continues to be the overall quality of care we provide to our patients and residents."
Since the state began its on-site monitoring, the facility seems to be coming into compliance with regulations, Starr-Bocian says. But it may be too late to prevent another headache for the nursing home: Several relatives of O'Hara residents have approached Denver attorneys John Holland and Kathleen Mullen about filing a lawsuit against the facility.
"As Colorado has recognized, O'Hara must be held accountable for failing to deliver the high-quality care it agreed to provide to a very vulnerable population at great expense to the public," Holland says. "We are currently representing several victims of the grossly substandard quality-of-care violations that the state found at O'Hara. We intend to prosecute claims against this facility vigorously."
Advocates for nursing-home residents think it's about time the state health department took action regarding O'Hara. "We've been concerned about that facility for over a year and have taken many complaints from relatives and friends of residents," says Virginia Fraser, the state ombudsman for long-term care. "We appreciate that the health department has recognized the seriousness of the situation."
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