Bethesda Nursing Home Could Lose Its Medicaid Certification
November 7, 2007
By Lori Aratani
Washington Post Staff Writer
Thursday, November 8, 2007; B04
Federal authorities have announced that a Bethesda nursing home already under scrutiny by state officials in connection with the deaths of two patients could lose its Medicaid certification this month because of concerns about the care it provides.
In a Nov. 1 letter, the federal Centers for Medicare and Medicaid Services said the nursing home would lose its certification by Nov. 20 unless another inspection demonstrates significant improvement. A facility must "be free of hazards to the health and safety of residents," said the agency, a division of the Department of Health and Human Services.
This is the latest in a series of sanctions against Bethesda Health and Rehabilitation Center, a 200-bed facility on Grosvenor Lane. Deficiencies cited in six state inspections have cost the facility $50,000 in fines. In July, Maryland's Office of Health Care Quality prohibited the facility from accepting government payments for new patients until it fixed problems cited by state investigators.
Experts in nursing home operations say the loss of Medicaid certification is among the most serious steps officials can take because nursing homes depend heavily on government money. But state officials say the facility might be able to avoid the loss of funding if it can prove it has corrected the problems.
Melody Chatelle, a spokeswoman for Bethesda Health and Rehabilitation Center, said in an e-mail that the nursing home has received approval to have another inspection before payments are cut off Nov. 20.
"The facility continues to review its options, including a possible appeal," Chatelle wrote. In a follow-up phone call, she declined to comment further.
During an annual inspection by the Office of Health Care Quality in March and April, inspectors suggested that a nurse's inability to detect changes in a woman's breathing in January might have resulted in the woman's death that month.
In May, the death of a second woman was attributed to issues related to the facility's staff, according to state inspection reports. In that instance, inspectors said it appeared a staff member failed to clear the woman's tracheotomy tube, and she eventually choked to death. The family of the second woman has retained a lawyer.
In addition to the March and April inspection, state officials made several other visits to the facility. Among other problems they cited was the case of a woman who was allowed to leave the facility with her daughter even though there had been changes in her condition that day. The woman missed several rounds of medication, returned to the center ill and had to be taken to the hospital.
In several other incidents, state reports said, patients were given wrong dosages of medication or not given medication at all, even though charts indicated they had received treatment. In some instances, residents turned up with unexplained bruises, the reports said. Inspectors arrived for an unannounced visit in October and found staff members who appeared to be asleep in the front room, according to the reports.
Wendy Kronmiller, director of the state Office of Health Care Quality, said her office has tried to work with the facility to correct the deficiencies. The number of violations has declined, but the agency still has concerns, she said.
She said it is rare for a facility to have so many deficiencies in such a short amount of time. "This is an unusual pattern of events," Kronmiller said.
States are required by federal law to conduct yearly investigations of all nursing homes. Officials may also investigate facilities in response to complaints by residents or their families. Maryland has 236 nursing homes.
State officials have told the Bethesda facility's management that it must inform residents and families of the ongoing problems.
The facility is owned by Atlanta-based Sava Senior Care, which operates about 180 nursing homes across the county, including a second location in Montgomery County, Arcola Health and Rehabilitation Center in Silver Spring. The company operates 10 homes in Maryland, but none in the District or Virginia.
Edward Watters, founder of a Maryland-based watchdog group that monitors nursing home care, said nursing homes typically receive about 65 percent of their funding from government sources.
Experts say it is rare for state officials to shut down a nursing home. Part of the problem is the difficulty of relocating residents, said Barbara Hengstebeck, executive director of the Coalition to Protect America's Elders, a Florida-based watchdog group. In 2005, Maryland officials closed down a Hagerstown nursing home for a series of violations including leaving an 83-year-old male resident with dementia alone during meal time against his doctor's orders. The man choked to death.
"Closing a facility down, to me, is the last resort and really should only be done because the place is beyond hope," Hengstebeck said. "Barring that, officials really should give the company every opportunity to fix what the problem is."
