×

Medicare to Stop Payments to Brookside Nursing Home: Feds Monitoring Relocation of Patients



Valley News Staff Writer
Wednesday, October 18, 2017

White River Junction — Citing health and safety violations, the Centers for Medicare & Medicaid Services has announced plans to stop making Medicare and Medicaid payments to a 67-bed nursing home in White River Junction at the end of this month.

CMS announced it intends to halt payments to Brookside Health and Rehabilitation Center on Christian Street beginning on Oct. 30, due to the nursing home’s “failure to meet Medicare’s basic health and safety requirements for skilled nursing facilities,” the federal agency said in a news release dated Oct. 13.

The halt to payments for skilled nursing services for Medicare and Medicaid beneficiaries will apply to Brookside patients admitted after Oct. 29; payments for patients admitted before then may continue for up to 30 days.

Halting payments “is generally a last resort after all other attempts to remedy the deficiencies at a facility have been exhausted,” the release said.

This announcement comes after inspections by state regulators repeatedly have found fault with the operations of the facility, which changed hands in 2015, when a New York-based group of real estate investors and nursing home operators purchased it from Thomas E. Rice, a White River Junction resident whose family opened the nursing home in the 1960s.

Deficiencies found in inspections conducted in recent months by the Vermont Department of Disabilities, Aging and Independent Living’s Division of Licensing and Protection have included food safety, staffing levels, a gap in contracts between providers of rehabilitation services that left some patients without such services for a time, and failure to ensure that patients see their doctor regularly.

Suzanne Leavitt, the assistant director of the Division of Licensing and Protection in charge of survey and certification, declined to comment in a Wednesday email. She directed questions to CMS. Emails and phone calls to CMS officials were not returned on Wednesday.

Despite the recent hiring of a food service director and previously documented issues with nutrition, at least one resident was gradually losing weight — that is, until staff stopped documenting the patient’s weight, according to a September inspection report. In February, the patient weighed nearly 110 pounds, but by early March that patient was down to 102 pounds, and in the following four months staff members failed to record weights for the patient.

Staff also failed to provide adequate supervision and assistance for 13 of the 39 patients residing at the facility on Sept. 5, according to the inspection report. Previous inspections revealed that a patient suffered a burn because of the failure to properly monitor food temperatures.

Patients also have suffered from other examples of poor treatment. In one instance in August, a licensed nursing assistant took a call bell away from a patient, preventing that patient — who has a cognitive impairment — from calling for help when he or she needed it, according to an inspection report. Despite reports to the director of nursing from other LNAs who observed this incident, the accused LNA was allowed to finish his or her shift and to work three more shifts before being fired.

Failure to properly document a patient’s known allergy to a medication resulted in a rash. In another instance, a resident was left with a sock on his or her hand, which left a red indentation on the patient’s skin.

Another symptom of issues at Brookside surfaced in May, when the relationship between Brookside and Dartmouth-Hitchcock ended and D-H physician Daniel Stadler stopped providing the facility’s medical direction.

“Dartmouth-Hitchcock terminated its medical director services arrangement with Brookside Nursing and Rehabilitation Center as of May 24, 2017,” D-H spokesman Rick Adams said in an email Wednesday. “We made this decision because we did not experience the level of engagement with the current administration that we would expect, in order to ensure high-quality patient care.”

On Wednesday afternoon, the facility’s administrator, Paul Kovacs, said he was in the process of informing residents, their families and his staff about CMS’ decision and the resulting impact. He urged a reporter to “come back tomorrow” after he had made the announcement in an afternoon meeting with residents and an evening meeting with relatives.

Though she couldn’t comment on the specifics of Brookside’s situation, Martha Chesley, the administrator for Hanover Terrace Health and Rehabilitation Center, said that in general, “nursing homes rely on Medicare and Medicaid funds. If they’re telling you as of a certain date they’re no longer going to pay you ... (you) can’t take care of people.”

Just like any business, a nursing home “can’t function without getting paid,” she said.

CMS, in its release, said it is “closely monitoring the relocation of Medicare and Medicaid recipients to other facilities.”

Tom Ralston, who leads the residents council for Brookside, where he has lived for four years, said he had not yet heard of CMS’ plan to begin denying payments to Brookside. The 62-year-old Ralston, who is paralyzed from his armpits down and also does not have the use of his hands, said his care at Brookside is covered by Medicaid and Social Security disability payments.

Ralston acknowledged that there have been challenges at Brookside in recent years, including in the areas of food service, leadership and housekeeping, but conditions have been improving, he said.

“It’s a work in progress,” he said.

Overall, he said, “residents are happy.”

A group of residents enjoyed a trip to the Tunbridge World’s Fair last month. Now, the residents are making masks for a masquerade ball and preparing to provide input to food service about their Thanksgiving meal, he said.

“We don’t have to stay with the same old fare,” he said.

On a personal note, Ralston said, he had complained to Kovacs about the single-blade razors the facility provided to residents for shaving, and Kovacs brought him some double-bladed razors, a small action that Ralston saw as “an indication of where (Kovacs is) helpful.”

Kovacs was hired this summer, which remedied the problem of having one administrator for the two Vermont facilities owned by this group of investors. The other is Green Mountain Nursing and Rehabilitation in Colchester, which has also been cited by state regulators for deficiencies including a gap in therapy services due to a change in providers.

Other examples of improvement at Brookside are the purchase of a label-maker for the laundry department and the purchase of a second lift for assisting residents in and out of bed and in using the bathroom, Ralston said.

Brookside, not unlike other Upper Valley employers, has struggled to find workers. A sign outside the facility on Wednesday said, “RN & LPN & LNA Help Wanted.”

It directed interested parties to call the director of nursing and concluded, “$$$!”

Holly Martin, whose 101-year-old father, David Fortin, is a Brookside resident, said she saw reason for optimism in the news about CMS halting payments to Brookside.

“Who knows?” she said. “Maybe this will be the push that we need to get him out of there.”

Fortin is mentally fit and has chosen to stay at Brookside rather than move to Florida to live with her, Martin said.

“Any choices he makes are his choices,” she said. “If it were up to me, he would not be there.”

Though otherwise “hale and hearty,” Fortin has been at Brookside for about two years following a foot infection that left him with reduced mobility, Martin said.

Martin’s concerns about Brookside include the maintenance of the building, an inability for patients and their families to have privacy and issues with food service.

“My father is a bag of bones,” she said. “Would you want to sit down to a plate full of gray food? It’s just awful.”

She also said that Brookside staff threw away her father’s dentures.

Last she knew, Martin said, her father’s longtime “lady friend” was deducting the cost of replacement dentures from his monthly bill of $8,000.

“It was just crazy,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.