Hanover Nursing Home Ranks in Lowest Tier After Inspection

Valley News Staff Writer
Saturday, August 15, 2015
Hanover — An area nursing home that changed ownership 14 months ago was recently cited by state inspectors for several deficiencies in patient care, including a failure to provide eating assistance to a patient with dementia who lost 23 pounds.

The citations contributed to Hanover Terrace Health and Rehabilitation Center’s ranking for health inspections on the lowest tier of an official list of the 76 New Hampshire nursing homes that care for Medicaid and Medicare patients.

The bad report came in the wake of “numerous changes in (Hanover Terrace’s) administrative team in the last few months” and that led to “changes in leadership (that) showed through as inconsistent implementation of system changes,” the managers of the 100-bed facility on Lyme Road said, according to the report from an April visit by surveyors, as nursing home inspectors are called.

In the most serious instance, for two days in a row an inspector observed a resident sitting over her lunch tray and showing little or no interest in her food. Only on the second day, after an inspector pointed out the situation, did a staff member assist her in eating. From August through February, the weight of that resident, who was suffering from end-stage Alzheimer’s disease, fell from 111 to 88 pounds.

Hanover Terrace was without a dietitian for five weeks, the inspectors learned. Other patients were also observed sitting and not eating or receiving assistance, inspectors said.

All in all, Hanover Terrace failed to keep up-to-date and adequate care plans for 10 residents and admitted some new residents without administering required tuberculosis tests, according to the inspection report. The nursing home also missed deadlines for reporting incidents of potential abuse or neglect, and laid off two of the four activities staff members and then curtailed evening activities, the inspectors said.

Malcolm Dean, the nursing home administrator, referred questions to Michael Lincoln, who Dean described as a spokesman for a Florida-based owner.

Lincoln declined to answer questions but said: “The facility did have its annual survey ... in April and did receive deficiencies. They submitted a plan of correction which was accepted and approved by the state and all deficiencies were cleared up (by the time of a) routine follow-up.”

An inspection report supplied by the New Hampshire Department of Health and Human Services showed that the initial survey was completed April 9 and signed by Dean on May 11 and that many corrections were due to be completed by May 24.

Lincoln emphasized the facility’s commitment to providing quality care to its residents: “Their health and well-being is our primary focus.”

But Hanover Terrace’s two-star, or “below-average,” overall rating on the website run by the Centers for Medicare and Medicaid Services, the federal agency that administers those programs, put it below 54 of the 76 New Hampshire skilled nursing facilities evaluated on the site. The website (bit.ly/MedicareNHCompare) compares all nursing homes that participate in government health insurance programs.

CMS gives an overall rating in a range from one to five stars to each nursing home. The computation begins with the number of stars awarded for a third-party health inspection. Stars can then be added or subtracted to reflect a nursing home’s self-reported quality of care and staffing levels. Quality of care and staffing reports aren’t subject to independent verification by a third party.

In 2014, a New York Times study of the rating system concluded that some nursing homes had gamed the system to win “a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.”

Hanover Terrace received a single star after its health inspection. That’s the lowest possible rating, marking its performance in that critical area as “much below average.” Only 14 New Hampshire nursing homes received a single star for health inspections.

Hanover Terrace got two stars, or below average, for the quality of its care. A second star was added to its overall rating to reflect an “above-average,” four-star rating on its staffing levels. That’s what boosted Hanover Terrace’s overall rating above those of the nine New Hampshire nursing homes on the bottom tier of the five-star ratings scale.

CMS awarded five stars to 24 (including Woodlawn Care Center in Newport and Kendal at Hanover) of the 76 New Hampshire nursing homes that care for Medicare or Medicaid patients. Another 18 received four stars (none in the Upper Valley), 12 got three stars (including Sullivan County Health Care in Unity and Genesis Healthcare’s Lebanon Center), 13 got only two stars (the William P. Clough Extended Care Center in New London, along with Hanover Terrace) and the Elmwood Center at Claremont and eight others got the lowest, one-star rating.

In Vermont, CMS rated 37 nursing homes and 12 got five stars (including Brookside Health & Rehabilitation in White River Junction, Menig Nursing Home in Randolph Center and Cedar Hill Health Care Center in Windsor), eight got four stars, seven got three stars (including Springfield Health & Rehab in Springfield), seven got two stars and three got the lowest, single-star rating.

Until June 1, 2014, Hanover Terrace was owned by Kindred Healthcare Inc., a publicly traded company with annual revenue of $5 billion that owns dozens of nursing homes and other medical properties.

Medicare.gov, the official website of the program that provides health insurance to seniors and some people with disabilities, shows that two entities each own at least a 5 percent interest in Hanover Terrace: CH-Hanover LLC and Chestnut Health and Rehabilitation Group Inc. Lincoln said those records were accurate but declined to elaborate.

According to the website of the New Hampshire Secretary of State, CH-Hanover is a limited liability company registered in Delaware with an office in Scranton, Pa. CH-Hanover registered to do business in New Hampshire on Feb. 14, 2014, and its New Hampshire registration was suspended on Aug. 3. Administrative suspensions by the secretary of state reflect a “failure to file reports and/or fees and/or failure to maintain a registered agent,” according to the secretary of state’s website.

Hanover Terrace’s nonprofit owner also seems to exist in a legal gray area. According to its 2012 tax return, Chestnut Health is a nonprofit organization based in an office suite in Bala Cynwyd, Pa., that also includes the real estate law offices of Howard Jaffe, the nonprofit’s president. At the end of 2012, Chestnut Health had a balance sheet deficit of $31,000, according to the return. Guidestar.org, a nonprofit organization that says it “gather(s) and disseminate(s) information about every single IRS-registered nonprofit organization,” lists the physical address of Chestnut Health as Suite 900 at 1675 Palm Beach Lakes Boulevard in West Palm Beach, Fla.

But neither Chestnut Health nor Hanover Terrace, whose sign alongside Lyme Road proclaims it is “a not for profit facility,” is on the list of charities of the New Hampshire Attorney General’s Charitable Trust Unit, which oversees all nonprofits operating in the state. The state requires each charity or nonprofit to file an annual report.

The Internal Revenue Service also requires nonprofits to file a tax return, called a Form 990, and make copies available upon request to the public.

Last week, Sherry Perry, an office manager at the reception desk in Hanover Terrace, said she was not familiar with the Form 990 and could not provide one. She said she would refer a reporter’s inquiry to Lincoln, but he did not respond.

Meanwhile, change is coming in the ownership of the 46-year-old structure that houses Hanover Terrace. The facility was built in 1969 and has changed hands three times since 1990, according to town records. The land and building are assessed at $5.1 million which, in the current tax year, would generate a bill of just over $100,000.

The current owner of the modest, sprawling building that houses the nursing home, which is across the street from the Hanover police and fire headquarters, is Ventas Inc., a publicly traded real estate investment trust that owns senior living and health care properties, has $21 billion in assets and posted net income of $477 million on revenue of $3.1 billion in 2014.

In 2001, a Ventas unit called Ventas Realty paid $7.2 million to acquire the property from another Ventas entity that had purchased it for $3 million three years earlier, according to town records.

But in recent securities filings, Ventas disclosed that its local property is included in a package of 355 nursing facilities that will be spun off in a transaction scheduled to occur on Monday. If completed, the spun-off entity — a new, publicly traded real estate investment trust called Care Capital Properties Inc. — would own properties that house 105 former Kindred nursing homes and facilities, including Hanover Terrace.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.


The quality of care at Hanover Terrace Health and Rehabilitation Center in Hanover has a two-star, or “below average,” rating from the Centers for Medicare and Medicaid Services website. A story in Saturday’s Valley News incorrectly stated the facility’s quality of care rating.