An effective Aging-in-Place strategy will include, as a last resort, identification, consideration and communication of standards used in selecting institutional care. So many folks assume they have an effective Aging-in-Place plan, but never consider the likelihood of short or long-term institutional care, which may, regardless of an underlying plan, be inevitable.
This oversight can have tragic consequences if short-term institutional care becomes inevitable! If decision-makers cannot effectively evaluate competing institutional care options, a choice of care may be uninformed. Mistakes can be severe and permanent. Consider the case of a Massachusetts nursing home.
Massachusetts officials announced this week that they are maintaining a freeze on admissions at a South Yarmouth nursing home as a federal investigator’s report reveals details about the death of a patient that collapsed during physical therapy, and later died.
According to a Centers for Medicare & Medicaid Services (CMS) report, Windsor staff failed to perform chest compressions or use an automated external defibrillator (AED) on a patient who became unresponsive while doing light hand and wrist exercises in his wheelchair in the rehabilitation gym. The CMS report describes a chaotic scene, with precious and possibly life-saving moments lost while staffers scrambled to respond. Reading the report of the event one might conclude that there was no consideration by the management or staff of the possibility of such an event, and there appears to have been no knowledge of, reference to, or implementation of a concerted emergency life saving plan.
CMS criticized the institution for going three years without mock trials of code blue emergency drills, which include notifying the entire nursing home staff of an emergency and making the facility accessible to rescue personnel.
The result was horrific. A physical therapy assistant said she couldn’t get an outside line on a nursing home phone while dialing 911 emergency services and after numerous attempts resorted to using her personal cell phone to call 911. Other staff struggled put the patient, who wore a nasal cannula for oxygen, in an oxygen mask, but it was not applied properly. By the time emergency rescue crews arrived and started performing CPR, the resident had no cardiac activity or signs of life. When a second rescue crew arrived about three minutes later with additional emergency equipment, access to the patient was delayed by locked doors as many of the staff were unaware of the emergency.
The American Heart Association says that after 10 minutes few attempts at resuscitation succeed.
The patient was transferred to Cape Cod Hospital and put on a ventilator, but family members decided to withdraw life support March 6, and the patient died one hour later.
CMS fined Windsor Skilled Nursing and Rehabilitation Center $90,000 following the death of the 54-year-old resident in March. The sanction works out to approximately $3000 for each of the almost 30 years of the patient's life expectancy. The sanctions took place after investigators determined that Windsor staff failed to do CPR on the patient after he went into respiratory and cardiac arrest.
The nursing home submitted a plan of correction with public health officials that is under the process of review. If the 120-bed nursing home is not brought into “substantial compliance” with regulations by Aug. 27, the government will no longer reimburse Windsor for services delivered to Medicare and Medicaid patients.The federal agency threatened to rescind Windsor’s Medicare and Medicaid contract by June 19, but that deadline has now been extended to Nov. 27. The sanctions and warnings started after state Department of Public Health officials took the rare move of finding that Windsor was in “immediate jeopardy” May 27. "Immediate jeopardy" was changed to “non-immediate jeopardy” June 7, but a CMS letter to Windsor dated June 8 said “substantial compliance, however, had not been achieved.” Meanwhile, the institution to cares for patients.
Windsor spokesperson Ernie Corrigan said earlier this month that the nursing home staff has gone through “hundreds of hours of training” since the May 27 jeopardy finding. He said in an email that the staff had followed proper protocol as far as life-saving measures were concerned:
The response staff was continuously at his side, detected and continued to detect a pulse, and followed the protocols outlined by emergency medical trainers and the American Heart Association that dictate that you do not provide CPR or AED assistance when a patient continues to have a pulse. It is our view that everyone involved did their very best and performed admirably during a rapidly deteriorating medical emergency that eventually led to this patient’s death.
State health inspectors will conduct an unannounced follow-up inspection once the nursing home submits an acceptable plan of correction, according to an official with the state Department of Public Health. If DPH finds the nursing home to be in compliance with regulations, it will lift the freeze on admissions, the DPH official said.
In addition, CMS will not terminate its contract with Windsor if the nursing home comes into compliance with state and federal regulations, a CMS spokesperson said.
Findings of jeopardy and nursing home terminations in Massachusetts are not common. Last year, five Massachusetts nursing homes were placed in jeopardy, a DPH spokesman said. Only one nursing nursing home in Massachusetts has had its Medicare provider agreement involuntarily terminated since June 2015.
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