Lack of effective oversight on nursing homes poses serious concerns

Paul Lanzikos and Richard Moore

Dignity Alliance Massachusetts is concerned about the oversight of a number of nursing homes in the Commonwealth and the well-being of their residents and staff.

Several facilities of concern owned by Blupoint Healthcare have just been placed under receivership by the Attorney General, which we commend: Blackstone Valley in Whitinsville (Northbridge), Pioneer Valley in South Hadley, and Mill Town in Amesbury.

However, there are additional nursing homes owned by Athena Health Care Systems which are problematic including of special note Highview of Northampton in Leeds as well as Bear Mountain at Worcester which was the subject of an investigatory report by the Disability Law Center. Issues involving these and other facilities have been reported in local media reports. In many instances, the unacceptable conditions in these homes have continued for months. Why are these situations allowed to go unabated? Why have admission freezes not been imposed? Has any type of operational oversight been imposed?

Our concerns have been amplified by a July 21, 2024, report in The Connecticut Mirror about Athena Health Care Systems which details major financial problems including failure to pay employees’ health care bills for more than six months as well as various vendors and suppliers. If this is occurring in Athena’s Connecticut facilities, it is surely also in its 17 nursing homes and three hospice programs operating in Massachusetts. Moreover, we are hearing that similar problems may also be occurring with other Massachusetts nursing home owners. Is the Commonwealth prepared to respond to failures of this magnitude?

Data reported by CMS relative to nursing home deficiencies and fines are, indeed, sobering. Many Massachusetts licensed facilities appear on the list with multiple serious violations. We view, as disturbing, that in the period from July 2021 through May 2024, hundreds of thousands, possibly millions, of dollars in penalties were levied against Massachusetts nursing homes but not processed until June 1, 2024. Why is it that fines levied a few years ago are just now being processed? We believe that timely enforcement, especially if brought to public attention, can help to expedite corrective action and identify other areas of concern.

At a Senate Ways and Means Committee hearing earlier this year, Dignity Alliance testified: We call for the increase of nursing home inspections and the decrease in the use of antipsychotics with nursing home residents. Massachusetts nursing home surveyors (inspectors) have the highest number of homes to inspect in New England, and more frequent inspections could improve quality of care and resident safety. The misuse of antipsychotics is a special concern, since Massachusetts also has one of the highest usage rates in the country, despite the requirement of informed written consent (IWC) before the administration of psychotropics and ongoing required dementia care trainings for specified staff. Over-drugging can be used to keep residents quiet, especially when nursing homes are understaffed in violation of state regulations. Dignity Alliance applauds legislators for establishing a system for tracking opioid drugs and supports a similar process for tracking antipsychotics and other psychotropic drugs, along with more effective regulation of the legislatively mandated requirement for IWC.

We have several questions about the survey process and DPH’s capacity to monitor all nursing homes in a timely fashion and ensure regulatory compliance: - Are there enough fully trained and experienced surveyors?

- Are there too many homes for each surveyor to cover?

- Does DPH prioritize inspections, such as focusing on one-star and twostar facilities?

- How does DPH handle complaints, especially repetitive ones?

- How are Massachusetts’ minimum staffing requirements being enforced?

- How are facilities operating “specialty” programs and services being monitored to ensure regulatory compliance and quality of care?

- In light of the BluPoint facilities, for which ownership has recently changed, is the current vetting process during suitability review sufficient?

Dignity Alliance is very concerned with the lack of effective oversight by DPH regarding the nursing homes for which the agency is statutorily responsible and for which the federal government provides financial support.

DPH is the licensure agency for nursing homes, hospices, and other health care providers in the Commonwealth. As such, it has the authority — and responsibility — not only to monitor and evaluate, but to act and protect when the safety and well-being of persons, especially those who are vulnerable and dependent upon others, are at risk. When it is apparent that the issuance of deficiency reports and imposition of fines and penalties are not sufficient, state agencies must be willing to exercise authority to impose operational controls up to and including receivership and licensure revocation.

We also believe that MassHealth has a responsibility to the taxpayers of the Commonwealth to make sure that public funds are being effectively spent. Each year, funds for nursing homes have increased to cover a declining number of residents and, in many instances, a reduction in quality care.

We raise these issues and ask the questions on behalf of the more than 30,000 residents in 350 nursing homes in Massachusetts, their family members, caregivers, and the Commonwealth’s taxpayers.

Paul J. Lanzikos is the coordinator of Dignity Alliance Massachusetts and Richard T. Moore is the chair of the DignityMA Legislative Workgroup.