Two Mass. nursing homes on national watch list

By Alice Dembner, Globe Staff

Two problem-plagued Massachusetts nursing homes have been placed on a national watch list of facilities that must improve or face increasingly severe penalties, officials announced today.

The list, in place since 1998, is being made public for the first time in the hope that public pressure will accomplish what government oversight has not. The federal government posted on the Internet the names of 54 of the 128 homes on the list -- those homes it said had not shown significant improvement on their most recent inspection. All the homes have been cited for harming residents, and most have a history of fixing the worst problems, but allowing new problems shortly thereafter.

Officials cited Milton Health Care in 2006 for ignoring the psychiatric needs of a depressed resident who subsequently slit her wrist, for failing to treat bed sores and for inadequately managing residents' pain, among other problems. The facility also lacked adequate staff and a medical director. Last year, the home was cited for failing to provide needed care, including eye drops, lab services, and proper diets. In quality, the state rates the facility among the worst 1 percent of Massachusetts' 450 nursing homes.

Cedar Hill Health Care Center in Randolph was cited in August for repeatedly giving a resident overdoses of a blood thinning drug. The resident had to be hospitalized for a blood transfusion to avoid a hemorrhage. The facility also left many residents lined up against the walls with no activities, had no infection control program and failed at basics, such as monitoring blood pressure and giving required drugs, according to state inspection records. In 2005, the staff allowed two residents at risk of falls to wander the facility. One fell 13 times, breaking his arm and cutting his chin and skull, according to a state official.

Publication of the list drew praise from consumer advocates.

"Consumers need to know and have a right to know about poor-performing facilities," said Alice Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. But she said the government needs to go further and announce when any facility is sanctioned for poor care, since only a few of the low-quality nursing homes make the list. In Massachusetts, there are more than 45 homes that state officials rank lower in quality than Cedar Hill.

In addition, Hedt said, the government needs to do more to enforce higher-quality care in the nation's 16,000 nursing homes. "We believe that there’s a long way to go," she said.

Nursing homes on the list are inspected twice a year, instead of once, and can face fines, a cut-off of federal payments for care, or imposition of new management. Over the last nine years, about half of the homes on the list have improved in two to three years, the federal government said, and about 16 percent were cut off from state and federal funding, which typically forces them to close.

The "effort to identify poor-performing nursing homes is intended to promote more rapid and substantial improvement in the quality of care," Kerry Weems said in a statement. Weems is acting administrator of the Centers for Medicare & Medicaid Services, which oversees nursing homes for the federal government.

Paul Dreyer, the state official who oversees nursing home quality, said the list is "one tool that we have in our arsenal." However, he said that the state has too few inspectors to respond to all consumer complaints.

Dreyer said a third Massachusetts nursing home -- Harborside Healthcare in Wakefield -- is also on the list, but made enough improvements in the last year to avoid the government publicity campaign.

In statements, officials of the two Massachusetts nursing homes on the public list said they were making significant improvements and expected to be off the list soon.

"Milton Health Care, under a new leadership team, has been intently focused on improving the facility during the last 18 months and has made outstanding progress," said spokeswoman Lu Anne Stewart. She said the 160-bed, for-profit facility now has more staff and has undergone $160,000 in capital improvements.

John Fredette, administrator of Cedar Hill, said the facility "has been working tirelessly over many months and has achieved a high level of care." In addition, he said the 168-bed for-profit home had recently won accreditation from the Joint Commission, a national organization that evaluates healthcare organizations.