The federal government has threatened to stop paying for new Medicare and Medicaid admissions to a Buffalo nursing home, because the home failed to correct violations that included residents' being left lying in urine.
The Manhattan Manor Nursing Home's skilled-nursing facility frequently smelled strongly of urine and feces, and its staff often ignored residents who needed help, according to a state investigation.
The problems, found by state investigators during a surprise two-day visit Jan. 8 and 9 and a follow-up inspection April 2 and 3, involve both management and the supervision of nurses in the 44-bed facility at 300 Manhattan Ave.
William Zacher Jr., owner of Manhattan Manor, could not be reached to comment.
Manhattan Manor also houses an 81-bed health-related facility that cares for people who do not need skilled nursing. That facility was not involved in the investigation.
The state concluded that problems with resident care at the skilled-nursing facility stemmed from an over-reliance on personnel from temporary agencies who know little about the facility and who failed to receive proper supervision while working there.
Manhattan Manor responded to the deficiencies with a plan to correct them. But when the state investigated again, it found that many of the problems still existed. A nursing home official Thursday said the facility has undertaken measures to correct violations by the end of May.
The state report includes numerous accounts of staff members' failing to clean up after incontinent residents and, in one case, of ignoring a resident who asked to go to the bathroom. Some residents spent much of the day in urine-soaked clothes or with urine or feces in their beds.
Many residents remained unshaven, their hair oily, matted and uncombed, and their clothes stained by food from several meals, according to the report.
In some instances, staff members ignored written or spoken orders by supervisors and refused to perform tasks, the report said. Investigators described how no one cleaned up a puddle of urine under a resident restrained in a wheelchair. The puddle flowed past the bed of another resident and out the room until an investigator made mention of it.
Instead, staff members carefully stepped over the puddle when they entered and left the room even after it was suggested that they clean up the resident and the puddle.
"The nursing home's problem is extensive use of temporary agency staff. There are enough people but weak supervision, low performance levels and no continuity of care," said James H. Campbell, area administrator of the state's Office of Health Systems Management, which conducted the inspections.
Campbell's office investigated the nursing home as the result of a complaint about incontinent patients being left unattended.
"Nursing services are the core services for patients in a nursing home," said Janet F. Engasser, long-term care program director at the state office. "What we have here is an inability to maintain the basic elements of long-term care and an inability to correct serious problems with that care."
In 1988, the state fined Manhattan Manor $24,000 -- with $8,000 suspended -- in connection with a patient who was scalded in a bath in 1983 and with violations of state and federal regulations found in 1985. The state also found nursing-service deficiencies in 1987 and 1988.
The state plans to fine the home for the current violations, Campbell said. Moreover, a new state policy required the nursing home to post a large yellow poster in a prominent location to advise staff, residents and visitors of the state and federal actions.
The federal Health Care Financing Administration, which administers Medicare, intends to stop paying for new Medicare and Medicaid admissions as of June 14 unless the problems are corrected. The ban would not affect current residents -- 22 private pay, 11 Medicare and 11 Medicaid.
Manhattan Manor officials told federal authorities this week that the facility would comply with regulations by Monday. Investigators then would inspect the home again.
"I cannot disagree with the January report. I walked through with the surveyor and saw the problems," said Lorraine A. Kramer, administrator of the facility.
"Obviously, the supervision needed to be changed. We want to provide good care. We ran into an unfortunate situation, and it will not happen again."
Ms. Kramer said the problem was that although residents received care, it was not prompt.