A Delaware Avenue nursing home was cited by state inspectors for 22 deficiencies in its latest annual survey, including three at the "immediate jeopardy" level for an inconsistent system regarding the use of directives for end-of-life care.
The state removed the "immediate jeopardy" designations after the Emerald North Nursing and Rehabilitation Center made changes in its procedures and, as is the practice in the industry, will submit a plan of correction.
An advocacy group for nursing home quality issued a report Friday highlighting the survey results and, citing federal data, indicated that Emerald North's inspection history had worsened since an ownership change that converted the facility from not-for-profit status to for-profit.
"We're trying to make the public aware of what is going on in our nursing homes and let people know that they have a choice about where to go if they need one," said Tony Szczygiel, a volunteer attorney with the Center for Elder Law & Justice.
Nearly one-third of the nursing homes in Western New York have the lowest possible scores in current ratings, including Emerald North. The federal Centers for Medicare & Medicaid Services currently gives a 1-star rating to 22 of the region’s 74 nursing homes. Of those, 19 are proprietary facilities. The agency uses a 5-star scale to measure how well nursing homes deliver care.
New York state inspects its nursing homes on behalf of the federal government, grading deficiencies according to severity and scope. A deficiency deemed an immediate jeopardy to a resident's health and safety is the most severe level, and can be isolated, a pattern or widespread in scope.
The Center for Elder Law & Justice plans to issue reports after annual surveys of 1-star nursing homes in the region to bring greater attention to quality issues. Lindsay Heckler, a center attorney, said it's important for consumers to know their options at a time when nursing homes with good scores on inspections have space for residents.
"You would think that four-star and five-star nursing homes would be at full capacity, but they are not," she said.
Emerald North's survey completed last month noted that eight of 29 residents examined did not have advance directives properly documented, including inconsistencies with the physician orders, a problem considered a pattern in scope. The survey documents, which were provided by the legal center, have not yet been publicly posted by the state. In one case in 2016, an unresponsive resident with a physician's do-not-resuscitate order was resuscitated with cardiopulmonary resuscitation and advanced cardiac life support.
Among the other deficiencies, the facility was cited for a resident admitted from a hospital in October with a catheter to drain urine who had no physician's order for its use in the nursing home, and there was no documented attempt to remove it until January, according to the statement of deficiencies.
Richard Sullivan, an attorney with the Harris Beach law firm representing Emerald North, said the nursing home always cooperates fully with the state Health Department. He also said that quality at Emerald North is good and has improved under current ownership, and that the perspective of poorer quality offered by the Center for Elder Law & Justice is contrary to management's experience at the facility.
Not-for profit Presbyterian Senior Care of Western New York in 2012 turned over operation of its Harbour Health and Hawthorne Health MultiCare Centers for Living at 1175 Delaware Ave. and 1205 Delaware to a voluntary receivership from mid-2012 until the spring of 2014, when the facilities were sold to a Long Island ownership group and renamed Emerald South and North. Ownership is in the name of Judy Landa. A related ownership group owns four other facilities in the area – Safire Rehabilitation of Northtowns, Safire Rehabilitation of Southtowns and Williamsville Suburban.
Compared to the previous ownership, Emerald North has received more deficiencies in surveys and larger weighted scores, a grade based on the scope and severity of deficiencies, said Szczygiel, retired director of the University at Buffalo’s William and Mary Foster Elder Law Clinic.
In New York, for-profit facilities accounted for 53 percent of 635 nursing homes in 2010 but saw their share of the market increase to 56 percent of 629 facilities in 2014, according to federal data.
Todd Hobler, a vice president of Local 1199, Service Employees International Union, which represents 4,500 healthcare workers at 40 nursing homes, including Emerald North, said the increase in for-profits and their record on quality bears watching. But he said a larger issue for his union is the Medicaid reimbursement rate facilities receive for care of residents. About one-quarter of Medicaid spending in the state goes to long-term care.
"The current rates make it difficult, especially in the inner city, to sustain adequate staffing, and staffing is 70 percent of a nursing home's costs," he said.