Death came suddenly for Arturo Bucci. The 85-year-old retired machinist was in his motorized wheelchair when it toppled more than 12 feet down a creek embankment. The spill left him face down in the water outside an East Aurora nursing home.
For Donna Bantle, death came more slowly. Her daughter noticed a large, ugly bedsore on Bantle’s back when she was a resident at Absolut Center for Nursing and Rehabilitation at Aurora Park — the same facility where Bucci died.
“This thing is going to kill me,” she told her daughter. Months later, when Bantle died, the death certificate listed an infection in a lower back wound as a contributing factor.
For four years, the Absolut nursing home has been one of the lowest-rated in Erie and Niagara counties and among the lowest-rated in New York. The federal government’s overall rating for the facility was one star, or "much below average," every month for four years until last month. Only a handful of the 620 nursing homes in the state had worse ratings in recent years than Absolut at Aurora Park when all five criteria in the five-star rating system are considered.
In October, the nursing home's overall rating improved to two stars, or “below average.” There are improvements at the home — the owner invested $2 million in renovations — but it's too early to say if the uptick in ratings will continue.
Government records show problems have persisted for years at the home in East Aurora. It has been fined $39,210 in the last four years, including a citation for “actual harm” to two residents who did not receive proper treatment for bedsores. The state Health Department also cited the home for failing to provide adequate supervision and an accident-free environment when Bucci died.
The facility was among the first of 16 nursing homes in Erie and Niagara counties that were sold to out-of-town investors in the last 11 years. Like many of those homes, registered nurses there spend less time on average with residents than RNs at nursing homes across the state, according to the federal data.
Absolut at Aurora Park’s troubled history goes back decades — long before the 2007 sale of the nursing home to a company owned in part by Israel Sherman, a New York City resident with ownership interest in 16 nursing homes.
Sherman is committed to improving conditions at the East Aurora nursing home, said Chris Luterek, Absolut's vice president for business development. Recent changes, he said, include increased evaluations to prevent bedsores and offering bonuses to staff.
"This building has yet to overcome its history, but we are working really hard to provide five-star quality care," Luterek said. "It is hard work to turn a nursing home around."
But visit Absolut at Aurora Park, and you are likely to run into unhappy residents or their families.
Karen Caffiero said she had to hire a certified nursing assistant out of her own pocket to help care for her son, a stroke victim, because there wasn’t always enough staff.
Tammy Kelver said the sight of bloody gauzes left on the floor shocked her when she visited her 92-year-old father-in-law.
"My first thought was, 'I can't believe they have a certificate of occupancy,' " Kelver said.
In lawsuits against the nursing home, residents and their survivors have alleged everything thing from untreated bedsores to broken bones to wrongful death.
Absolut at Aurora Park agreed to pay $820,000 to settle four lawsuits last year, according to State Supreme Court records. That was the highest amount that The Buffalo News could document among the 47 nursing homes in Erie and Niagara counties in 2018. Most settlements are sealed from public view by judges at the request of the nursing homes.
Problems go back decades
In 2003, former owner Neil M. Chur Sr. paid the state $3 million to settle a lawsuit over allegations involving the nursing home and a second facility he owned in Orchard Park. The New York State Attorney General's Office determined the two understaffed facilities had failed to deliver care to some residents, and that workers, in some cases, had falsified records stating care had been given.
Two years after Chur died in 2005, 11 of his nursing homes were acquired by Sherman's companies, with four of those homes located in Erie and Niagara counties.
The purchase, approved by the state Department of Health in 2007, was the first in a series of local nursing homes sales to owners from outside the region, according to state and federal records. Sherman's companies now own 16 for-profit nursing homes across New York and Ohio, according to government records.
Their record as a nursing home owner is mixed.
The federal government rates nine of their nursing homes in New York State below average or worse. Four are rated average. Two are rated much above average.
In April, Sherman's company said it had sold four nursing homes to Personal Healthcare LLC, a downstate chain. Personal Healthcare is operating the homes in Dunkirk, Eden, Houghton and Salamanca under contracts as it seeks Health Department approval.
Insights from the inside
From the outside, Absolut at Aurora Park, a three-story brick structure, could pass for a well-kept apartment complex in quaint East Aurora. Built in 1972 on four acres, the facility is set back from the village's Main Street with a buffer of trees and green space.
Tannery Brook flows through the grounds. On warm days, residents sit outside on shaded porches.
But inside the facility, individuals who have loved ones there paint a less picturesque view.
In June 2016, Andrew Burg suffered a stroke that left him barely able to speak and unable to walk or go to the bathroom by himself. He arrived at Absolut at Aurora Park's rehabilitation unit from Buffalo General Medical Center in August 2016.
During one of her first visits, his mother, Karen Caffiero, a 78-year-old widow from Williamsville, said she found him lying in his room without the lights on.
"I said to the nurse, 'You know he's not a vegetable,' " the retired Buffalo School District math teacher recalled. "After that, I made sure the lights were on in his room and that music was playing to stimulate him."
Caffiero said she was concerned about the lack of care her son was receiving. "The nursing home aides want to get in and out of the room when they take care of Andy. It's so fast," Caffiero said.
She said she would often see the nursing staff talking on their cell phones instead of attending to residents. So she hired a certified nursing aide to visit Burg in the nursing home one or two times a week. The cost of the aide is $30 an hour — more than double the $12.74 starting rate for Absolut's certified nursing aides.
While a Buffalo News reporter was interviewing Caffiero and her son, the 56-year-old Burg required assistance in urinating. Caffiero pressed the call button light and went out in the hall looking for help. A CNA informed her a second aide would be needed.
More than 30 minutes passed without help arriving. Burg became highly agitated, hitting his hand on his groin area because he was in pain. His mother hurried from the room and found the aide, who was still looking for help. Together, the mother and CNA succeeded in re-positioning Burg in his chair and he was able to urinate.
The aide searched through Burg's dresser and closet but could not find a replacement diaper. He then went to another resident's room and "borrowed" a clean brief.
"As you can see, there's a problem with briefs and keeping up the supply," Caffiero said.
Thelma Stachawicz, 87, a resident at Absolut at Aurora Park, said she has had to wait three hours for the staff to change her soiled diaper.
"There's never enough staff," she said.
The federal Centers for Medicare and Medicaid Services rates nursing homes for the level of staffing they have. Absolut at Aurora Park improved this month to a three-star staff rating or "average."
Registered nurses spend on average 25 minutes per day with each resident at Absolut at Aurora Park. That is 17 minutes less than state average for RNs at nursing homes. Compare that with McAuley Residence, a nursing home in the Town of Tonawanda owned by Catholic Health that is rated overall at four stars, or "above average." At that facility, RNs spend 81 minutes per day with each resident.
In Erie and Niagara counties, RNs at only five nursing homes spend less time per day with residents than those at Absolut at Aurora Park.
An Absolut executive said the company has taken several steps to address complaints that the facility does not have enough staff. They include offering bonuses for CNAs and tuition to help them become licensed practical nurses and registered nurses.
In trying to put the challenges faced by the East Aurora facility into perspective, Luterek said the nursing home is bigger than some area hospitals. With 320 beds, Absolut at Aurora Park is the second biggest nursing home in the two counties.
"What this means is we are truly a regional medical center that attracts residents from all over Western New York," he said. "We are positioned to treat a fairly high acuity level."
Luterek says that Sherman comes to Buffalo at least three days a week and regularly visits the facilities.
"When he goes into rooms, he is checking on the residents' conditions, everything from how cold their water is to cleanliness of the rooms, to how the residents look. He is very, very engaged. He is not an absentee owner by any means," Luterek said.
"This building made $1 million last year… and he is putting $2 million into renovations and updating of this building," Luterek said.
The work included renovating rooms and hallways, dining facilities and nursing stations, and expanding the rehab unit from 44 beds to 54 beds.
"That to me does not say, 'this is a guy who is not invested in his company,' " Luterek said.
Death from a bedsore
Mary Sharp, a nurse and the daughter of Donna Bantle, described the care at the East Aurora nursing home as substandard.
Sharp said her mother, who lived in Elma, was transferred there from Mercy Hospital in Buffalo in January 2014 for rehabilitation involving a wound that had developed in her groin area from a urinary tract infection. While she was at Absolut at Aurora Park, Bantle developed a bedsore on her lower back.
"She would sit for long periods of time in her wheelchair or bed. I'm a nurse and know what you should be doing, turning and repositioning so that you are not always in the same spot," Sharp said of the pressure wound.
The daughter says she brought it to the attention of a staff nurse, and requested that her mother's doctor be notified so that arrangements could be made to send Bantle immediately to the hospital.
"I said, 'You need to let him know what's going on.' The nurse said, 'Yes, it's red and we'll put some cream on it. She has a doctor's appointment tomorrow.' I said, 'You need to do more than that,' " Sharp said.
The next day Bantle was sent to the emergency room at Mercy Hospital and ended up in the operating room for the first of a series of surgeries related to the bedsore, her daughter said.
"It was really just a slippery slope, going downhill for months," Sharp said.
Bantle, 71, died Oct. 18, 2014. On the death certificate, sepsis was listed as the cause of death. Contributing factors included an infected wound at the base of the back and a bone infection.
Sharp hired the Brown Chiari law firm to file a lawsuit in March 2016 in State Supreme Court against the nursing home, Mercy Hospital and Catholic Health, which owns the hospital. The pending lawsuit alleges negligence resulting in the "development and worsening of pressure sores."
The state Health Department did not investigate Bantle's death, according to the law firm.
But in inspection reports, the Health Department has cited Absolut's failures in treating bedsores. A July 2015 Health Department inspection determined there had been "actual harm" to two residents who had not received proper treatment for bedsores.
That prompted the Health Department to fine Absolut $10,000 in 2016.
Among Absolut at Aurora Park's long-term residents, 11 percent had bedsores in 2017. The statewide average was 7 percent. This year, the nursing home's percentage of residents with bedsores has improved. It equaled the state average in the second quarter of 2018.
In judging the quality of resident care, Absolut at Aurora Park was one of only 11 nursing homes in New York to earn a one-star rating from the federal government in ratings issued in September. Its rating in that category improved to two stars in October.
‘It’s just mind boggling’
Bedsores haven't been the only problem at Absolut at Aurora Park.
A Health Department investigation determined the nursing home’s staff did not properly protect Bucci, the resident who died after falling into Tannery Brook in his wheelchair on Aug. 29, 2013.
Absolut failed in providing adequate supervision and an accident-free environment, according to the Health Department findings.
That is of little comfort to Bucci's family.
"We put our father in the nursing home to ensure his safety. Otherwise, he could have stayed home," said Julie Wardak, one of Bucci's five children. "It's just mind-boggling."
Bucci and his wife, Italia, were both residents at Absolut at Aurora Park. He had COPD, a chronic lung disease, and used an oxygen tank to help him breathe. Italia, who had dementia, died in 2016, three years after her husband.
Their children are suing Absolut at Aurora Park over Bucci’s death.
There are at least 13 pending lawsuits filed against Absolut at Aurora Park in Erie County. Brown Chiari has filed 11 of them, including the one involving Bucci.
Making changes to improve
Luterek, the Absolut executive, says Absolut has recently made a number of changes in the way it operates the East Aurora facility, including how it prevents bedsores.
"We do weekly skin rounds on our residents. In addition, we have a surgeon that comes in weekly to evaluate wounds and we have contracted with AmeriWound," Luterek said of the national company that provides doctors who specialize in wound care.
Luterek also says Absolut has instituted a five-day customer service survey after each resident arrives.
"This helps the building to be able to determine where a family feels we may be deficient and it allows us to address concerns immediately," he said.
A few months ago, members of the nursing home's management team, he said, began hourly rounds of going into residents' rooms to check on conditions. If call lights are on, they address the needs of the residents, he said.
"We are trying to be very proactive," Luterek said.
Contact reporter Lou Michel at firstname.lastname@example.org.
Story topics: Nursing Homes