Jamie Anzalone, Esq. has prosecuted multiple nursing home neglect cases and commented “We see, unfortunately, that local nursing homes are either understaffed or being staffed incorrectly,” Anzalone said. “When there is not enough of them or they are not skilled enough, injuries occur.”
BY TERRIE MORGAN-BESECKER STAFF WRITER | CITIZENS’ VOICE
No one paid attention to Carmela Mecca’s fingernails, not even after a wound developed from their growing an inch into her clenched fists.
By the time anyone at her Blakely nursing home noticed, the 89-year-old dementia patient nearly lost her right hand from the deep cut in her palm.
“The doctor said it looked like road kill,” said her daughter, Carolyn Sanders, of Dunmore. “The nail grew so long it cut into her skin muscle down to the bone and tendon. They didn’t know at the time if they would be able to save the hand. I thought, ‘Oh my God, how could they not see this?’ ”
The state Department of Health cited Aventura at Terrace View, formerly known as Lackawanna Health and Rehab Center, in April for failing to properly care for Mecca. It is among 122 health and safety citations issued against the home from January 2019 through December 2022.
Of Pennsylvania’s 677 nursing homes, Aventura at Terrace View has the fifth-highest rate of citations, nearly five times the state average of 27.
Three other nursing homes of the 18 in Lackawanna County also had a much higher-than-average number of citations: Mountain View Care and Rehabilitation Center in Scranton, with 87; the Gardens at Scranton, with 86; and Guardian Healthcare at Taylor, formerly known as Riverside Healthcare and Rehabilitation Center, with 75.
Citations at most of the other nursing homes were either below or closer to the state average. The Gino J. Merli Veterans Center and Allied Services Transitional Rehabilitation Unit had the fewest, 13 each.
The state Health Department inspects homes annually and additionally when someone complains.
Violations at Guardian at Taylor, the Gardens at Scranton, Aventura at Terrace View and Mountain View were so serious that the Centers for Medicare and Medicaid Services (CMS) identified them as candidates for its Special Facilities Focus program as of January. The designation, placed on the worst-performing homes, subjects them to more frequent inspections and the potential loss of Medicare and Medicaid funding.
Guardian at Taylor disagrees with the basis for some of its citations, but is “committed to addressing the problem and making any necessary corrections,” spokesman Andrew Benson said in an email.
Multiple attempts to reach officials at the Gardens at Scranton, Aventura at Terrace View and Mountain View were unsuccessful.
The large number of citations at some of the county’s nursing homes is alarming and reflects growing concerns over the overall state of the industry, said Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based nonprofit that advocates for nursing home residents.
“Obviously there’s a serious issue,” Mollot said. “That should be an enormous red flag.”
Other Lackawanna County nursing homes with fewer citations had serious violations since 2019 that injured and/or jeopardized residents’ health and safety.
The most common violations relate to failing to prevent falls of residents known to be a fall risk and not properly treating and preventing bed sores from developing.
Among the most serious violations:
- Sexual assaults: Four facilities received citations for failing to protect residents from sexual abuse committed by a fellow resident. They are: Guardian at Taylor; Allied Services Skilled Nursing Center in Scranton; Aventura at Creekside in Carbondale; and the Gardens at Scranton.
- Elopements: Seven facilities had citations for failing to prevent residents from wandering from the homes or losing sight of a resident while on an outing. They are: Aventura at Creekside; Carbondale Nursing and Rehabilitation Center; the Gardens at Scranton; Guardian at Taylor; Linwood Nursing and Rehabilitation Center in Scranton; Aventura at Terrace View; and Mountain View.
- Drug diversion: Four facilities received citations for staff suspected of stealing residents’ medication. They are: Dunmore Health Care Center; Mountain View; the Gardens at Scranton; and Abington Manor in South Abington Twp.
The issues found during June inspections at both Guardian at Taylor and Mountain View were so serious that state inspectors declared an “immediate jeopardy” to residents’ safety and health — the most serious citation a facility can receive.
Guardian at Taylor was faulted for not preventing a resident known to be sexually aggressive from sexually assaulting another resident.
The inspector declared an immediate jeopardy because the home knew the man exhibited sexually inappropriate behavior when he was admitted on May 12. Despite that, it did not implement a plan to protect other residents until after a staff member caught him fondling a fellow dementia patient’s breasts on May 31.
The plan called for a staff member to monitor the man’s whereabouts every 15 minutes. On June 14, the man sexually assaulted the same resident again, placing his hands down her pants. The inspector learned the employee assigned to monitor him failed to do so because of being too busy tending to other residents.
In the Mountain View case, an inspector declared an immediate jeopardy after a resident fractured her pelvis from falling out of a mechanical lift because workers used the wrong sling size. The facility failed to ensure residents are properly assessed for the correct size sling, placing them at risk, the inspector said.
In both cases, the homes immediately took corrective actions and inspectors removed the designations the same day.
Mollot questions why the state health department did not issue more serious sanctions against the homes, such as downgrading their licenses to provisional status.
“We depend on the state to crack down and ensure if there are violations, they are corrected in a meaningful way so it is not a potential death trap for incoming individuals,” he said. “What kind of red flags does it send when you have dozens of citations year after year after year.”
Pennsylvania health department spokeswoman Maggi Barton said the agency does not comment on specific incidents. Speaking generally, the department is committed to ensuring quality care and will take disciplinary action when warranted, she said.
Wilkes-Barre attorney Jamie Anzalone, who represents several clients suing nursing homes, said most problems stem from overworked and under-trained staff.
“We see, unfortunately, that local nursing homes are either understaffed or being staffed incorrectly,” Anzalone said. “When there is not enough or them or they are not skilled enough, injuries occur.”
Zach Shamberg, executive director of the Pennsylvania Health Care Association, a Harrisburg-based industry trade group, said nursing homes are doing the best they can. Finding staff has always been challenging and the COVID-19 pandemic exacerbated it.
“Our full-time employees have a vested interest in the care that they’re providing and the mission that they’re carrying out every single day,” Shamberg said. “I don’t think it can be overstated, the workforce and labor challenges that we’ve had have certainly impacted providers’ abilities to carry out their mission of caring for our senior citizens.”
President Joe Biden’s administration vowed to address nursing home staffing issues. The White House announced plans in October that require nursing homes meet minimum staffing levels. CMS is still developing the regulation, which is expected to be released later this year.
Sanders said she hopes beefed up enforcement will help prevent issues like those that led to her mother’s injury. After dementia robbed her mother of the ability to care for herself, she placed her in Aventura at Terrace View in 2018 because it had the only open bed at the time. Mecca is now at another nursing home.
Mecca’s dementia causes her to clench her fists. The inspection report faulted the home for failing to examine her hand, which led to her overgrown fingernails penetrating her skin.
Three employees at the nursing home faced criminal charges for neglecting her, but a magisterial district judge dismissed the cases. Sanders plans to file a civil lawsuit.
Her Montgomery County attorneys, Brett Kaminsky and Derek Layser, recently put the home on notice about her intentions to sue.
Kaminsky said he’s had an influx of calls about nursing home care in the past year. He wants this lawsuit and others to send a clear message to the industry that it will be held accountable for poor care.
“The staff at Aventura at Terrace View knew about chronic staffing issues, which would inevitably lead to patient neglect, but failed to do anything about it,” said Kaminsky. “There is simply no excuse. When nursing homes like Terrace View put profits over staffing and the safety of its residents, people’s loved ones get hurt.”