If the records of a Mariner nursing home in Catonsville, Md., told an accurate story, the treatment of a 73-year-old woman connected to a feeding tube on Jan. 9 would have been a model of conscientious care.
The nursing staff administered seven medications at 9 a.m., and another five medications at 5 p.m., the records showed. The staff noted that the patient's feeding tube was checked four times, her feeding pump was run continuously during the day and evening shifts, and she was given `water flushes' to clear the feeding tube every four hours.
But the home wasn't as thorough as it seemed.
Before any of that care was supposedly provided, inspectors found, the patient "had expired and her body had been removed from the facility."
Citing persistent deficiencies in patient care, regulators recently dropped the Mariner Health of Catonsville nursing home from Medicare and Medicaid, the government insurance programs for the elderly, poor and disabled.
The problems at Mariner Health of Catonsville may be a sign of the times, or simply an illustration of the failings that have always been endemic to nursing homes.
Either way, Mariner Health of Catonsville provides a warning of what can go wrong in facilities entrusted with the care of sick, elderly, vulnerable people -- and the warning has taken on new urgency, because much of the nation's nursing home business is in financial distress.
Mariner Post-Acute Network Inc., the corporate parent of the Catonsville home with more than 400 facilities and 50,000 beds nationwide, is a case in point. It lost $117.8 million on revenue of $1.3 billion during the six-month period that ended March 31, and its stock closed at 62 1/2 cents yesterday, down from a 52-week high of $17.12 1/2 last July.
Mariner, which was formed through a pair of corporate mergers in 1997 and 1998, may not have enough money "to sustain operations" and pay its debts as they come due, the company said in its latest quarterly report to the Securities and Exchange Commission. Last week, the company's chief executive resigned.
Mariner acknowledges shortcomings at Catonsville but says it is fixing them and that they are not representative of the company's performance.
In August, a patient at the Catonsville facility was given cardiopulmonary resuscitation despite a do-not-resuscitate order, regulators reported. In April, another patient suffered a heart attack following a series of alleged lapses in her care. She was not given CPR.
"According to the facility's director of nurses, who interviewed the licensed practical nurse involved, CPR was not done because `it didn't cross the nurse's mind to do it,' " an inspection report said.
Among other things, Mariner Health of Catonsville was faulted in the care of three patients whose sores led to leg amputations since April 1998. One developed a bedsore on her heel that "showed the bone protruding" and died days after undergoing an amputation, an inspection report said.
The nursing home was threatened with disqualification from Medicare and Medicaid in November but failed follow-up inspections in January and April, prompting its termination and fines totaling $216,000.
"There were problems, serious problems, in the home," Mariner's Spell said. "I think any time that an industry [is] . . . in crisis and facing deep cuts, that you see an effect," she said.
The company is losing nursing home workers at an annual rate of 68.7 percent, Spell said. "Finding qualified people to do these very hard jobs is a challenge across the country," she said.
In the case of the patient with the deep bedsore, amputation became necessary "despite aggressive interventions," the facility said in a statement to regulators.
Why did the staff record extensive treatment for someone who was already dead? The Mariner spokeswoman wouldn't say. The facility told regulators that the nurse responsible the "documentation errors" was reported to the Board of Nursing "for possible disciplinary action."
"On the face of it, it looks like somebody sat down and filled out the medical record to reflect care that should have been given . . . regardless of whether or not the care was actually given," said Carol Benner, who oversees nursing homes for the Maryland Department of Health and Mental Hygiene.