A Prince George's County nursing home that repeatedly has been cited for poor patient care is about to have its Medicare and Medicaid funding cut off by state and federal officials, a move that could force the relocation of 115 frail or disabled residents beginning next week.
Manor Care Health Services in Largo has failed nine state inspections since 1997, most recently in August. On Oct. 27, federal health officials accepted Maryland inspectors' recommendation and terminated the facility's Medicaid and Medicare funding as of Nov. 15. A request for reconsideration by Manor Care representatives was rejected last week. The company said it is considering appealing to federal administrative law judges.
The lifting of Medicaid and Medicare funds--the lifeblood of hospitals and nursing homes--is a dramatic step that officials use only as a last resort in trying to deal with care problems at a facility. Maryland has 261 nursing homes; the Largo home would be the third one to be closed this year because of such deficiencies.
"We believe the residents are entitled to safe care, and that's what they have not gotten at Largo," said Carol Benner, head of Maryland's office of health care quality.
But executives at HCR Manor Care Inc., the Largo home's parent company, contend that Benner's agency has gone overboard.
"The medical evidence shows we're innocent," said the company's national medical director, Karen Babos, a geriatrician who visited Largo recently and heaped praise on the home.
"It's one of our best facilities," she said. "It never smells. The place is clean. When you talk to a resident, they all seem very happy with the care. I even found a lot of people who like the food, and usually old people don't like the food no matter how good it is."
The most serious recent problem at the home, state inspectors say, came in August, when an inspector on a scheduled visit reviewed a random sample of medical records. The inspector found that a 73-year-old woman with terminal bladder cancer and other complex health problems gave end-of-life instructions that allegedly were misinterpreted.
The resulting actions of nurses, pharmacists and doctors put her health in jeopardy until the inspector spotted the problem during the Aug. 25 visit, Benner said. The woman's treatment then was stepped up, and she improved again before ultimately dying of cancer in late September, the state said.
Benner said she was particularly frustrated that HCR Manor Care, a publicly traded company that owns 298 nursing homes and other health facilities in 32 states, couldn't improve its performance despite warning after warning.
"They knew they were in trouble; they knew we were going to be back because they were under an intense microscope, and we still found problems," she said. "That's scary."
Benner said that HCR Manor Care must decide whether to continue operating in Largo without Medicaid or Medicare payments. If that happens, the facility would be subject to a period of intense state scrutiny, whether it relocates residents or keeps them there while it reapplies for Medicare-Medicaid certification.
Babos said that Maryland has the toughest regulators in the nation and that they are overstepping their responsibilities by second-guessing reasonable decisions made by doctors.
"Maryland is beyond aggressive," she said. "I have to say Maryland is the worst. There have been other hot spots like Florida, Pennsylvania, Ohio and California, but in those states, if you have a good medical case, they listen."
Nursing home regulation has grown more stringent in recent years as the U.S. Health Care Financing Administration issued stronger standards, increased penalties and beefed up enforcement efforts.
Nursing homes whose Medicaid and Medicare payments are terminated have 30 days of continued funding to care for patients during the relocation period, which is supervised by state inspectors.
"It's not easy to relocate residents," Benner said. "It's not something we like to do or routinely do, and when we do it, we try to do it in the safest way possible."
Greenbelt Nursing and Rehabilitation Center shut down in January and Windsor Ridge Nursing Home in Baltimore County did so in March, under similar circumstances.
Benner said Manor Care Largo residents were found to have suffered "actual harm" on five of nine inspections. Most cases involved bedsores and dehydration. Some cases involved residents who went to Largo from the Greenbelt nursing home after it closed.
"It more than frustrates me," Benner said of those who were moved from Greenbelt and then were at Largo when that home was cited for deficient care. "It makes me more than upset. I was angry and hurt for those residents."
In the August case, the 73-year-old woman, an amputee, had gone to the Largo nursing home to learn how to walk with a new artificial leg. She asked to be allowed to die if her heart stopped, according to state records.
But the attending physician was told erroneously that the patient wanted "comfort care only," which means only relief of symptoms and pain but no treatment of underlying illnesses, officials said.
The woman's condition worsened at times, allegedly because the "comfort care only" protocol led doctors to prescribe inappropriate drugs and limit lab tests, the state said.
"Nothing of a medical nature was withheld from this lady," Babos said. ". . . The issue is that the [state] surveyors are acting like doctors."