Following an investigation, the Vermont Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU) announced a settlement with an assisted living facility company. It is alleged that the company, which is the operator of four residential care homes in Rutland, Vermont, failed to properly train staff and adequately document and monitor the delivery of resident care services, resulting in abuse and neglect of residents. The settlement requires the company to implement new training and compliance practices, including designating an internal compliance monitor that will evaluate their performance. Additionally, if the company fails to meet certain standards at any point in the next three years, it will be required to pay $40,000 in damages and penalties.
MFRAU’s investigation of the company, which began in December 2020, alleges that the facilities:
- Failed to properly supervise the administration of medication on repeated occasions
- Failed to protect residents from abuse
- Failed to properly supervise and train staff, resulting in neglect
- Failed to ensure that allegations of abuse were timely and properly reported
Among the allegations in the settlement agreement are that staff gave a patient with Alzheimer’s Disease Benadryl to sedate the patient, even though it had not been prescribed for that purpose, and that an employee grabbed a patient suffering from Alzheimer’s Disease by the genitals, hit their arm, and caused them to fall. A death occurred in January 2021, when an employee allegedly turned a shoulder into a patient who was charging the employee. The patient allegedly fell and lost consciousness, and only hours later was taken to the hospital. The patient was diagnosed with a subdural hematoma and died.
Under the terms of the settlement, the company must designate an internal compliance monitor to (1) ensure that all individuals who deliver care services are properly trained; (2) improve the monitoring of resident needs and the timely delivery of services to meet those needs, and (3) implement a plan for improving regulatory and statutory compliance. The compliance monitor will also conduct a series of performance evaluations and issue reports to MFRAU, assessing the quality of resident care at the facilities. The compliance monitor will serve for a minimum term of two years.
The company has also agreed to develop and implement a mandatory staff training and orientation program to ensure that every individual delivering care of any kind is familiar with the residents and their care plans. This training requirement is separate from and in addition to existing training requirements for employees of residential care homes imposed under state and federal regulations.
The company will be liable for $40,000 in damages and penalties under Vermont law. These damages will be suspended unless the company is issued a statement of deficiency by the Division of Licensing and Protection at any time in the next three years.
Issue:
Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being consistent with the resident’s comprehensive assessment and plan of care. Residents’ rights for freedom from abuse, neglect, and exploitation must be protected by all staff. Quality of Care violations and lack of supervision can easily escalate to actual harm to a resident or residents, which could result in an immediate jeopardy citation for a facility. Appropriate nursing staff must demonstrate competency in medication management and resident medical necessity requirements.
Discussion Points:
- Review your policies and procedures for nursing services and other trained disciplines in providing quality of care for residents, supervision and training of staff, and medication management. Also review your policies and procedures for timely and properly reported allegations of abuse. Update policies as needed.
- Train staff regarding their responsibility to prevent abuse and neglect and when to report incidents to their supervisor, the state agency, or through the facility’s Hotline. Conduct medication management competencies for nurses, to include ensuring they understand the importance of medical necessity for all ordered medications. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that incidents of potential abuse and neglect are fully investigated, documented, and reported to the proper authorities. Involve your consultant pharmacist in the effort to audit for unnecessary drugs during his or her monthly medication regimen review and to provide training for nursing staff on medication management.
