The Justice Department has filed a complaint under the False Claims Act against an Ohio nursing home operator and three affiliated nursing homes for providing grossly substandard skilled nursing services between 2016 and 2018. The nursing homes are in Ohio, Pennsylvania, and Iowa.
In its complaint, the United States alleged the three nursing homes provided grossly substandard services that failed to meet required standards of care in various ways. For example, the United States alleged the defendant facilities failed to follow appropriate infection control protocols and did not maintain adequate staffing levels.
The United States also alleged that the Pennsylvania nursing home housed its residents in a dirty, pest-infested building; gave its residents unnecessary medications, including antibiotic, antipsychotic, anti-anxiety, and hypnotic drugs; failed to safeguard residents’ personal possessions; subjected residents to verbal abuse; neglected to provide residents with activities or stimulation; and failed to provide needed psychiatric care.
The United States similarly alleged that the Ohio and Iowa nursing homes failed to create and maintain important medical records, and that the Ohio facility repeatedly gave its residents unnecessary medications, including antibiotic, antipsychotic, anti-anxiety, and hypnotic drugs, while also failing to ensure that its residents had the prescriptions they actually needed.
The United States’ complaint provides specific allegations of how grossly substandard care harmed nursing home residents. For instance, the complaint alleged that a resident in the Pennsylvania nursing home was admitted with a history of self-harm and was hospitalized after slashing his wrists while in the facility’s care. Yet when this resident returned to the facility, it again ignored additional warning signs and failed to provide him with needed psychiatric services. Weeks after being readmitted to the nursing home, the resident committed suicide by hanging himself with a bedsheet in one of the shower rooms.
The United States’ complaint stems from an investigation that the Department of Justice initiated as part of its National Nursing Home Initiative. The department launched the initiative in March 2020 to identify and investigate nursing homes that provide grossly substandard care.
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. Resident’s rights for freedom from abuse, neglect, and exploitation must be protected by all staff. Failure to meet these requirements may be viewed as substandard quality of care, which could result in immediate jeopardy citations for the facility with fines and other sanctions. All staff members should be aware of warning signs for identifying suicide risk and suicide ideation, and to immediately report warning signs to leaders of the facility. The leaders should be knowledgeable in what to do if a resident is thinking about committing suicide, and must take all reports seriously. All staff must follow infection control and prevention best practices and ensure a clean, hazard-free environment for residents. Appropriate nursing staff must demonstrate competency in medication management and resident medical necessity requirements.
Talking Points:
- Review policies and procedures for infection control, preventing abuse and neglect, suicide prevention, and medication management. 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. Train staff on identifying warning signs of residents demonstrating suicide risk or voicing suicide ideation and how to immediately respond. Provide periodic refresher training on infection control and prevention requirements, including specifics for each department. 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. Periodically audit to ensure that the infection control plan is being followed by all staff members. Audit staff understanding of warning signs of suicide ideation or risk, and how to immediately report concerns. Involve your consultant pharmacist in the effort to audit for unnecessary drugs and to provide training for nursing staff on medication management.
