NORMANDY, Mo. (AP) — Over the past 10 years, inspectors have cited a St. Louis County nursing home for scores of problems, ranging from failure to swiftly report alleged abuse to lack of heat in the facility during a cold snap in April.
After a string of deficiencies this year, federal regulators sent a letter to the home, Normandy Nursing Center off St. Charles Rock Road, saying they were poised to terminate Medicare funding.
But the center filed notice it was fixing the problems, and, three days before the deadline, regulators reversed course.
“Things have to be really bad, and sustainably bad, with no improvement for a long time,” said Marjorie Moore, executive director of VOYCE, a nonprofit based in Marlborough that advocates on behalf of nursing home residents. “And that is a problem.”
The U.S. Centers for Medicare and Medicaid Services, which funds and regulates nursing homes, rarely threatens to terminate Medicare funding. And it even more rarely follows through: It has cut off reimbursements to just three nursing homes in Missouri in the past decade, according to agency records. And yet facilities here and across the country are littered with “deficiencies,” as described by state inspectors.
Across the state, there are more than 500 nursing homes eligible to receive federal reimbursements. The Centers for Medicare and Medicaid Services, known as CMS, rates nursing homes on a scale from 1-star, or “much below average” quality, to 5-star, or “much above average” quality.
The St. Louis region has an outsized share of low-rated nursing homes. Statewide, 21% of facilities in the Medicare and Medicaid programs have 1-star ratings from CMS. In St. Louis and St. Louis County, the number is 46%.
Today, Normandy Nursing Center has a 1-star rating.
The home is licensed for 116 beds, and from 2011 to 2019, the reports show, the census was normally about 90 or 100 when inspectors visited. In recent months, it has hovered between 30 and 50, according to CMS data, suggesting a dramatic drop in occupancy during the pandemic.
The nursing home’s inspection reports going back 10 years showed that surveyors have told management to fix nearly 200 issues over that time.
Recently, family members of a Metro East man who stayed there for three days this spring said he suffered a broken nose while under the facility’s care, and they have been unable to get any explanations.
Kathy Plurad, 62, a physical therapist, said she worked part-time at Normandy Nursing Center on a staffing agency contract from November 2011 to April 2012. Plurad said she noticed patients being neglected and spoken to disrespectfully by staff.
One day, when an inspector came to survey the facility, Plurad wrote on a piece of paper: “You need to close this place.”
She said she showed the inspector the note, and then ripped it up, and threw it away.
The facility’s owner, Creve Coeur-based MGM Healthcare, didn’t return multiple phone calls seeking comment.
‘Expectations should be high’
The state Department of Health and Senior Services is responsible for inspecting nursing homes twice a year. CMS and the Missouri Medicaid Audit and Compliance Unit are responsible for imposing fines. They can also terminate a facility’s federal reimbursements — but that happens in only the most extreme cases.
In 2012, CMS revoked the Medicare agreement for Shady Lawn Nursing Home, in the northwest Missouri city of Savannah. CMS did not respond to requests for details about the reason for the closure in time for publication, and the state health department said it did not have the inspection reports because, under its records policy, they are destroyed five years after a facility is closed.
In 2015, CMS cut off Medicare funding to Liberty Terrace Healthcare and Rehabilitation Center, outside of Kansas City. The decision followed a series of bad inspections and multiple wrongful death lawsuits, a local NBC affiliate reported at the time.
In 2016, the agency revoked Medicare funding from Benchmark Healthcare of Festus, a 79-bed nursing home, after the facility failed to provide enough food for its residents, failed to give four residents their medications, and fell far behind on its bills. Employees spent their own money on grocery runs, and washed residents’ soiled clothes and sheets in their own houses and laundries after the nursing home’s washing machines broke down. The then-owner of the facility was later sentenced for stealing Medicaid dollars.
In 2018, CMS stopped reimbursing care for new residents of a nursing home in Ferguson — Christian Care Home — and threatened to terminate all funding if dramatic improvements weren’t made. The nursing home shut down shortly after, with leadership citing financial issues.
Advocates are trying to catch problems before they become serious.
VOYCE regularly sends staff and volunteers into 374 area nursing homes to talk to residents about their concerns.
“We’ve been able to make facilities better just by our presence,” Moore said.
They were unable to go into facilities when they were locked down due to COVID-19, so the number of complaints the program received slowed down significantly. Now they are back in the nursing homes and attempting to catch up for lost time. The numbers of complaints and requests for information now, Moore said, are back to pre-pandemic levels, and more come in as VOYCE gets more staff and more resources.
“Running a nursing home is a big responsibility,” Moore said. “The expectations should be high.”
In March, an inspector visiting Normandy Nursing Center wrote that staff had not immediately reported when a resident had expressed fear of a staff member and alleged that the employee hit the resident across the ankles. The administration investigated the incident and was unable to substantiate the allegation, it said in a report.
In April, during a follow-up inspection, a resident who was incontinent complained that he or she had not been changed during the night, despite calling for staff. And when the outside temperatures dropped to lows of 33 and 30 degrees, staff handed out blankets to residents but didn’t turn on the heat.
Then in June, an inspector found that an exit door did not latch properly, and a resident had left the nursing home without the staff’s knowledge.
In each case, as with all the deficiencies filed this year, the nursing home made changes. It gave employee training on abuse prevention and reporting, caring for incontinent residents, and protocols for residents at risk of leaving without staff knowledge, according to the plans of correction it filed with CMS. It repaired the faulty exit door, and said it would do audits regularly to make sure residents were getting the care they needed, and that the temperature was comfortable.
But some are still worried.
Robert Allensworth, a resident of Wood River, Ill., and a former Olin Corp. machinist, was diagnosed in 2018 with a traumatic brain injury after a surgery, and from then on has required constant care. Over the next few years he moved around to a handful of different long-term care facilities.
This spring, he had a three-day trial stay at Normandy Nursing Center, starting on April 12, according to police records and interviews with two of his family members. But late that evening, Normandy Police were called to the nursing home because Allensworth was causing a disturbance and had barricaded himself in a room with two other people, according to a police report.
Allensworth was taken in an ambulance to South City Hospital, where he was given a psychiatric evaluation. He was taken back to the nursing home on April 14, and then brought back to the hospital once more, on April 15, to pick up a prescription.
His mother, Sharon Allensworth, said that when she went to Normandy Nursing Center to pick up her son on April 15, his face and nose were swollen and he had bruises on his chest. She took him to Alton Memorial Hospital the following day, and learned that he had a fractured nose. She didn’t know when or where he had been injured during the three-day period.
Robert had fallen and gotten injured at other facilities in the past. But Sharon Allensworth said she was used to being notified of each injury, and receiving an explanation of how it had happened. She was shocked that no one at Normandy Nursing Center had notified her.
The family reported the incident to the Normandy Police Department. Sharon Allensworth said she had called the nursing home countless times. And the family made a report to the state Department of Health and Senior Services, which responded on Aug. 27 in a letter to Robert Allensworth’s sister, Patricia Robien.
The letter says the department made unannounced visits to the facility in April and “no information was found” to show that her brother had been injured at the facility, but that in “no way negates” her concerns.
By late summer, Robert Allensworth was living at his home, with help from family and a hired caregiver. His family said he caught COVID-19, and died in August at the age of 56.
His family is still searching for answers about his injuries in April.
“I’m not going to let this go,” Robien said.
“I just want them to respond to me,” Sharon Allensworth said. “What happened? How did he get hurt?”