ANNAPOLIS, Maryland — Nursing homes in Maryland would get better oversight under two bills passed this year by the General Assembly.
The two Senate bills each passed on the Legislature’s final day, outlining the state’s effort to address a need for better quality in its nursing homes.
Sen. James Mathias, D-Somerset, Wicomico and Worcester, the sponsor of one of the two bills, made that clear in his testimony on Senate bill 386 before the House Health and Government Operations Committee on March 27.
“We always tout with great pride how great we do in Maryland,” Mathias said. “Unfortunately, with our nursing homes, we haven’t done so well.”
Mathias’ bill requires the Maryland Department of Health to, within 10 business days of a complaint alleging actual harm in a nursing home, initiate an investigation. If a complaint alleges immediate jeopardy to a resident, the department must make every effort to investigate within 24 hours and is required to investigate within 48.
Additionally, the Office of Health Care Quality, which responds to nursing home complaints in Maryland, starting in fiscal year 2020 and ending in fiscal 2024, will annually receive 10 new, full-time merit positions.
A 2017 report from the U.S. Department of Health and Human Services Inspector General lists Maryland as the seventh-worst state in the nation for on-time investigation of nursing home complaints.
The same report reveals the state did not investigate 74 percent of high-level nursing home complaints within the federal deadline of 10 days, averaging 47 days to respond, all while being “historically understaffed,” according to the report.
Sen. Shirley Nathan-Pulliam, D-Baltimore City and County, who brought these problems to the attention of the General Assembly about 19 years ago, said little has changed for the better in that regard.
She introduced Senate bill 4, which will make changes to the Oversight Committee on Quality of Care in Nursing Homes and Assisted Living Facilities.
Testifying in front of the Senate Finance Committee on Feb. 1, Nathan-Pulliam described an instance in October 2017 when her son, rehabilitating from surgery, was in a facility reported to have bed bugs. Nathan-Pulliam said she had the facility investigated and they reported back with finding one bed bug, which indicated to her that there could be more.
A call from a constituent recounting a nursing home’s failure to bathe her paralyzed husband inspired Nathan-Pulliam to act on the issue, she said. The senator, who walks with a cane, said the poor treatment wasn’t limited to others.
“I was sent for rehab in one that I signed myself out of overnight for that very same poor quality of care,” Nathan-Pulliam said.
Nathan-Pulliam’s legislation adds new members and adjusts roles and responsibilities within the nursing home oversight committee. The additions include the secretary of disabilities, a state long-term care ombudsman and the director of the Office of Health Care Quality.
“Senate Bill 4 and Senate Bill 386 offer additional guidance from the Maryland General Assembly regarding how to best meet state and federal mandates for these facilities,” the Maryland Department of Health told Capital News Service in a statement.
Gov. Larry Hogan, R, has yet to take action on the bills, which would become law unless he vetoes them.
Michele Douglas of the lobbying firm Public Policy Partners testified in support of both nursing home bills on behalf of the Alzheimer’s Association.
“What we’re trying to do through Senate bill 4 is really revitalize the committee,” Douglas said.
While she set out to improve nursing home quality, Nathan-Pulliam said not all nursing homes in Maryland are lacking in quality, but the ones that fall short need fixing, fast.
The Maryland Department of Health’s Office of Health Care Quality 2017 annual report showed that, between fiscal year 2016 and 2017, the number of complaints and facility self-reported incidents in nursing homes increased by 856 — a 34.4 percent increase. There were 3,342 total in the last full fiscal year.
There were also 1,749 quality of care allegations and 941 resident abuse allegations in nursing homes across the state during fiscal year 2017, which constitute 34.5 percent and 25 percent decreases from 2016, respectively, according to the report.
The official U.S. website for Medicare has a rating system for nursing homes by state. In Maryland — according to data collected through Dec. 31 — 20 nursing homes were below average or worse in terms of quality measures. Twenty were below average or worse with regard to staffing.
Sixty-two nursing homes earned a two-star overall rating or lower, meaning more than 27 percent of the 226 listed nursing homes in Maryland are considered by the federal government to be, at best, below average in terms of quality.
According to a family satisfaction survey by the Maryland Health Care Commission, where the most recent data comes from 2016, 1,140 out of 8,302 family members of patients in nursing homes said they would probably or definitely not recommend their family member’s nursing home to someone seeking nursing home care.
The timing of the bills links up with a February Maryland Court of Appeals decision upholding Attorney General Brian Frosh’s authority to prevent patient dumping from nursing homes.
Mathias told Capital News Service that his bill was not related to Frosh’s efforts, but it adds another aspect to the attempts to improve nursing home conditions.
A September 2016 Capital News Service investigative report examined nursing home discharges and oversight in Maryland. (http://cnsmaryland.org/discharging-trouble-maryland-nursing-homes/)
In December 2016, Frosh sued Neiswanger Management Services after uncovering that, during a seven-month period ranging from Jan. 1, 2015, to May 31, 2016, Neiswanger’s five facilities in Maryland issued at least 1,061 involuntary discharge notices. During that same time frame, the other 225 licensed nursing facilities issued just 510 notices combined, according to Frosh’s lawsuit.
Neiswanger Management Services moved to dismiss Frosh’s suit, alleging he didn’t have the authority to sue them over the patient dumping. However, in February, the Court of Appeals of Maryland upheld Frosh’s power to proceed.
The Office of the Attorney General said last month there was no update on the case.
Meanwhile, in March, a federal judge upheld a lawsuit by Neiswanger, which alleges state officials targeted their nursing homes, violating constitutional rights with enforcement procedures.
Attorney Brian Glasser, who is representing Neiswanger, told Capital News Service this week both cases are in the discovery phase, meaning each side is giving depositions and producing documents to one another.
While the cases are still in the early stages, Douglas said the new legislation could bring about improvements that address patient dumping if the problem persists.
Particularly, Nathan-Pulliam’s bill gives the committee opportunities to look at issues like the one Frosh addressed, Douglas said.
“This is the Legislature and advocates coming together and looking to constantly look at ways to continually improve quality of care for residents in nursing homes and assisted living facilities,” Douglas said. “That job is never done. We can always improve at any point.”