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Virginia Nursing Home Faces Possible Medicare Termination

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Carriage Hill Health & Rehab in Fredericksburg, Va., is on the federal Special Focus Facility list for nursing homes with a pattern of serious problems.
Rebecca Blatt
Carriage Hill Health & Rehab in Fredericksburg, Va., is on the federal Special Focus Facility list for nursing homes with a pattern of serious problems.
Joseph Roberts, Jr., recovers from severe burns after his clothes caught on fire while staying at the Carriage Hill Health & Rehab facility in Fredericksburg, Va. Photo courtesy of Charlotte Roberts.

A jury recently awarded $1.45 million to a Virginia family in a negligence suit against a Fredericksburg nursing home. The incident is just one in a series of serious problems which could ultimately compromise the facility.

Joseph Roberts Jr., a 47-year-old veteran, arrived at the Carriage Hill Nursing and Rehab Center in May 2011. He had broken his hip and had a host of other medical conditions, including numbness and paralysis on one side. He was taking painkillers for severe back trouble and was being treated for depression.

Roberts was a smoker, and that was significant, because Carriage Hill is a smoke-free facility. He insisted on smoking anyway, and early one morning a Carriage Hill staff member took him outside in a wheelchair near a landscaped area to have a cigarette.

"He was left outside," says Roberts' wife, Charlotte. "And they went back in to do their work, and when they came back he was on fire."

Roberts has since died of an unrelated infection. Charlotte did not witness the incident, but she says she's pieced the story together from his recollections and testimony of others.

Exactly how the fire started has been in dispute. In the civil trial this summer, Carriage Hill cited Roberts' history of mental illness and suggested he may have lit his clothes on fire intentionally. But attorney Charles Meltmar, who represents the Roberts estate, says Roberts testified that the fire started by accident.

"He didn't see where it landed because he suffered from left side paralysis," he says. "So what he testified to in deposition was that he saw the fire coming up his left leg, and he tried to put out. But because he had left wrist contractures, he was unable to do it."

Joseph was taken to the Medical College of Virginia in Richmond with second and third-degree burns on his legs. Earlier this month, a jury in a civil trial awarded his family nearly $1.28 million plus $170,000 in interest.

"He was someone who was suffering from mental impairment as well as physical impairment," Meltmar says. "And the combination of the both of those illnesses meant that he either needed to be watched or evicted and they did neither."

Carriage Hill has been on the Special Focus Facility list for 19 months, and according to CMS, it has not shown improvement. It's the only facility in Northern Virginia or D.C. on the list.

"A Pattern of Serious Problems"

Carriage Hill administrators had agreed to an in-person interview with WAMU to discuss the case, but they canceled at the last minute, saying they were evaluating options for an appeal and decided a conversation would be premature.

In a written statement, the facility said it respectfully disagrees with the jury's decision.

"Carriage Hill Health & Rehab Center is committed to providing safe and professional care to our patients and residents," the statement reads. "We practice security and safety measures which ensure that patients and residents are cared for in the most caring and respectful manner."

Carriage Hill refused to discuss safety issues that continue to plague the facility. In January 2012, six months after the fire, Carriage Hill was placed on a federal list of so-called Special Focus Facilities. According to the Centers for Medicare and Medicaid Services (CMS), these are nursing homes with a pattern of serious problems that have persisted over a long period of time.

According to CMS guidelines, Special Focus Facilities are supposed to reach one of three outcomes within 18-24 months of being added to the list: They can improve and graduate, they can be terminated from Medicare and Medicaid, or they can be granted an extension if they show strong improvement.

Carriage Hill has been on the Special Focus Facility list for 19 months, and according to CMS, it has not shown improvement. It's the only facility in Northern Virginia or D.C. on the list. Two facilities in Maryland are on the list, but both are in a group with documented improvement.

CMS gives Carriage Hill one star out of five and calls its overall rating "much below average."

The most recent state health department inspection in June documented numerous problems and prompted a $3,000 fine from CMS. The inspection cited a case in December in which a patient fell while trying to move from a wheelchair to the toilet --- sustaining a hip fracture that required surgery. The inspection quotes a Carriage Hill report attributing the fall to the failure of a certified nursing assistant. The CNA reportedly wheeled the patient to the bathroom and then left the patient alone.

In a written response to the report, Carriage Hill says all nursing staff will be educated on resident transfers and providing assistance as needed.

A Community Concern

Joani Latimer, Virginia's Long-term Care Ombudsman, says consumers should be concerned about safety records like Carriage Hill's.

"I think that it's a concern for the whole community around that nursing home to be aware of that and to be a resource get involved in trying to help find out what the underlying problem is," she says.

Latimer encourages families to look at records on the CMS website before choosing a nursing home or rehab center, and she suggests reaching out to local agencies on aging before choosing a facility. But she says often it's hard to make sense of reams of inspections, evaluations and quality measures.

"It can be pretty overwhelming," she says. "Even if they know where to find the information, how to really interpret it is another piece of it."

Latimer encourages people to visit nursing homes, even several times, and talk with staff, patients and their families before making a decision about where to go.

Resolution in Court

As for the Roberts case, both parties are due back in court on Monday, when the judge is expected to formally enter the jury's verdict into the court record. Charlotte Roberts says she thinks her husband would have been pleased with the jury's assessment. She says in addition to severe burns, Joseph often had nightmares and flashbacks from the incident.

"He had suffered a long time," she says. "And he felt like that the way he explained it to me, he felt like they owed him for what had happened to him."

She says mostly she's relieved the jury agreed that the fire wasn't Joseph's fault, and that Carriage Hill should have done more to keep him safe.

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