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LAKELAND\u00a0\u2014 First, the 120-bed Oakbridge Healthcare Center lost its federal contract to take care of Medicaid and Medicare patients\u00a0and had to send most of its patients to other facilities. Now, its state nursing-home license is in litigation.<\/p>\n The\u00a0license was due for renewal Dec. 31, but\u00a0the state Agency for Health Care Administration denied Oakbridge’s application. Oakbridge, which is part of the for-profit nursing-home chain Consulate Health, filed an appeal. If the appeal is denied, Oakbridge will shut down.<\/p>\n Oakbridge had known since\u00a0June 5 that its\u00a0Medicaid\/Medicare contract\u00a0would be terminated if it did not start following health and safety regulations. In December, family members of Oakbridge patients were caught off guard by the nursing home’s sudden announcement\u00a0that\u00a0they had until Jan. 8 to find\u00a0new homes for their loved ones whose bills were being paid by Medicaid or Medicare.<\/p>\n Despite the black marks and risk of losing its operating license, the home continued to be cited by inspectors for numerous deficiencies through the summer, fall and winter. On Aug. 21 and again Oct. 23, \u00a0the Centers for Medicare and Medicaid notified\u00a0Oakbridge\u00a0its contract would be involuntarily terminated in December.\u00a0<\/p>\n Final action to end the Medicaid\/Medicare contract\u00a0came\u00a0after\u00a0state inspectors visited again Dec. 3 through Dec. 5\u00a0for\u00a0licensure\u00a0and quality surveys.\u00a0The Dec. 8 notice of\u00a0involuntary termination of Oakbridge’s Medicare\/Medicaid contract said the nursing home\u00a0had been out of compliance with federal regulations since June 5. The report cited 11 deficiencies.<\/p>\n Of particular concern was an “actual-harm incident” involving a hospice patient whose wife called 911 after two attempts to get staff to call a doctor.<\/p>\n Actual harm<\/p>\n A woman visiting her husband Sept. 16 called 911 after finding he “was not very responsive” and “was breathing really fast,” according to a recently released inspection report. Emergency Medical Services workers told the inspector that when they arrived, nursing-home staff said “he had been getting that way over the past two days” but “they just did not have enough help to take care of him at that time.”\u00a0<\/p>\n A licensed practical nurse, unnamed in the report, told inspectors he was the only nurse on duty on the first floor that day and was caring for 51 to 56 patients, and only two LPNs were on the second floor to care for the rest of the patients in the facility.<\/p>\n The report said the wife went to the nurse and told him he needed to call a doctor. The nurse checked on the patient and did not think he was in distress. Thirty to 45 minutes later, the wife again tracked down the nurse and asked him to call the doctor. The nurse said to give him a few minutes, saying he would do it as soon as he could. Soon after, the nurse said, he saw emergency medical workers had arrived but he was working in another hallway and did not go back to the patient\u2019s room.<\/p>\n “I guess I did nothing or not enough for him,” the nurse said to the inspector. “The family member called 911 because I took too long. She probably came up to me, too, and she said I was rude. Thirty, forty-five minutes \u2013 I had no concept of time that day. I need to remind you I was the only nurse on duty that day and one of the nurses came down (from the second floor) and helped me with some of the meds. On Sept. 16, there were only three of us in the building.”<\/p>\n The inspector also learned that the director of nursing had not reported to work since Hurricane Irma passed through Polk County about five days earlier. After a short period of suspension, the director of nursing was fired Sept. 26. An LPN who had been unit manager was also fired for not taking responsibility for the floor when the director of nursing failed to show up, the report said.<\/p>\n Staffing shortages had been an issue for months.\u00a0 A June inspection report said the facility had failed to provide sufficient nursing staff for one out of every five shifts.<\/p>\n License<\/p>\n The sprawling, 33,760 square-foot, two-story Oakbridge facility, located off Harden Boulevard at \u00a02110 Oakbridge Blvd., opened in 1982 and for years was considered one of the better nursing homes in the area. Consulate has owned it since at least 2011.<\/p>\n While\u00a0the licensing litigation is pending, private-pay patients can remain at the nursing home and new private-pay patients still can be admitted. The price of a semi-private room at Oakbridge is $278 a day, according to FloridaHealthFinder.gov.<\/p>\n Oakbridge administrator Barnardo Carotenuto did not return calls for comment, nor did a spokesperson at its corporate offices in Maitland.<\/p>\n Consulate Health, a for-profit national nursing home chain,\u00a0has 82 centers in Florida, including Oakbridge.\u00a0Consulate\u00a0owns four\u00a0other nursing homes in Polk County: Wedgewood Healthcare,\u00a0Consulate Health Care\u00a0of Lake Parker, and Consulate Health Care of Lakeland\u00a0and Consulate Health Care of Winter Haven.\u00a0<\/p>\n Wedgewood is also in danger of losing its state license after the Agency for Health Care Administration denied renewal. The license is listed as being in litigation, meaning the nursing home is appealing the denial. Medicare.gov lists Wedgewood as a\u00a0two-star or below-average\u00a0facility and notes that its health inspection ratings are much below average.\u00a0<\/p>\n Consulate Health of Lakeland is currently on the state agency’s watch list.<\/p>\n Finding new homes<\/p>\n Charlie Dyches said it took him a couple of weeks to find a new placement for his 89-year-old mother, Betty Dyches. She had been in Oakbridge since July. Using a provided list, he visited nursing homes until he found\u00a0Solaris Health Care in Plant City, a 180-bed not-for-profit nursing home.<\/p>\n Dyches described the period when Oakbridge patients were dispersing as stressful and chaotic and the facility as stinky and filthy.<\/p>\n “She is in a lot better place now. It\u2019s clean; the amount of people working there is better,” he said. “She says the food is much better, she has made friends, her spirits are better. Of course she still wants to come home, but she cannot walk (after breaking her hip in a fall at home in early July).”<\/p>\n While the Medicare.gov Nursing Home Compare website ranks Oakbridge as a one-star (much-below average) facility, it ranks Solaris as a five-star (much above average) facility.<\/p>\n “Solaris is 180 degrees different from Oakbridge,” Dyches said. “The other day they called me to tell me she would have another person as a roommate. Oakbridge never communicated anything to me,” he\u00a0 said.<\/p>\n “My problem was in not checking Oakbridge out before she went there,” Dyches said. “Living in Lakeland, Oakbridge used to be known as the greatest nursing home in the area, but things can change. It is a bad experience putting your mother somewhere like that and then you learn they did not take care of her.”<\/p>\n Timothy Darby of Darby Law Group, which specializes in elder-care law, said the firm had a few clients living at Oakbridge when the Medicare\/Medicaid contract was terminated.<\/p>\n “Some were quickly placed. There were some comments from families that there was not a lot of notice; it just happened,” Darby said. “Certain placements may not have been geographically ideal, but they did the best they could in the amount of time they had.”<\/p>\n \u00a0Darby said his grandfather had been in Oakbridge in a hospice situation in 2008. “There was no negligence; the experience then was fine.”<\/p>\n Payments<\/p>\n Nursing homes have three main streams of revenue, said David Bruns, spokesman for AARP Florida.\u00a0 Across the industry, 60 percent to 70 percent of\u00a0 the 75,000 nursing home beds in Florida are paid for through Medicaid \u2014 a federal and state program that pays for health care for\u00a0low-income, disabled\u00a0adults and children.<\/p>\n Florida requires counties to\u00a0match part of the state’s share of\u00a0Medicaid payments, and\u00a0Polk County pays its share through the local half-cent sales tax for indigent health care.\u00a0<\/p>\n “How much a particular nursing home depends on financing from Medicare and Medicaid varies widely,” Bruns said. “But generally Medicaid is the backbone of nursing home care in Florida and most other states.”<\/p>\n Typically, as elderly people come out of a hospital, they are\u00a0eligible for 20 days of 100-percent, Medicare-funded\u00a0rehabilitation services, a service most nursing homes provide.\u00a0For the next 80 days, the patients\u00a0are eligible for 50 percent Medicare funding at a long-term care facility.<\/p>\n “After that, Medicare will not reimburse for nursing home care in most instances,” Bruns said.<\/p>\n In cases when the patient has been unable to go home, the billing usually switches to private pay and assets have to be spent down until low enough to qualify for Medicaid. Since typical nursing home costs run $7,000 to $8,000 a month, it does not take long to deplete the typical family’s savings, he said.<\/p>\n Quality<\/p>\n “AARP strongly believes one of the best ways to improve quality of care in skilled nursing facilities is to have adequate levels of staff,” Bruns said. “Florida at one point had some of the highest staffing requirements in the nation. Those requirements have been gradually eroded since established 15 years ago.”\u00a0<\/p>\n The Legislature excused nursing homes from having to comply with tougher\u00a0staffing regulations after complaints that Medicaid funding was insufficient,\u00a0Bruns said. “Gradually the statues were relaxed, with AARP very much in opposition.<\/p>\n “If we decide as a society that we wanted to make nursing-home quality a priority, we would\u00a0raise nursing-home staffing standards and raise Medicaid reimbursement rates,” he said.<\/p>\n While staffing standards and funding are key factors in nursing-home quality, consumers\u00a0should also be looking at whether the nursing home is nonprofit or for profit, whether it is associated with a continuing-care community, and whether it is faith based, Bruns said.<\/p>\n “You can look at some of the faith-based nonprofits and they are doing an excellent job by any standard,” Bruns said.\u00a0<\/p>\n “If my older relative were in a nursing home,\u00a0I would tell family members to show up \u2013 a lot \u2013 and don\u2019t tell the staff when you are coming. If staff knows that family members are likely to show up at unpredictable hours and pay close attention to the care loved ones are getting, my experience is that has an impact on the care the loved one is getting.<\/p>\n “And it does not hurt to bring dessert to the\u00a0nursing staff.”<\/p>\n Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558.<\/p>\n<\/p><\/div>\n
Marilyn Meyer @marilyn_ledger
LAKELAND\u00a0\u2014 First, the 120-bed Oakbridge Healthcare Center lost its federal contract to take care of Medicaid and Medicare patients\u00a0and had to send most of its patients to other facilities. Now, its state nursing-home license is in litigation. The\u00a0license was due for renewal Dec. 31, but\u00a0the state Agency for Health Care Administration … <\/p>\n
\n\t\t\t\tMarilyn Meyer @marilyn_ledger
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