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County nursing home falls short of federal standards

Commissioners vote on $200,000 supplementary funding for facility

November 25, 2010
HAVERHILL- The Grafton County nursing home is appealing a federal report that resulted in a $5,000 fine, while the county commissioners seek $200,000 in supplementary funding for the facility.

"The majority of the deficiencies cited had to do with documentation," said Grafton County Nursing Home Administrator Eileen Bolander last week in reference to a 70-page report from the Center of Medicaid and Medicare Services (CMS).

The report is the result of an annual survey the Department of Health and Human Services conducts. This year, CMS visited in September and found enough deficiencies in the way the facility handled documentation particularly in regards to several pressure ulcer cases to charge the nursing home $5,000. If the nursing home does not adequately address the problems laid out in the report by Dec. 3, the facility could lose Medicaid reimbursement, said Grafton County Executive Director Julie Clough.

Bolander has already submitted a plan to CMS that addresses the deficiencies, and two CMS representatives visited last week to check the facility's progress. Bolander is also in the process of appealing the decision, which will hopefully reduce or completely eliminate the fine. She sent a letter into CMS last week. If the appeal is granted, CMS will set a date for the county nursing home to go in front of a board of appeals in Boston.

Regardless of the outcome of the appeal, Bolander notes that the negative report is a symptom of a larger problem: a lack of funding.

"We had the poor survey as a result of not having the time to document properly," she said.

Bolander traces this back to the staff reductions the nursing home has been forced to

make over the past three years to stay within a level budget appropriated by the county and its taxpayers. The county nursing home has had to layoff by attrition an estimated five to seven nurses in recent years, said Bolander, and this has taken its toll on the facility.

"Other than medicine-administering or talking on the phone to physicians, the majority of the work a nurse is doing is documentation," said Bolander.

The remaining nurses have had to spend more of their time helping aides with treatment of the patient rather than properly filling out paperwork when forced to make the choice between treatment and paperwork, she said, nurses will always choose treatment.

The commissioners have already approved the $200,000 appropriation, but the county delegation has yet to vote. A public hearing on the matter was scheduled for Monday morning, with a vote to follow. Though she couldn't predict anything, said Clough, she was expecting the appropriation to be approved. Should that be the case, the nursing home would have immediate access to the funds, she added, which would come out of the county's fund balance.

The appropriation should augment the roughly 220 employees currently working at the nursing home. The money would go towards hiring five more full-time licensed nursing assistants (LNAs) and a 30-hour dietary aide. If granted in its entirety, additional funds would go towards offering higher quality food and bringing back activities that have been cut, such as the Annual Family Day Barbecue and some of the residents' bus rides. The Grafton County nursing home currently has about 125 patients, and a month-long waiting list.

"These things are important to residents, so they're important to us," said Bolander.

Bolander noted that, although the situation the facility finds itself in is less than ideal, it highlights a statewide funding problem.

"I think it's nice that it's bringing attention to the fact that every county has a nursing home and this is a problem at all the nursing homes," said Bolander. "The bottom line is if you want a nursing home, you have to adequately fund it."

Bolander said she thinks the taxpayers take pride in the county nursing home and would want their tax dollars being well spent, which is not the case when a county facility falls short of compliance standards.

Martin Lord Osman
Martin Lord & Osman
Varney Smith
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