LAKELAND — First, the 120-bed Oakbridge Healthcare Center lost its federal contract to take care of Medicaid and Medicare patients and had to send most of its patients to other facilities. Now, its state nursing-home license is in litigation.
The license was due for renewal Dec. 31, but the 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.
Oakbridge had known since June 5 that its Medicaid/Medicare contract would 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 that they had until Jan. 8 to find new homes for their loved ones whose bills were being paid by Medicaid or Medicare.
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, the Centers for Medicare and Medicaid notified Oakbridge its contract would be involuntarily terminated in December.
Final action to end the Medicaid/Medicare contract came after state inspectors visited again Dec. 3 through Dec. 5 for licensure and quality surveys. The Dec. 8 notice of involuntary termination of Oakbridge's Medicare/Medicaid contract said the nursing home had been out of compliance with federal regulations since June 5. The report cited 11 deficiencies.
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.
Actual harm
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."
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.
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’s room.
"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 – 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."
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.
Staffing shortages had been an issue for months. A June inspection report said the facility had failed to provide sufficient nursing staff for one out of every five shifts.
License
The sprawling, 33,760 square-foot, two-story Oakbridge facility, located off Harden Boulevard at 2110 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.
While the 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.
Oakbridge administrator Barnardo Carotenuto did not return calls for comment, nor did a spokesperson at its corporate offices in Maitland.
Consulate Health, a for-profit national nursing home chain, has 82 centers in Florida, including Oakbridge. Consulate owns four other nursing homes in Polk County: Wedgewood Healthcare, Consulate Health Care of Lake Parker, and Consulate Health Care of Lakeland and Consulate Health Care of Winter Haven.
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 two-star or below-average facility and notes that its health inspection ratings are much below average.
Consulate Health of Lakeland is currently on the state agency's watch list.
Finding new homes
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 Solaris Health Care in Plant City, a 180-bed not-for-profit nursing home.
Dyches described the period when Oakbridge patients were dispersing as stressful and chaotic and the facility as stinky and filthy.
"She is in a lot better place now. It’s 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)."
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.
"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 said.
"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."
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.
"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."
Darby said his grandfather had been in Oakbridge in a hospice situation in 2008. "There was no negligence; the experience then was fine."
Payments
Nursing homes have three main streams of revenue, said David Bruns, spokesman for AARP Florida. Across the industry, 60 percent to 70 percent of the 75,000 nursing home beds in Florida are paid for through Medicaid — a federal and state program that pays for health care for low-income, disabled adults and children.
Florida requires counties to match part of the state's share of Medicaid payments, and Polk County pays its share through the local half-cent sales tax for indigent health care.
"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."
Typically, as elderly people come out of a hospital, they are eligible for 20 days of 100-percent, Medicare-funded rehabilitation services, a service most nursing homes provide. For the next 80 days, the patients are eligible for 50 percent Medicare funding at a long-term care facility.
"After that, Medicare will not reimburse for nursing home care in most instances," Bruns said.
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.
Quality
"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."
The Legislature excused nursing homes from having to comply with tougher staffing regulations after complaints that Medicaid funding was insufficient, Bruns said. "Gradually the statues were relaxed, with AARP very much in opposition.
"If we decide as a society that we wanted to make nursing-home quality a priority, we would raise nursing-home staffing standards and raise Medicaid reimbursement rates," he said.
While staffing standards and funding are key factors in nursing-home quality, consumers should 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.
"You can look at some of the faith-based nonprofits and they are doing an excellent job by any standard," Bruns said.
"If my older relative were in a nursing home, I would tell family members to show up – a lot – and don’t 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.
"And it does not hurt to bring dessert to the nursing staff."
Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558.