Alaska ranks high nationally for nursing homes deficiencies, but why?

So far this year, 10 nursing homes in Alaska have been cited more than 100 times for health or safety shortfalls, according to state and federal inspection reports.

The state has some of the highest rates of nursing home deficiencies in the nation, according to ProPublica, an investigative reporting outlet. But Alaska inspectors say context is important.

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Alaska nursing homes are inspected on the state and federal level annually to make sure they’re meeting regulations.

Brenda Vincent runs the state’s program that oversees health facilities’ licensing compliance, which includes nursing homes.

She says the inspections are unannounced, and that over a few days, a small team of surveyors analyze everything from the fire safety code to treating residents respectfully.

Nursing Home Inspect

Lookup inspection reports from nursing homes in your community or elsewhere on ProPublica’s Nursing Home Inspect site

“We use tools of observation, interviews, record reviews,” Vincent says,”all just to ensure that they’re being compliant and following state and federal regulations, and ensuring that the best care is delivered to residents in those facilities.”

Angela Rick has been inspecting nursing homes for eight years.  She says that over time, there are some things that nursing homes are repeatedly cited for.

“Our most common ones would be dignity of the resident, so making sure that it’s a homelike environment and the resident is treated in the manner that you would want to be treated or your family member treated,” Rick said. “Infection control would be a common deficiency (as well).”

Rick says high turnover among nursing home staffers can contribute to some of the inconsistencies.

“We used to say that you’re only as good as your worst performer,” she said. “So it’s very difficult sometimes to monitor what the staff is doing, and so one person could make a mistake or could have a practice and that would cause you do a get a deficiency in that area.”

According to data from the Centers for Medicare & Medicaid Services, inspectors logged 147 deficiencies at the 10 Alaska nursing homes visited so far this year. Alaska has a total of 18.

Source: Centers for Medicare & Medicaid Services. (Graph by Lakeidra Chavis/KTOO)

Most of the deficiencies are categorized as causing minimum to no harm. Some incidents are isolated, some are repeated. There are serious deficiencies, too.

At the nursing home in Petersburg, for example, deficiencies included administering the wrong medication dose and not returning a resident’s money after the person died.

In Wrangell, a resident with a condition requiring a “nectar consistency” diet to reduce choking risk, reportedly used a spoon to drink over thickened coffee because a staffer added thickener without measuring. Other residents reported similar problems.

Vincent says although the number of citations is high, the goal is to keep these institutions accountable.

After each inspection, nursing home administrators are required to submit a plan of correction, which surveyors review.

“And if we find a deficiency, we need to bring that forward to the facility and let them know,” Vincent said. “You know, if you don’t, then change isn’t going to be made and that’s important. I mean, if you see something wrong, it needs to be corrected. If you don’t bring it to the light, then it just stays uncorrected.”

Nursing homes with severe deficiencies can rack up penalties. Since 2013, the agencies have fined nursing homes more than $100,000, or denied Medicare and Medicaid payments.

Source: Centers for Medicare & Medicaid Services. (Graph by Lakeidra Chavis/KTOO)

For the Prestige Care & Rehabilitation Center in Anchorage, the problems were so bad that thestate took control of the facility last year to address the issues.

After a national investigation into nursing home safety, ProPublica, ranked the states with the most severe deficiencies in nursing homes. Their most recent data ranks Alaska as the fourth worst.

“Number-wise, we’ve heard that and I don’t know why,” she said. “I just think that we have a really good team.”

Vincent says that compared to the Lower 48, the turnover for Alaska inspectors is low and the nursing homes are a lot smaller.

She says in about a year, the state will switch to a newer model of surveying, following a national trend. It will combine the traditional boots-on-the-ground method with a computer-based survey.

Vincent says that it’s important for people to know that there is oversight. She worked as a registered nurse in Alaska before switching to the inspection side five years ago.

“I’m on the other side ensuring the care that you are getting is quality, and safe, and complies with best practices and standards that have been set,” she said. “So I really think that what I do and what my team does, makes a difference.”

Becky Hultberg is the president of the Alaska State Hospital and Nursing Home Association, which lobbies for its members.

She says inspection reports are just one of the ways to measure nursing home care.

Becky Hultberg, president and CEO of the Alaska State Hospital and Nursing Home Association, gives a presentation about Medicaid expansion at the Alaska Capitol, March 19, 2015. The event was sponsored by Sen. Berta Gardner, D-Anchorage, Rep. Paul Seaton, R- Homer, and Sen. Donny Olson, D-Nome. (Photo by Skip Gray/360 North)
Becky Hultberg, president and CEO of the Alaska State Hospital and Nursing Home Association, gives a presentation about Medicaid expansion at the Alaska Capitol, March 19, 2015. (Photo by Skip Gray/360 North)

“As an example, there are several CMS quality measures where Alaska skilled nursing facilities have better outcomes than most facilities in other states,” Hultberg said. “Specifically, Alaska does very well in preventing falls, reducing the use of antipsychotics and successfully managing the use of physical restraints.”

She says Alaska is a small state with a small number of nursing homes, and that calls the attention of federal regulators.

“I would note that there are times where we have more surveyors in a facility than we have residents…the ProPublica data was not a huge surprise to me,” she said.

Hultberg says a lot it has to do with a federal law she calls the minimum of five.

“The federal government is required to survey five percent of facilities in a state a year, or a minimum of five facilities,” Hultberg said. “Well if you’re a state that has hundreds of facilities, obviously you’re going to be getting fewer federal surveys, than a state like Alaska where we only have 18 facilities.”

Based on inspection reports alone, of the 10 nursing homes inspected so far this year, Alaska’s most deficient are the Prestige Care and Rehabilitation Center of Anchorage, Wrangell Medical Center and the Yukon Kuskokwim Elders Home in Bethel.

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