Voorhees says most of his nursing home cases concern negligence—not turning people often enough to avoid pressure sores, for instance, or failing to take proper precautions to prevent falls—rather than abuse.
But even a simple mistake can have disastrous results if it’s not reported.
From 2005 until this February, federal and state investigation reports for Casa Real reveal a pattern of unreported neglect, abuse or errors. In one report, investigators interviewed two different registered nurses who witnessed the same staff member verbally abusing residents. Neither reported it.
Anderson tells SFR that any unexplained incidents—such as a resident who falls when no one’s around—must be reported to Casa Real superiors, as well as to the state’s Department of Health. Both Voorhees and Harvey say that frequently doesn’t happen.
Three of Voorhees’ current cases, he says, involve unreported or unexplained falls.
One man fell out of bed, Voorhees says, “and staff just picked him up and put him back in bed with a broken hip.” Another involves an elderly female resident: “When they took her to the hospital, the doctor said the break was three days old.”
Voorhees says nursing home staffers often don’t want to get in trouble or lose their jobs.
But, according to federal and state investigation reports (called “surveys”) on nursing home quality, most disciplinary action involves retraining staff rather than terminating them.
In addition to those surveys, which the Centers for Medicare & Medicaid Services (CMS) conducts every nine to 15 months for every nursing home in the country, both CMS and DOH also conduct surveys in response to complaints related to specific nursing homes.
Additional oversight comes from a host of other state and federal agencies.
The New Mexico Department of Health is responsible for investigating complaints of abuse, neglect or exploitation allegedly perpetrated by nursing home employees, while Adult Protective Services, an arm of the state’s Aging and Long-Term Services Department, deals with abuse, neglect or exploitation perpetrated by community or family members. Finally, as the state’s long-term care ombudsman, Everhart oversees 10 regional coordinators—such as Trotter—each of whom frequently visits nursing homes in his or her area, investigates non-abuse-related complaints and advocates for residents’ rights.
As part of each state’s ombudsman program (which is created by federal law, but administered by individual states and is charged with advocating for residents), nursing home residents have their own bill of rights. These rights range from freedom of abuse and neglect to eating “appetizing and nutritious meals.”
In part because she must refer abuse and neglect cases to either APS or the DOH, Trotter says most of the work she does advocating for nursing home residents has to do with those rights.
Everhart also notes that New Mexico is the only state that requires monthly meetings in which the ombudsman, DOH, APS and the state Human Services Department’s Medicaid Fraud Unit discuss their concerns about the state’s nursing homes and strategize to address them.
“That is a tremendous protection because not only does it work, we support each other,” Everhart says. “It isn’t that there aren’t problems; there are. And there are some very serious problems. But between APS and the Department of Health and the ombudsmen, we are getting to them.”
That may be, but it’s hard to know.