‘Level of concern’ at home

The pain in the nursing-home resident’s right leg was so intense, she let out a stream of blood-curdling screams.

An employee at St. Monica Manor responded, but somehow dropped the resident on the floor while evaluating her. The worker never reported the fall to a physician.

The woman already was in agonizing pain following surgery earlier that day. Not having access to Percocet, the strong painkiller that the resident had been prescribed, the nursing-home staff gave her Tylenol.

The woman complained of discomfort throughout the night and only stopped the following morning – when she was pronounced dead.

This incident is one of several detailed in a recent state report on St. Monica Manor, 2509 S. Fourth St.

The facility was known as Methodist Hospital Nursing Center until the Archdiocese of Philadelphia’s Catholic Health Care Services purchased it for $2.8 million last summer. The 180-bed home currently houses 175 residents.

The Pennsylvania Department of Health is responsible for monitoring the conditions at nursing-home facilities throughout the state, basing its analyses on patient care and building safety.

Facilities can receive citations in 11 categories for failure to adhere to regulations (see sidebar). A scale classifies the citation’s potential impact on a resident, from no harm to minimal, actual or serious harm.

Minimal harm occurs when residents experience minimal discomfort or can no longer achieve their highest functional status; actual harm indicates a deficiency has compromised a resident’s ability to maintain his or her most practicable physical, mental and psychosocial well-being; and severe harm indicates a resident is in immediate jeopardy of a situation that may cause injury, harm, impairment or death.

OVER A 30-MONTH period up to the present, St. Monica Manor (which, for most of that time, was known as Methodist Nursing Center) received 43 no-harm citations, 28 minimal-harm citations and three actual-harm citations. The statewide average during that time frame is 17 citations for no harm, 17 for minimal and one for actual.

Department of Health spokesperson Richard McGarvey said the above-average results, particularly for actual-harm incidences, are at a "level of concern" for family members with loved ones in the facility.

Michael Curry, former administrator for Methodist Nursing Center, said the high numbers are "skewed" due to building safety deficiencies, primarily involving old furniture.

"From a patient-care standpoint, we had a good reputation," said Curry, who is now vice president for physician operations and support services for Methodist Hospital, Broad and Wolf streets.

"All of the deficiencies cited have been corrected. Prior to selling, we replaced all of the furniture and did major renovations."

The state’s patient-care inspection report based on a routine Jan. 24 visit makes note of four residents who were victims of actual-harm incidences. These combined cases resulted in one actual-harm citation for the nursing home.

"It was determined that the facility failed to administer/provide medication as ordered, obtain laboratory results, notify the physician of bruising, injuries or laboratory studies and obtain laboratory results as specified by the physician for three … residents … and for one resident who was not assessed or provided timely treatment after a fall," the report stated.

The last resident mentioned, who complained of "not feeling well" on Jan. 3, was not monitored or assessed until Jan. 7, according to nursing documentation outlined in the report.

That woman was the one who died the morning after having surgery. X-rays revealed a fracture to the resident’s right thigh, though it is not reported whether being dropped caused the fracture, McGarvey said.

According to the Department of Health report, "there was no evidence that the resident was assessed throughout the night, there was no documented vital signs from 2 a.m. to 10:30 a.m., when the resident was found to be unresponsive. The resident expired at 10:40 a.m."

Minimal-harm incidences at St. Monica included a resident whose doctor ordered her to have a topical medication applied to a pressure sore for about a week, but did not receive it from any member of the staff.

All of the cases are public record and are posted on the Department of Health Web site and inside nursing-home facilities.

WHENEVER A NURSING home receives citations for offenses that fall in the minimal-, actual- or serious-harm category, the facility must develop a plan of correction about 15 days post-inspection, said McGarvey.

"We will then go back through the facility, determine if this plan of correction fixes the problem and prevent it from occurring in the future," he said. "We don’t tell a facility how to correct a problem. We can’t tell them what’s best for their facility because we’re not the ones caring for the residents."

As of April 26, St. Monica Manor was "found to be in full compliance, with the previously cited deficiencies being corrected," said Stewart Skinner, director of facility-based operations for Catholic Health Care Services, which manages five nursing homes in Philadelphia.

Inspection results on the Department of Health’s Web site confirm this statement.

The state’s reports use anecdotes merely to highlight common occurrences, not to single out individuals, McGarvey said.

"We don’t look at one particular resident," he added. "We look at a pattern in their facility."

But those detailed cases can help a facility identify employees who have deviated from protocol and possibly placed a resident at risk.

Skinner declined to comment specifically on the employee who dropped the woman with the leg injury and did not report it, but said, "In such a case as that, the employee would be dealt with through the disciplinary process."

Nursing-home residents have access to groups that might be able to assist with a problem before it reaches the citation level.

The Center for Advocacy for the Rights and Interests of the Elderly, or CARIE, is one of two federally funded ombudsman programs in the city.

Members of this group participate in facility inspections and try to resolve residents’ grievances.

"We act on behalf of the residents. We are purely there to make sure their rights are not violated," said Lori Walsh, CARIE’s ombudsman coordinator. "What’s hard for us is if you don’t have a resident saying they have a problem, there’s really nothing for us to do."

While she receives calls from both nursing-home staff and residents’ relatives, Walsh said a situation is not evaluated unless "we talk to residents and see if there really is a problem."

CARIE also aims to protect the rights of aging adults, even if their actions – such as smoking – aren’t the healthiest of practices.

"Just because you’re in a nursing home, it doesn’t mean you should be stripped of your rights, even if those rights are bad choices," said Walsh, who added that despite the sometimes-negative perception of nursing homes, they allow residents an opportunity to socialize.

Nursing homes have yet another means of solving some in-house concerns. Each facility, under state law, must assemble a resident council that encourages dialogue aimed at fixing problems from within.

ST. MONICA MANOR was a longtime goal of the Archdiocese of Philadelphia and, more specifically, Monsignor Aloysius F. Farrell, a former pastor of St. Monica Parish who led the charge to establish a Catholic nursing home in South Philly in the 1950s. The facility’s name pays homage to the priest’s parish.

Farrell and his aunt, Mary Townshend, left money in their wills to fund the construction of a nursing home, but the archdiocese had difficulty honing in on a suitable location. The current site was eventually purchased on June 30, 2004, shortly after the merger between Methodist and St. Agnes hospitals forced the sale of the nursing home.

Skinner, of Catholic Health Care Services, said the facility inherited some compliance issues from its previous owners, but is now looking to turn over a new leaf.

"Is the home where we want it to be yet? No," he said, "but the Department of Health said they have seen an increase in the standards of care since CHCS has come in there."

Spokesperson Troy Thompson said the Department of Health did not have documentation to confirm Skinner’s statement.

Outside consultants assist the St. Monica staff with daily operations. The facility operates under a regular licensure status and not a provisional one, which is administered by the state if residents’ health and safety are believed to be in jeopardy, Skinner said.

A five-year employee at St. Monica Manor who declined to give her name said the staff must regularly attend in-service seminars on a range of topics, including abuse and neglect of the elderly.

"Even us as workers can see abuse if it’s going on and are obligated to report it," said the resident of Second and Morris streets, who said she has never witnessed questionable incidences at the facility.

Joe Pollino, whose mother, Laura, is a resident at the facility, described the staff as "nice people."

Yet the 62-year-old resident of Fifth and Porter streets contended that his mother has received smaller portions of food since the new administration took over.

Skinner said the facility recently switched food providers and spares no expense in providing residents with quality food options.

In light of the citations at St. Monica Manor, McGarvey said preventive measures are the most important step nursing homes can take to ensure the welfare of their residents.

"Whenever an error takes place, we want to find out how the error happened and put policies and procedures in place so the error doesn’t happen again," he said.