Each time they visited the nursing home, state inspectors filled dozens of pages with what they say went wrong: A man wouldn’t take his medications because he thought communists were trying to kill him, so employees held him down and injected him. Ailing residents had to use the stairs because the elevator had been broken for months. The place was dirty and smelled of urine.
The records for Carlton Manor nursing home, which is facing imminent shutdown, say that a man threatened a nurse with a radio antenna; another punched his roommate in the face. One, with a history of sexual abuse, fondled the breasts of a woman with developmental disabilities.
The diagnoses for the residents, listed not by name but by assigned numbers, include schizophrenia, explosive personality disorder, traumatic brain injury, bipolar disorder, alcoholism, habitual cocaine use and suicidal.
Among the 130 people living at Carlton Manor in Washington Court House are 27 registered sex offenders — at least 10 of them rapists and at least eight who have been convicted of sex crimes in other states — and many other residents who have violent backgrounds. There is a man who once tried to murder his landlord, another who attacked several young children.
As the state moves to close the Fayette County nursing home because of repeated violations, everyone involved seems to agree on this: Such a group of people deserves high-quality care, but how to best achieve that is complicated.
Almost no one disputes that housing such a high number of people with so many needs in one facility is not a good idea.
And as the state looks for new homes for the residents, it rekindles a debate over whether Ohio’s sex-offender law should be changed so that other nursing-home residents or their caregivers are notified when a sex offender moves in. Past attempts to change the notification law have failed.
“The issue both of housing these offenders and of notifying others is complex,” said Caroline Berdzik, a lawyer and partner with the New Jersey firm of Goldberg Segalla. “It raises all sorts of ethical dilemmas. And there are no clear parameters, no best practices, established across the country on how to best handle this.”
Berdzik has represented a number of national long-term-care companies and is considered among the experts on this issue.
In Ohio, there is no special licensing or designation for nursing homes that care for violent residents, mentally ill patients or ex-cons. To keep its operating license, however, a nursing home must prove that it has the proper care plans and properly trained employees to handle every resident, said Beverley Laubert, the state’s long-term-care ombudsman with the Ohio Department of Aging.
“If a nursing home like Carlton Manor chooses to take on mental-health patients or criminal offenders, they can’t say, ‘We’ll meet most of their needs,’ or ‘We’ll meet their needs on average.’ It has to meet the needs of every single resident,” Laubert said. “And at Carlton Manor, that wasn’t done.”
Most insiders say Carlton Manor had developed a reputation for taking difficult residents. Employees say real improvements were underway at the facility and that no one is giving them credit for taking residents few others would accept.
Research by the Scripps Gerontology Center at Miami University in Oxford last year found that
7 percent of 871 long-term-care facilities in Ohio that responded to a survey said they had at least one sex offender or resident with a violent criminal background.
None, however, reported numbers anything close to those at Carlton Manor, which did not participate in the survey.
Some of Carlton Manor’s residents arrived directly from prison. Ricky Seyfang, spokeswoman for the Ohio Department of Rehabilitation and Correction, said it is just one facility on a list of places that case managers contact when a prisoner is about to be released.
“It can be tricky,” Seyfang said. “Sex offenders and arsonists are our biggest challenge when it comes to placement.”
Carlton Manor has asked for an administrative hearing with the Ohio Department of Health to try to keep its license. Nonetheless, the Medicare and Medicaid reimbursement that pays for 94 percent of its residents will stop next month.
Meanwhile, for officials, the attention shifts from “How did we get here?” to “Where do we go?”
Jane Straker is the senior researcher at the Scripps Gerontology Center who worked on the criminal offender/nursing-home-care study last year. She said they found that it could be developed into niche care, but there is no uniform standard or best practice yet.
“We instantly recognized the challenges and found that, in many cases, the nursing homes are not really equipped to deal with these potentially violent issues, this behavior that differs from dementia aggression,” she said.
Laubert has said assessments are proving that some of Carlton Manor’s residents don’t need a nursing home and might be able to live in a community setting with the right programs. For those who do require long-term care, many nursing homes have stepped forward to say they can take one or two of the high-need residents, which seems appropriate, she said.
Then, the question shifts to notification.
State legislators have debated adding a requirement to Ohio’s sex-offender registration laws that would extend to nursing homes, but efforts have always failed. Currently, people living within a certain distance must be notified when a sex offender moves into their neighborhood, but the person in a long-term-care bed 5 feet away doesn’t have to be told.
Berdzik’s law firm tracks legislation in all 50 states as it relates to sex-offender notification in nursing homes. According to its research, Louisiana, Illinois, Minnesota and North Dakota require notification inside the facility. Virginia requires that new residents or their caregivers be given information on how to access the state’s sex-offender registry.
Berdzik said it’s a delicate balance of protecting other residents and providing care to those who need it, many of whom are so infirm they pose no threat.
“These folks are there because they need medical attention,” she said. “The bottom line is that they deserve quality care, too.” ..Source.. by Holly Zachariah
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