Federal officials have fined the state veterans nursing home in King $76,900 in connection with substandard care it provided in the death of a 94-year-old resident.
The violation of nursing home standards drew a serious rebuke from regulators in March but didn’t lower the facility’s five-star rating for more than eight months.
Under federal rules, the public should have learned of the home’s downgraded status shortly after April 15, when an initial appeal by the state Department of Veterans Affairs was rejected.
But for reasons that aren’t yet clear, the change was kept from public view until late November.
The King home on March 9 received an “immediate jeopardy” citation, the most severe violation inspectors can give. It means the home’s practices created a crisis situation placing vulnerable residents’ health and safety at risk, according to the federal government’s inspection manual.
The citation dropped the health rating for the unit where the death occurred to two stars, or below average, but the change wasn’t reflected until Nov. 28 on the website the federal government has set up to help the public compare and make choices among nursing homes.
Wisconsin Department of Veterans Affairs administrators were notified of the fine in a June 1 letter, which the state Department of Health Services and the Centers for Medicare and Medicaid Services (CMS) released at the request of the Wisconsin State Journal.
The fine is based on a $4,000-per-day penalty for 18 days beginning Feb. 7 when conditions at the unit placed residents in immediate jeopardy, and $100-per-day for an additional 49 days when the facility still was not in substantial compliance with health regulations because it failed to correct deficiencies.
The home’s rating on the federal website was not downgraded immediately after inspectors found the deficiencies because of federal rules that postpone public notification until after an initial appeal has been decided in mid-April.
But after that there were months of additional delays because of an unspecified “issue” in the uploading of the information to a federal database, CMS Chicago-based program representative Jan Suzuki said in emails to veterans advocates who raised concerns.
The state Department of Health Services shares inspection responsibility for nursing homes with CMS.
The agencies haven’t specified the nature of the data problem.
Sen. Tammy Baldwin, D-Madison, has asked CMS to explain the delay.
King under audit
The four nursing homes operated by the state Department of Veterans Affairs in King are facing a state audit sparked by newspaper reports of serious shortcomings in care provided to more than 700 elderly veterans and family members who live there.
In recent months, Gov. Scott Walker and Veterans Affairs Secretary John Scocos have responded by defending King and maintaining that it provides top-notch care.
CMS issued the citation to the 200-bed Olson Veterans Home, which had held an overall five-star rating since 2014.
Olson’s top status remained on the federal Nursing Home Compare website until Nov. 28, when it was reduced to two stars in the category of health inspections, four stars for staffing, five stars for “quality measures,” and four stars overall.
Scocos denies reports
In September, six months after the citation was issued, Scocos told lawmakers that reports of substandard care were unsubstantiated.
In October, after one of the other homes at King was upgraded, Scocos issued a news release announcing that for the first time all four homes at King had received five-star ratings.
Asked if Scocos should have acknowledged the immediate jeopardy citation, department spokeswoman Carla Vigue said the citation is public record that could have been obtained by anyone who requested it.
Nearly a month after the nursing home was cited, the state Department of Veterans Affairs’ filed its initial appeal through the Informal Dispute Resolution system.
The April 4 appeal was rejected on April 15, Vigue said.
The department has since filed a formal appeal that will be heard by an administrative law judge, Vigue said. Only the informal appeal puts a hold on public disclosure under federal rules.
In February 2013, a Wisconsin State Journal investigation in the wake of a resident’s death uncovered a trend of increasing citations, including two that posed immediate jeopardy to residents.
Some of the problems occurred when lawmakers boosted the number of residents in the homes to increase revenue before increasing staffing numbers.
This year, articles in the Capital Times brought renewed attention to King, prompting lawmakers to order the audit.