As I told you last week, Northampton County's Gracedale nursing home now has a Provisional II license. It previously had a Provisional I license. In early May, Executive Tara Zrinski said the home did very well in its annual survey, but the downgrade from Provisional I to Provisional II indicates that the facility is in worse shape now than it has ever been.
Although Zrinski has previously stated that she is happy with Administrator Michelle Morton, the state Department of Health has had to visit the home 27 times since she has been there. Gracedale has been cited eight times since her arrival last year (six times last year and twice this year). The home has been repeatedly cited for elopements (escapes) and a failure to meet minimum staffing requirements.
next to its name to warn potential residents and their families about the possibility of abuse. The home has operated with a Provisional license since February.
All of this, not some of it, has happened during Morton's tenure. And that's understandable. She's had 23 different jobs since 1983. Her background is therapeutic recreation, not nursing or nursing homes.
In her Exec report last week, Zrinski tried to downplay the problems, stating that they were caused by being too lax in admitting people. I'll agree that is likely one of the causes. Sure, Gracedale should be a sanctuary for the indigent, but should decline residents who are violent to other residents and to staff. But that is only one of the causes.
Administration is another. The sheer number of visits from the DOH alone indicate that people (staff, residents or both) are unhappy with Michelle Morton, the current Administrator. The decline in the home's ratings, the citations, and the downgrade to a Provisional I and then a Provisional II license have all happened under her watch. I have no doubt she could succeed in some role, but not as Gracedale's administrator.
A third root cause of Gracedale's problems is its heavy reliance on agency nursing. These are nurses brought in from outside agencies. They are paid far more than regular staffers, which obviously causes resentment. And since they come and go as they please, they are unable to build up the relationships with residents that regular staff have.
A final problem, quite frankly, is politics. The continuum of care positions that Zrinski sought and got are political hires who come and go with the exec. They should have the protection of either career service or a contract. When he was first elected Exec, one of the first things Lamont McClure did was fire the Director of Nursing, Her position was career service, but she must have been probationary, or he'd be unable to axe her. Here's what she wrote in 2018:
"Gracedale has been neglected for years. Not just the last four years but for many decades. The outdated and appalling status of the living conditions for the residents of Gracedale actually brought me to tears the first time I saw the cinder block walls and furniture obviously from decades ago. The resident mattresses had not been replaced for years (actually no one could tell me when) leading to resident skin pressure injury. An assessment revealed these mattresses were no longer offering any pressure reduction. The mechanical lifts recently assessed found 22 lifts were in poor condition. The most vulnerable of our population have been ignored and the taxpayers should be appalled as I was. However, my goal was to work to improve the conditions and the mattresses have been replaced, some furniture has begun to be purchased and the next step was to begin mechanical lift replacement. The ultimate goal being to develop a purchasing replacement plan yearly to assure that this would never happen again.
"I knew the position would be a challenge, and I happen to love a challenge that works to improve the lives of residents in long term care. So imagine my response in early December when I received a letter from the new county executive- elect that stated “this past November our voters spoke loudly and issued a mandate for change.” It went on to say “ I write at this time to inform you that you will not be re-appointed to your position in the new administration” and “your last day of employment with the County of Northampton will be January 1, 2018.”
I believe this nurse was canned because she was chosen by the John Brown administration.
In her report to County Council last week, Zrinski stated that the downgrade to Provisional II occurred because of yet another resident elopement as well as a resident who brought contraband (I'm told it was a K-Bar knife) into the facility. These matters do not yet appear on the DOH deficiency site, but I suspect we'll be seeing them soon. An alarm actually went off during one of Zrinski's visits. "I assure you that person did not get away," she declared.
As NorCo Council member Dave Holland stated last week, a provisional license means that the state DOH can do a number of things. They can stop new admissions. They can stop Medicaid reimbursements. They can take over the facility with their own managers.
How common is a provisional license in Pennsylvania? I decided to check.
According to the DOH nursing home facility webpage, there are 661 nursing homes in Pennsylvania. Gracedale is the only one operating with a Provisional II license.
Of 417 for-profit nursing homes, four are operating with Provisional I licenses: Emerald Nursing and Rehabilitation (Elizabethtown); Kadima Rehabilitation and Nursing (Palmyra Pa); Rochester Residence and Care Center (Rochester); and Wecare at South Hills (Canonsburg) Provisional I.
Of 223 NonProfit Facilities, all have regular licenses.
Of 14 county-owned facilities, only Gracedale has a Provisional license
Of 7 State-owned facilities for veterans, all have regular licenses.
Another point made by Zrinski during her Exec report is that for-profit homes are less likely to accept Medicaid. Northampton County has 11 nursing homes. All but 1 accept Medicaid.
1 comment:
In other words, Gracedale's performance really sucks. Thanks for letting us know how badly, relative to its peers.
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