Late on the afternoon of December 15, 2023, Northview Village Nursing Home, the largest nursing facility in St. Louis, Missouri, abruptly closed, moving all 170 remaining residents overnight to 14 other nursing facilities in Missouri and Illinois (See here and here and here.) Residents were sent to facilities without their personal belongings and medical records. Many had only the clothes they were wearing. Some families were searching for their relatives who were transferred during the night and one resident remained missing, nearly three weeks after the closure. Staff were not paid.
The abrupt closure makes this facility the poster child for meaningful, corporate-wide enforcement. Northview Village Nursing Home has a record for poor care and is affiliated with six other facilities that also have exceptionally poor records for resident care.
As of December 18, 2023, the federal website Care Compare reports that Northview Village Nursing Home was cited with nearly twice as many deficiencies as the statewide average, had 12 federal fines imposed in the past three years totaling $142,026, and provided extremely limited nursing care (the most important predictor of quality of care for residents):
- 18 minutes of registered nurse care per resident per day, just two-thirds of the 27 minutes provided, on average, by other Missouri nursing facilities and less than half the national average of 40 minutes
- a total of one hour 57 minutes of nursing care, 1.95 hours per resident day (HPRD) of nursing care, far less than the Missouri average of 3.3 HPRD and the national average of 3.78 HPRD.
Correlated with the lack of sufficient nursing staff, the facility reported that 32.2% of its long-stay residents take antipsychotic drugs, compared to the statewide average of 21%.
As required by President Biden’s nursing home reform agenda, the Centers for Medicare & Medicaid Services (CMS) created a database of nursing facilities with common ownership. CMS recently began publicly reporting information about affiliated nursing facilities. Each certified nursing has a homepage on Care Compare that includes, if relevant, a link to a separate federal website with information for all its affiliated entities, https://data.cms.gov/quality-of-care/nursing-home-affiliated-entity-performance-measures.
Northview Village Nursing Home is one of seven facilities with common owners, Healthcare Accounting Services, LLC. As of December 18, 2023, Healthcare Accounting Services’s seven facilities provided extremely poor care to residents. The seven facilities received 2 of 5 stars (2 stars are defined as “average”) in health inspections; 1.3 of 5 stars in staffing (just above the lowest rating, 1 star, “much below average”); and overall ratings of 1.4 of 5 stars (also just above “much below average”). Three of the seven facilities (42.9%) were cited for resident abuse.
The seven facilities had 45 federal fines, totaling $925,915.66 and averaging $132,273.67 per facility. When the average federal fine in 2021 was $15,000, the fines imposed at Healthcare Accounting Services stand out. The seven affiliated facilities also had another federal sanction imposed, a total of eight denials of payment for new admissions.
President Biden’s nursing home reform agenda calls for increased accountability and an expansion of enforcement authority “for chain owners of substandard facilities.” A recent law review article by Nina A. Kohn, “Using What We Have: How Existing Legal Authorities Can Help Fix American’s Nursing Home Crisis,” 65 Wm. &Mary L. Rev. 127 (2023), recognizes that CMS already has the statutory authority it needs to engage in corporate-wide enforcement. Kohn cites the 1987 Nursing Home Reform Law (at 42 U.S.C. §§1395i-3(f)(1), 1396r(f)(1), Medicare and Medicaid, respectively), which defines the Secretary’s “duty and responsibility” to ensure that federal standards for care and their enforcement “are adequate to protect residents’ health, safety, welfare, and rights and to promote the effective and efficient use of public moneys.”
Conclusion
The abrupt closure of Northview Village Nursing Home highlights the need for better and stronger enforcement of federal standards of care for nursing homes, both for individual facilities and for facilities under common ownership. CMS must immediately:
- Take action against the facility, its owners, Healthcare Accounting Services, LLC, to hold them accountable for the abrupt closure, in violation of federal requirements;
- Begin a process to propose regulations to require enforcement against all facilities under common ownership/affiliation.
January 4, 2024 – T. Edelman