A Connecticut-based long-term care management company operating nursing homes across southern New England has agreed to pay $1.75 million and adopt a series of critical compliance measures in a settlement reached by Massachusetts Attorney General (AG) Maura Healey’s Office, and announced on December 21, 2022. The settlement resolves a series of allegations, including that the company failed to meet the needs of nursing home residents experiencing substance use disorder (SUD). The largest nursing home settlement ever reached by the AG’s Office, these funds will be directed to the state’s Opioid Recovery and Remediation Trust Fund for prevention, harm reduction, treatment, and recovery across Massachusetts.
The AG’s Office investigated reports of substandard care or regulatory violations at the company’s nursing homes that allegedly started in March 2016, based on complaints referred by the Massachusetts Department of Public Health (DPH) and the Office of the Long-Term Care Ombudsman.
The AG’s Office alleges that the facilities, at the direction of the management company, admitted substantial numbers of residents with histories of SUD, despite the fact that the facilities did not have adequate levels of appropriately trained staff to meet the needs of those residents. The AG’s Office also alleges that numerous overdoses occurred at the facilities, some of which the facilities failed to report to DPH. According to the AG’s Office, the company was aware that this conduct led to noncompliance with regulations, but it still encouraged the facilities to admit residents with histories of SUD.
Under the terms of the settlement agreement, in addition to the financial payment, the company has agreed to participate in a special program which will result in updates to the company’s policies, procedures, and trainings with respect to its treatment of residents with histories of SUD. The company has also agreed to hire an auditor to review records every six months to assess this program, the results of which will be reported to the AG’s Office. Furthermore, under the terms of the settlement, the company represents that it has adopted or is in the process of adopting a series of compliance initiatives, including mandatory compliance training, annual mock surveys, hiring of four full-time regional nurses dedicated to clinical operations and compliance, and implementation of a system-wide electronic dashboard. The AG’s Office also has authority, pursuant to this agreement, to require many of the facilities to contract with an independent compliance monitor if those facilities receive serious deficiencies in future surveys from DPH.
Compliance Perspective
Issue
Skilled nursing facilities participating in Medicare and Medicaid must follow various state and federal statutes, regulations, and rules governing their procedures and conduct. Facilities must have sufficient numbers of staff who have the skills and competencies to monitor residents with SUD. The behavioral healthcare needs of those with SUD or other serious mental disorders should be part of the facility assessment, and the facility should determine if they have the capacity, services, and staff skills to meet the requirements. Residents living with mental health and SUDs may require different activities than other nursing home residents. Facilities must ensure that activities are provided to meet the needs of their residents. Meaningful activities are those that address the resident’s customary routines, interests, preferences, etc. and enhance the resident’s well-being.
Discussion Points
- Review your policies and procedures on SUD, resident assessments, quality of care, and staffing. Update as needed.
- Provide staff education on SUD, including the importance of administering the necessary care and person-centered services which reflect the resident’s goals for care, while maximizing the resident’s dignity, autonomy, privacy, socialization, independence, choice, and safety. Offer the residents with SUD supportive education and access to appropriate medical care and support groups. Place training documentation in each employee’s education file, and record patient/ resident education in his or her medical record.
- Periodically audit to ensure residents with SUD are receiving appropriate interventions and monitoring and that there are sufficient qualified staff who demonstrate the competencies and skills necessary to provide appropriate services to the residents.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
