A question of care

A review of 205 inspection reports, 63 lawsuits and 105 police reports dating to 2011 found that the quality of nursing homes in Anderson, Greenville, Oconee and Pickens counties varies widely. Although nursing homes here have, on average, fewer deficiencies than those around the nation, care is inconsistent, and when quality suffers patients can be put in danger. We found cases where residents were left outside in scorching summer heat, where drugs were left out without supervision and where care workers refused to perform basic duties such as changing adult diapers. We also discovered that the Upstate’s largest nursing home care provider was among those with the most deficiencies. All of these factors can make even more difficult what already are tough questions for those seeking nursing home care for elderly or infirm relatives.

Deficiencies endanger nursing home residents

When a resident at a Greenville nursing home had a bowel movement in her bed, an employee berated her and showed pictures of the soiled sheets to his coworkers, according to a report from a 2016 inspection.

“What’s wrong with you?” the certified nursing assistant asked the resident at Magnolia Manor, according to the report. He also complained about having to “deal with this mess.”

The incident is one example of many that were revealed in an eight-month investigation of nursing home care by the Independent Mail. Such occurrences make an already difficult decision — how to care for older and infirm relatives — even more complicated.

The investigation of the quality of care at nursing homes in Anderson, Greenville, Oconee and Pickens counties included a review of data from 205 inspections, 63 lawsuits and 105 police reports dating to 2011. The reports revealed that deficiencies are common at nursing homes in the Upstate and throughout South Carolina, but not as prevalent as the national average. The investigation also found that the Upstate’s largest provider of nursing home care, a Tennessee-based company called Orianna Health Systems, has some of the lowest quality ratings in the region.

Experts say low pay for nursing home workers and staffing shortages contribute to problems with nursing home care.

A complaint about the verbal abuse of a resident led to the July 2016 inspection of Magnolia Manor, a 99-bed nursing home near Greenville High School. Because of privacy rules, the names of the resident and nursing assistant were omitted from the report.

The resident told a state inspector she lost control of her bowels while coughing. She said the nursing assistant who was summoned to her room said, “What in the world have you done now?”

“He kept telling me that I was lazy. I know he said it at least five times or more,” the resident said, according to the report. “Talking to me that way made me feel old and it hurt my feelings because I know I can’t help it.”

The nursing assistant’s language was “indicative of psychological abuse” and may have caused the resident “serious emotional distress,” the report said.

Magnolia Manor “conducted a thorough investigation and ultimately terminated the employee,” administrator Kirk Broome wrote in an email to the Independent Mail.

The nursing home “enforces strict policies and procedures for abuse prevention” and its “first priority is ensuring the safety and well-being of its residents,” Broome wrote.

Because the report does not reveal the nursing assistant’s name, it is difficult to determine if he still is employed in the healthcare industry. Nursing homes are required to conduct criminal background checks on new employees and verify their state licenses or certifications, but such searches may not reveal all incidents in a potential employee’s past.

Falls, bedsores and medication errors

More than 3,000 residents live at 35 state-licensed nursing homes from Fountain Inn to Seneca. The majority of these residents are elderly women such as Lottie Vest.

Before dying at age 83 in 2014, Vest fell 26 times in two years at a nursing home, according to a lawsuit filed by her nephew. Her falls at the home previously known as Laurel Bay Healthcare of Greenville led to three hospital visits for treatment of a broken ankle, fractured leg and other injuries, the suit claimed.

The 132-bed nursing home on Rutherford Road denied being liable “in any manner” for Vest’s falls, but agreed to pay $85,000 to settle the lawsuit, court records show. Vest’s nephew did not return a phone call seeking comment.

Now called Greenville Rehabilitation and Healthcare Center, the facility is managed by Orianna Health Systems, which runs 13 Upstate nursing homes. Greenville Rehabilitation and Healthcare Center has an overall rating of below average, according to the federal Centers of Medicare & Medicaid Services.

Since 2011, 23 Upstate nursing homes have paid a total of $7.4 million to settle lawsuits involving the deaths of 41 residents, court records show. Bed sores and falls were cited in at least 24 of those suits. Inspectors have frequently cited Upstate nursing homes for failing to prevent falls and bedsores.

Donald Young, a 76-year-old Simpsonville resident, went to the NHC Healthcare nursing home in Mauldin to recover from a hip replacement in November 2012. About a month later, he was sent to a hospital emergency room for treatment of an elevated white blood cell count and diarrhea, according to a lawsuit.

A transfer form indicated that Young’s skin was healthy. But the hospital staff discovered an ulcer extending from his thigh into his scrotum, the suit alleged.

“The wound was gangrene and needed emergency surgery,” the suit stated. Young died nine days after the surgery.

The 180-bed nursing home and Young’s doctors reached a $362,500 settlement with his widow, while saying they bore no responsibility for “any alleged negligent acts or omissions” regarding his care, court records show. Young’s widow could not be reached for comment.

The NHC nursing homes in Mauldin, Greenville and Anderson are among the most highly rated in the Upstate.

Issues involving medications are another common problem, accounting for at least 124 inspection-related deficiencies since 2011 — or 11 percent of the overall total during that period.

“The No. 1 concern of nursing homes is medication errors,” said Anderson County Deputy Coroner Don McCown.

According to a June 2016 inspection report, two nurses at Simpsonville Rehabilitation and Healthcare Center were fired for falsifying documents. They tried to cover up that nursing assistants had been dispensing medications for several weeks, which violates state regulations, the report said.

Thomas Conrad, administrator of the 132-bed nursing home, did not return phone messages seeking comment. Simpsonville Rehabilitation and Healthcare Center, formerly known as Diamond Health & Rehab of Simpsonville, is managed by Orianna Health Systems. Simpsonville Rehabilitation and Healthcare Center has an overall rating of much below average.

Problems with the food served to nursing home residents also are prevalent.

More than 1,100 deficiencies

Inspectors have found more than 1,100 health and fire-safety deficiencies at Upstate nursing homes since 2011, according to data from the Centers for Medicare & Medicaid Services.

Nursing homes in the Upstate are not unique in terms of inspection-related deficiencies. More than 5,000 deficiencies were found at South Carolina’s 194 state-licensed nursing homes between 2011 and 2016. More than 530,000 deficiencies were documented at the 15,000 nursing homes across the nation in the same period, federal statistics show.

According to the latest data, an average of five deficiencies are found during each nursing home inspection in South Carolina. The Upstate nursing homes are very close to the state average. The national average is 7.2 deficiencies per inspection. In Georgia, nursing home inspectors find an average of 3.6 deficiencies per inspection, compared to 4.9 deficiencies per inspection at nursing homes in North Carolina.

For-profit companies run 29 of the Upstate’s nursing homes, accounting for 85 percent of the total nursing homes beds in Anderson, Greenville, Oconee and Pickens counties, according to state records. Between 2011 and 2016, inspections at these nursing homes resulted in an average of 4.9 deficiencies annually. During the same period, inspectors found an average of 4.4 deficiencies annually at the Upstate’s three nonprofit nursing homes. The government-run nursing homes had an average of 5.2 deficiencies.

Nationally, for-profit nursing homes tend to have more deficiencies than nonprofit facilities, according to the latest federal data. However, the same data shows for-profit and nonprofit nursing homes in South Carolina have an equal number of deficiencies.

The state’s nursing home residents typically are well cared for, said J. Randall Lee, president of the South Carolina Health Care Association. His organization serves as an advocate for nursing homes.

“I would put our quality of care up against anyone,” he said.

Lee cautioned against putting too much emphasis on a poor inspection at a nursing home. He said each inspection only represents a “snapshot” of a facility’s overall quality.

“It’s just like a restaurant,” he said. “Some people have better days than others.”

The South Carolina Department of Health and Environmental Control has 15 inspectors who make unannounced annual visits to nursing homes that receive Medicare and Medicaid insurance payments. Inspectors spend three to five days looking at all aspects of resident care. They also investigate complaints.

For instance, Magnolia Place was cited for last year for failing to maintain comfortable sound levels. According to an inspection report, one resident’s family complained that employees at the 120-bed Greenville nursing home talked too loudly. Another resident complained about often hearing other residents “yelling and screaming throughout the day and night.”

Joshua Becton, administrator of Magnolia Place, did not respond to email and telephone messages seeking comment.

Less than two weeks after the complaint about the resident at Magnolia Manor being berated by the nursing assistant, a wheelchair-bound man was left in the same nursing home’s courtyard for three hours on a 95-degree day, according to another inspection report. He had blisters on both shoulders and a body temperature of 106.6 degrees when he was taken by ambulance to a hospital for treatment of dehydration.

Magnolia Manor’s director of nursing and director of training instituted new procedures and conducted education classes for staff members to prevent a similar problem from recurring, the report said.

Magnolia Place and Magnolia Manor are both owned by a company called THI of South Carolina. There have been 57 inspection-related deficiencies since 2011 at Magnolia Place, which has an overall rating of much below average. Inspectors have documented 35 deficiencies since 2011 at Magnolia Manor, which has overall rating of below average.

The results of state health and fire safety inspections are a key factor in federal nursing home ratings. Staffing levels and reports on an array of quality measures ranging from emergency room visits to vaccination rates also figure into a nursing home’s overall rating.

The rating scale ranges from five stars, which is much above average, to one star, which is much below average.

Eight Upstate nursing homes have an overall rating of much above average and seven are rated as above average. Ten are rated as average, three are rated as below average and five are rated as much below average. Federal officials do not rate nursing homes such as Clemson Downs that don’t accept Medicare or Medicaid insurance.

Even top-rated nursing homes can experience problems with how staff members treat residents.

Bryan Moorhouse, administrator of the five-star rated NHC nursing home in Greenville, called the Greenville County Sheriff’s Office in October 2014 after learning two caregivers had taunted an 80-year-old male resident. Moorhouse told a deputy one employee had filmed the other while they both made vulgar comments about what the resident’s wife was doing while he was away, according to a sheriff’s report.

Moorhouse said both employees were being terminated, according to the report. The deputy told him the caregivers’ actions “were distasteful and very mean” but did not constitute a crime.

$1 million in fines

Federal officials can impose fines for the most serious deficiencies found during nursing home inspections.

Since 2011, 12 nursing homes in Anderson, Greenville, Oconee and Pickens counties have paid 38 fines totaling slightly more than $1 million.

The Lila Doyle nursing home, which is on the campus of Oconee Medical Center in Seneca, paid the most in fines during that period — $192,757, records show.

The bulk of the fines paid by Lila Doyle — $187,882 — came after an inspection in April 2014, six months before the nursing home and nearby hospital were acquired by Greenville Health System.

The report from that inspection included details about a resident with Alzheimer’s disease who took a beverage out of a trash can and drank it. The same resident also ate a flower, tried to eat a Christmas ornament and a puzzle piece and was found chewing on a purple glove.

“None of the incidents were noted on the resident’s care plan and there were no interventions found specific to the repeated ingestion of the potentially harmful items,” the inspection report said.

The same report found no written evidence steps were taken to deal with the behavior of another resident who wandered out of the nursing home without supervision at least twice.

A total of 25 deficiencies have been found at the nursing home since 2011. Only seven of those deficiencies were documented during inspections after Greenville Health System started running the facility. Lila Doyle’s overall rating has improved from much below average to average since Greenville Health System assumed control.

“Over the past two years, we have implemented a number of quality improvement initiatives aimed at optimizing care transitions from the hospital to the skilled nursing facility, developing innovative models of care outside the acute care setting, reducing avoidable readmissions and enhancing the overall patient experience,” said Dr. Angelo Sinopoli in an email. He is the chief medical officer and vice president of clinical integration for Greenville Health System.

Staffing concerns

Many nursing home residents suffer from incontinence and cognitive impairments, and endure daily pain. Caring for them is a difficult and stressful job.

“We are taking care of the sickest of the sick,” said Lee, executive director of the South Carolina Health Care Association.

The amount of time nurses and nursing assistants spend with residents at Upstate nursing homes varies broadly, according to federal statistics.

On the low end of the scale, registered nurses at Seneca Health & Rehabilitation Center spend 31 minutes a day with each resident, compared with a state average of 48 minutes. Nursing assistants at the same facility spend one hour and 53 minutes a day with each resident, below the state average of two hours and 32 minutes. Federal officials have rated the 132-bed nursing home as much below average in terms of overall quality, staffing and quality measures.

Diane Parson, administrator of Seneca Health & Rehabilitation Center, said her nursing home exceeds state requirements for direct-care staffing.

Parson, who took over as the facility’s administrator in July 2016, said the nursing home’s current ratings are based on its past three inspections and are “not a true reflection of where we are today.”

Upstate nursing homes could do more to prevent employees from being overworked, said Jessica Winters, the regional long-term care ombudsman with the S.C. Appalachian Council of Governments in Greenville. Each month, she and her staff try to resolve about 100 concerns and complaints related to nursing home residents in Anderson, Cherokee, Greenville, Oconee, Pickens and Spartanburg counties.

“Facilities need to do more staff training. I believe if staff were better trained and were prepared to handle behavioral issues that come with residents with mental health issues and dementia, that would in turn decrease burnout,” Winters said.

“Consistent assignments for staff would also benefit both the staff and the residents,” she said. “Staff can better care for residents if they are assigned to them consistently and residents would feel more comfortable with the same staff caring for them regularly.”

Cameron Gantt, a 20-year-old Pendleton resident, has been a certified nursing assistant at Clemson Downs for the past six months. He was hired to work the 11 p.m. to 7 a.m. shift after completing a six-week training course at Tri-County Technical College.

He said he has enjoyed getting to know the nursing home’s residents.

“I’ve always been a caring type of person,” said Gantt, who is planning to become a licensed practical nurse.

He said one of the most challenging parts of the job is dealing with the hectic pace of early mornings when residents are getting out of bed.

For the most part, nursing home employees such as Gantt are remarkably dedicated, said Lori Smetanka, executive director of The National Consumer Voice for Quality Long-Term Care, which is based in Washington, D.C.

“They care very deeply for the residents that they provide care for,” she said.

But long hours and low pay can erode this sense of compassion, Smetanka said.

Nationally, the average annual salary of a certified nursing assistant at a nursing home is about $25,000. Often these employees are responsible for the care of 10 to 12 residents, Smetanka said.

At many nursing homes, she said, “there are just not enough staff on hand.”

Her group joined with the Center for Medicare Advocacy and Justice in Aging in criticizing federal officials last fall for failing to include a minimum staffing standard in a new set of nursing home regulations.

The groups said in a statement that “inadequate staffing is the greatest problem in nursing facilities today.”

Ellenburg: Residents faced ‘immediate jeopardy’

Residents at Ellenburg Nursing Center in Anderson were in “immediate jeopardy” of being scalded by dangerously hot water, according to the report from a March 2016 inspection.

An inspector found water temperatures “above accepted parameters” on three of four units in the 181-bed nursing home. The temperatures ranged from 125 degrees in one shower area to 147.6 degrees in a room in a locked unit for residents with Alzheimer’s disease, according to the report. Water temperatures higher than 140 degrees can cause third-degree burns in 5 to 6 seconds. The incident led to the home receiving the most serious deficiency rating allowable.

Nursing home deficiencies are graded on a scale of A, which is the least serious, to L, which is most serious, and also by the number of residents who face potential harm.

The issues with the hot water at Ellenburg Nursing Center, which the inspector said posed a threat to many residents, resulted in three L deficiencies, according to data from the federal Centers for Medicaid & Medicare Services. A $26,705 fine was imposed on the nursing home.

Ellenburg Nursing Center was one of only two nursing homes in South Carolina that were cited for L deficiencies last year. The other facility, Compass Point Acute Rehabilitation in Conway, received six L deficiencies during an inspection in April 2016.

With an overall rating of much below average from the National Centers for Medicare & Medicaid Services, Ellenburg Nursing Center is the lowest-rated nursing home in Anderson County.

The report from the inspection at Ellenburg Nursing Center said the nursing home’s maintenance director and administrator were aware water temperatures exceeded a safe range but did nothing to correct the problem.

Lyndon Ellenburg, the nursing home’s administrator and son of its founder, said the situation “was not exactly the way it was written” in the inspection report.

Ellenburg said the maintenance director told him about a leaky water heater that served a laundry area and two rooms in the Alzheimer’s unit. He said a new water heater was installed within hours after the inspector discovered high water temperatures in the Alzheimer’s unit. He also said the high water temperatures the inspector reported in other parts of the nursing home were “never duplicated.”

“We corrected the problem,” Ellenburg said. “No one was burned.”

The inspection report, however, said one resident claimed to have been burned in a shower. Another resident complained about a burned leg after a shower.

The nursing home’s beautician told the inspector “residents had complained about hot water intermittently over the past six months,” the report said.

Lyndon Ellenburg said he decided not to challenge the inspection report’s findings.

“We worked on correcting the situation,” he said.

Inspectors have found 48 health and fire safety deficiencies since 2011 at the nursing home, which is in a neighborhood on East Hampton Street.

According to data from the Centers for Medicare & Medicaid Services, 14.8 percent of residents who spent at least 100 days at Ellenburg Nursing Center were physically restrained at some point. The state average is 1.6 percent and the national average of restrained residents is 0.7 percent.

No health-related problems were found during the most recent inspection, which took place in January. An inspector did document three fire-safety deficiencies, including a failure to test the facility’s sprinklers and emergency generator and the use of power strips as permanent wiring in the rooms of two residents, as well as two offices. The nursing home agreed to correct the deficiencies.

Simpsonville resident Brenda Curenton said her 82-year-old mother, Ernestine Curenton, has spent the past few years at Ellenburg Nursing Center. Ernestine Curenton suffers from dementia.

“The quality of care there is very poor,” Brenda Curenton said.

She said staff members don’t interact with the residents. Curenton also said she has seen food “all over” her mother’s clothing on repeated instances. Curenton said her mother was treated at a hospital for dehydration last year. She now relies on a feeding tube for nourishment.

“We’ve had countless meetings” with staff members at the nursing home to discuss concerns, she said.

After these meetings, Curenton said, “they straighten up for a little while.”

Because inspection reports do not contain residents’ names, it’s impossible to independently verify these incidents. Ellenburg, whose father opened the nursing home in 1965, said he cannot recall meeting with Brenda Curenton.

“I am sorry that she feels that way,” he said. “That is not the way things are supposed to be here.”

Ellenburg added, “I think the community is evidence that we do provide quality care.”

“Families have been to other nursing homes with higher ratings and they say they have gotten better care here,” he said.

Ellenburg said he and his employees strive to address problems found by inspectors.

“Everybody is always trying to improve at every nursing home in the state,” he said.

Veterans home: ‘We did everything right’

In February 2016, an inspector accused two staff members at Richard M. Campbell Veterans Nursing Home of abusing a resident on New Year’s Eve 2015.

The state-owned nursing home near Anderson denied the allegation that stemmed from a nurse and a certified nursing assistant providing incontinence care for a resident against his wishes, and state officials sided with the nursing home during an informal dispute resolution meeting in June. The four deficiencies related to the incident were rescinded.

The case is an example of what nursing homes can do when they disagree with the findings of a state inspection report.

“We did everything right,” said William Biggs, president of HMR Veterans Services Inc. The Anderson-based company manages two of the state’s three veterans nursing homes, as well as several others in Alabama, Maryland and Texas.

HMR Veterans Services was paid $16.9 million by the South Carolina Department of Mental Health in the last budget year. The department oversees each of the state’s veterans nursing homes. Department spokesman Mark Binkley said in an August 2016 email that the 220-bed veterans nursing home in Anderson County has had five consecutive “deficiency-free surveys through the Veterans Administration’s annual survey process.”

“They also have been recognized this year (2016) by the American Health Care Association’s Quality Award Process as a Bronze Award winner,” he added.

The Richard M. Campbell Veterans Home has an overall rating of above average.

Biggs said veterans living in the nursing homes managed by his company “should expect great care.”

“They earned the right to be there,” he said. “I hold myself to a higher standard, but that doesn’t mean that we don’t make mistakes.”

Seventeen deficiencies have been noted during state inspections at the Campbell veterans nursing home since 2011, according to data from the federal Centers for Medicare & Medicaid Services.

According to a report from a 2014 inspection, the nursing home failed to report a resident’s allegation of physical abuse from a staff member. The resident wanted to call the police to file an assault charge against a certified nursing assistant after being grabbed by the neck and suffering an arm injury.

The same report said the nursing home also failed to report a case of possible neglect that involved a certified nursing assistant who refused to change a resident’s wet bed sheets.

“Well, you did it,” the nursing assistant told the resident, according to the report.

Foothills: One of the best

Dementia has robbed Gladys Jamison of her ability to speak. But sometimes she sings while riding in a bicycle-propelled wheelchair at the Foothills Retirement Community.

Jamison, 93, settled into Foothills in May 2016 after living in other nursing homes.

“This has been by far the best,” said her son, Marion Jamison. He was sitting on a bench as certified nursing assistant Chelsea McCormick pedaled his mother around a parking lot on a sunny morning.

Unlike at some nursing homes, McCormick and other caregivers at Foothills work with the same residents every day.

“We build a friendship with them,” McCormick said. “We fall in love with them.”

Inside the nursing home, an activities staff member turned off the TV in a lounge and began playing music.

“Lift your legs to the beat,” she urged a group of residents.

On the other side of the spacious lounge, Amanda Roberson watched her grandmother, Freda Dawkins, get a manicure.

“Everyone has been really great and really loves her like family,” Roberson said. “We know she is getting great care.”

In the nursing home’s kitchen, employees prepared seafood gumbo and sweet and sour pork that would be served in multiple dining rooms at lunchtime.

Karen Nichols, executive director of the Foothills Retirement Community, says her goal is “to bring the best of the best to the seniors who live here.”

“We love putting smiles on seniors’ faces and putting smiles on their families’ faces,” she said. “And we work hard to do that every day.”

Eradicating boredom

The Foothills Retirement Community nursing home is among eight nursing homes in Anderson, Pickens and Greenville counties that currently have five-star ratings from the Centers for Medicaid & Medicare Services. The agency’s top five-star rating is given to facilities that are considered to be much above average based on health inspections, staffing levels and quality measures.

The nonprofit Foothills nursing home is part of 68-acre continuing care community that includes apartments and assisted living housing. It is one of five similar complexes throughout the state owned by Presbyterian Communities of South Carolina.

The community’s nursing home is rated as much above average for staffing, above average for health inspections and average for quality measures. Inspectors have found only six deficiencies since Nichols arrived in January 2014, compared with 32 in the previous three years.

The entrance to the nursing home features soaring ceilings above a fireplace. The facility’s wide, well-lit hallways are adorned with an array of framed photographs.

“It is the little details that matter,” Nichols said.ail)

Smaller than most of its Upstate counterparts, the Foothills nursing home includes 22 beds for short-term residents, 22 beds for long-term residents and a recently opened 20-bed memory care center. There is also a swimming pool and hot tub.

“Our board of trustees has been very strategic in saying that they want us to stay reasonably small, focused on a high quality of care and being good at what we do best and not growing to the point that we outgrow ourselves,” Nichols said.

Unlike many facilities, Foothills does not accept Medicaid, which is the least lucrative form of compensation for nursing homes. As a result, seniors with limited financial resources probably can’t afford to live there.

“We are still surveyed under the same regulations for our residents who use Medicare as their payor source as those that have Medicaid,” said Nichols, who described her nursing home’s rates as mid-level.

Nichols said her staff strives to go beyond meeting the health needs of residents by offering an array of classes and other life-enrichment activities such as a music and memory program, Senior Olympics and a community choir.

“Life enrichment is about helping the residents find meaning and purpose and eradicate boredom,” she said. “We want to bring variety and spontaneity to people’s lives on a daily basis.”

Foothills also has a chaplain on staff.

“I can’t imagine doing this without a chaplain,” Nichols said. “Often we are dealing with some big spiritual issues.”

Art Nilsen’s mother was admitted to another Upstate nursing home several years ago. He said a caregiver stole her pain medication on the first night she was there. Nilsen moved his mother to Foothills on the next morning. She has returned twice for short-term rehabilitation stays.

“The folks here are so caring and upbeat,” he said. “I wouldn’t take her anyplace else.”

One provider’s homes pay millions to settle lawsuits

Bernadette Hancock died after drinking liquid morphine at a nursing home in Anderson, according to an autopsy.

Elouise Arnold died after the temperature soared to 90 degrees in her room at an Easley nursing home, according to a police report.

Thomsena Gist died after a staff member at a nursing home in Greer poured a nutrition drink down her throat while she was suffering a low-sugar episode, according to a lawsuit that was settled last year.

The deaths of these three elderly women have one thing in common — they happened at nursing homes that were run by a Tennessee-based company called Covenant Dove.

Covenant Dove changed its name in June 2016 to Orianna Health Systems. Most of its 13 nursing homes in Anderson, Greenville and Pickens counties also have new names.

Orianna manages more Upstate nursing homes than any other company. Among 10 other for-profit businesses in the region, its closest competitor is National HealthCare Corp., which owns three nursing homes in Anderson and Greenville. NHC also is based in Tennessee.

As part of an investigation into nursing home care in the Upstate, the Independent Mail reviewed data from 88 inspections, 31 lawsuits and 65 police reports since 2011 involving the facilities now run by Orianna. This review found:

  • Nine of Orianna’s homes agreed to pay $4.46 million to settle lawsuits involving the deaths of 20 residents. That total includes three settlements adding up to $752,500 that were approved after last year’s name changes.
  • Inspectors found at least 525 deficiencies at the company’s Upstate nursing homes, according to the Centers for Medicare & Medicaid Services. The deficiencies included instances of neglect, possible cases of abuse that were not investigated and medication errors, as well as failures to eliminate hazards, properly prepare meals and treat residents with dignity. The most dangerous deficiencies resulted in 26 fines totaling nearly $495,000.
  • The company’s nursing homes were responsible for 47 percent of the inspection-related deficiencies and 49 percent of fines at Upstate nursing homes. Orianna’s facilities account for 38 percent of the overall nursing home beds in the region.

‘Renewed focus on quality’

Orianna executives say last year’s rebranding of the company and its nursing homes ushered in a “renewed focus on quality.”

“Orianna Health Systems is dedicated to providing the highest quality patient care in the rapidly changing healthcare environment of South Carolina’s Upstate,” President and CEO Craig Robinson wrote in an email to the Independent Mail.

Mikki Meer, the company’s chief of operations, wrote in a email that Orianna has embraced an approach that seeks to use “empathy and compassion, dignity and integrity” to “improve the health and well-being of our patients through innovative care and the pursuit of excellence.”

The company’s origins date to 2007 when Behrman Capital, a New York private equity firm, founded Ark Holding Co., which conducted business as Covenant Dove. In 2010, Covenant Dove bought 21 nursing homes in South Carolina and two other states from Easley-based HMR Advantage Health Systems Inc.

In the first version of its website, Covenant Dove described itself a “faith-based company for quality-of-life services.”

Ark Holding Co. merged in December 2013 with 4 West Holdings Inc., an affiliate of Health Care Navigator, a New York-based long-term care consulting and advisory company. Health Care Navigator provides services to more than 120 skilled nursing and assisted living facilities with more than 14,000 beds throughout the United States.

The transition from Covenant Dove to Orianna began in late 2015 with a change in the company’s executive leadership team, Meer said.

Besides its Upstate nursing homes, Orianna has nursing homes in Aiken, Edgefield, McCormick, Orangeburg and St. Johns, according to the company’s website. The company also has facilities in Georgia, Idaho, Indiana, Mississippi, North Carolina, Oregon, Tennessee, Utah, Virginia and Washington.

According to the Centers for Medicare & Medicaid Services, 16 of Orianna’s 33 nursing homes outside the Upstate have overall ratings of below average or much below average. Eleven of its nursing homes are rated as much above average or above average and six are rated as average.

Meer said Orianna has increased staffing levels of registered nurses at its nursing homes across the nation. She said the company has seen improvements in regulatory results and quality measures.

Last year, Greenville Health System sold one of the Upstate’s mostly highly regarded nursing homes, The Cottages at Brushy Creek in Greer, to Orianna for $10.1 million. The facility now is known as Brushy Creek Rehabilitation and Healthcare Center.

Unlike most nursing homes where residents live in double-occupancy rooms flanking long corridors, Brushy Creek features 12 cottages with a total of 144 private rooms. Each cottage has its own kitchen and staff members.

While it has been one of the Upstate’s highest rated nursing homes, Brushy Creek has not been profitable. Greenville Health System reported a $3.2 million loss there in 2015, according to financial data provided to state officials.

“The decision to sell The Cottages of Brushy Creek was the result of a plan to position GHS to respond to a healthcare environment with rapidly changing reimbursement and care delivery patterns driven primarily by changes in Medicare and Medicaid,” said Dr. Angelo Sinopoli, vice president of clinical integration and chief medical officer for Greenville Health System.

“We screened a number of organizations and ultimately chose Orianna because they specialize in skilled nursing facility operations, have a significant presence in the Upstate and have already collaborated with GHS on a number of quality improvement initiatives that have yielded positive results,” he said in an email. “GHS views this not as a sale but a partnership with Orianna.”

Settled suits

Orianna’s Upstate nursing homes denied any wrongdoing in most of the lawsuits they settled involving the deaths of residents with infected bed sores, fractured hips and other health issues.

As with similar lawsuits throughout the nation, the amounts of the settlements varied broadly. The average settlement amount was $223,000. In comparison, the average settlement amount for 21 suits involving the deaths of residents at other Upstate nursing homes since 2011 was about $143,000.

The residents’ relatives who filed the suits against the Orianna nursing homes signed confidentiality agreements as part of the settlements.

Bernadette Hancock’s niece, Anderson resident Sheila Roberts, was unwilling to discuss the death of her 89-year-old aunt.

“It just brings up bad memories,” she said.

Hancock moved to Fellowship Health & Rehab of Anderson in February 2010, according to the lawsuit Roberts filed. The 88-bed nursing home on James Street is now called Linley Park Rehabilitation and Healthcare Center.

One morning nearly a year later, Hancock drank from a bottle of liquid morphine that a nurse left within her reach, according to the suit. The nursing home’s staff waited more than seven hours after Hancock developed respiratory distress before sending her to the emergency room at AnMed Health Medical Center in Anderson, the suit alleged.

Hancock died a few days later on Jan. 14, 2011.

An autopsy found her cause of death was aspiration pneumonia due to acute morphine toxicity, Anderson County Deputy Coroner Don McCown said. A toxicology test showed Hancock’s morphine level was more than four times the dosage considered to be lethal, McCown said.

The nurse surrendered his South Carolina nursing license in August 2011 after being informed he was under investigation, state records show.

The nursing home settled Roberts’ lawsuit in 2012 for $750,000, the largest known legal payout by an Upstate nursing home in recent years.

Carla Heritage, the administrator at Linley Park Rehabilitation and Healthcare Center, would not answer questions from the Independent Mail.

The Upstate was in the grip of a record-breaking heat wave in 2012 when police were called to Majesty Health & Rehab of Easley at 7:30 p.m. on June 30. The 103-bed nursing home near Baptist Easley Hospital is now known as Fleetwood Rehabilitation and Healthcare Center.

A resident’s son told an Easley police officer that a wing of the nursing home had been extremely hot for two weeks. The officer held his hand up to vents in rooms on the wing and noted “there was little to no air flow,” according to a police report.

The officer found Elouise Arnold, 84, gasping in her bed, according to the police report. Minutes later, she had no pulse.

Arnold was rushed to the nearby hospital, where she died that night.

An autopsy determined an elevated body temperature, heart disease, high blood pressure and a chronic urinary tract infection all contributed to Arnold’s death. No charges were filed because of the “mixed cause of death,” according to the police report.

Arnold’s sister filed a wrongful death suit in January 2015.

An attorney for the nursing home initially said Arnold’s treatment “was within the standard of care required of medical facilities and providers in the field,” according to court documents.

Arnold’s family and the nursing home reached a $525,000 settlement through mediation several months later.

Sandra Ferguson was the nursing home’s administrator when Arnold died.

She declined to speak about the case due to its “legal nature.” Ferguson now is administrator of the state-owned Veterans Victory House nursing home in Walterboro.

In August 2016, a Greenville County judge approved a $440,000 lawsuit settlement related to Thomsena Gist’s death. She died a little more than a month after going to Alpha Health & Rehab of Greer for short-term rehabilitation. The 133-bed nursing home has changed its name to Greer Rehabilitation and Healthcare Center.

According to the lawsuit, Gist had a dangerously low blood-sugar level on the morning of Feb. 3, 2012. She was breathing rapidly and writhing in bed when a staff member poured a protein drink called Ensure down Gist’s throat, and she choked on the drink.

Gist was taken to Greer Memorial Hospital.

“She arrived at the emergency room from the nursing home caked in feces with bed sores and in such poor condition that the hospital staff called Adult Protective Services,” according to court documents.

Her condition continued to deteriorate and Gist died on Feb. 19, 2012.

Before settling the suit, an attorney for the nursing home said “Alpha Health complied with the generally accepted standards of care” and that Gist’s death resulted from a “natural disease process,” according to court records.

Deficiencies and fines

Between 2011 and 2016, 82 deficiencies were found during inspections at the nursing home where Gist stayed — the highest number at any nursing home in Anderson, Greenville, Oconee and Pickens counties during that period, according to the Centers for Medicare & Medicaid Services.

Records from the same agency show the nursing home also paid six fines totaling $178,000. Fines are imposed when deficiencies result in potential or actual harm to nursing home residents.

A total of 31 deficiencies were identified during a March 2013 inspection. Several of the deficiencies stemmed from injuries to two residents. Other deficiencies involved missing medical records, medication errors, the improper restraint of a resident, failure to provide suitable treatments for bed sores and failure to serve food under sanitary conditions.

Jonathan Gibson’s 54-year-old mother was sent to the Greer nursing home last year after being hospitalized for heart failure. She had been there about a week when he visited her for the first time.

“She immediately started crying,” Gibson said. He said his mother told him she had been lying in soiled clothing and bedding for six hours.

Gibson complained to a supervisor, who ordered a nurse to clean his mother. The nurse was initially reluctant but eventually complied, he said.

“It was outrageous,” he said. “No one wanted to do their job.”

Edward Burton was the nursing home’s administrator from September 2012 until last summer, when he left to run the new Waterstone on Augusta Senior Living community in Greenville.

Burton said he was “not interested” in answering questions about inspection-related deficiencies and fines at the nursing home in Greer.

“You would have to contact the company about that,” he said.

The nursing home’s current administrator did not return four phone calls.

Greer Rehabilitation and Healthcare Center currently has an overall rating of below average.

Inspectors have found 46 deficiencies since 2011 at the Easley nursing home where Elouise Arnold lived. The nursing home paid six fines totaling $115,380 during the same period, records show.

Besides a medication-error rate that was more than twice the acceptable level of 5 percent, a June 2015 inspection found staff members didn’t respond when a resident urinated on the dining room floor. In March 2014, inspectors said the nursing home failed to properly address a resident’s allegation of verbal abuse, as well as an “injury of unknown origin” involving bruises on the neck of another resident who was unable to speak.

Meredith Williams, the current administrator of the nursing home now known as Fleetwood Rehabilitation and Healthcare Center, did not respond to repeated phone calls or an email seeking comment. The nursing home has an overall rating of average.

The administrator at Poinsett Rehabilitation and Healthcare Center in Greenville also did not return phone calls seeking comment about 57 inspection-related deficiencies at the facility since 2011. The 132-bed nursing home previously known as Glorified Health & Rehab of Greenville has paid four fines totaling $118,625 since 2011.

The nursing home has a much below average overall rating from the Centers for Medicare & Medicaid Services.

‘We still have work to do’

Robinson, Orianna’s president and CEO, said the lawsuits, deficiencies and fines “relate to time periods prior to the change in senior management and are not representative of the excellent care currently being delivered by the devoted employees of Orianna’s facilities in the Upstate.”

According to Meer, the company’s chief of operations, “All of the individuals who impacted operations under the prior ownership and previous owner’s leadership have been replaced.”

“Ownership and management has spent millions of dollars on physical plant upgrades, training programs and recruitment so as to provide the best care to the people of South Carolina,” she said. “As with all others in the state, we still have work to do, but our team has renewed focus and passion that may have not been evident under previous ownership.”

Of Orianna’s 13 Upstate nursing homes, four are rated as above average and five are rated as average. Two are rated as below average and two are rated as much below average.

In comparison, each of NHC’s three Upstate nursing homes have an overall rating of much above average, which is the highest level on the Centers for Medicare & Medicaid’s rating scale.

The agency’s ratings for nursing homes are based on health inspections, staffing levels and an array of nine quality measures for short-stay residents and 15 quality measures for long-stay residents. Among other issues, the quality measures gauge whether residents have made improvements in function, the rate of re-hospitalizations and emergency room visits, the prevalence of urinary tract infections, weight loss, the use of restraints and the percentage of residents receiving anti-psychotic medications.

Nine of Orianna’s Upstate nursing homes are rated as either below average or much below average on those 24 quality measures.

Linley Park Rehabilitation and Healthcare Center, the Anderson nursing home where Hancock drank liquid morphine, has an overall rating of average but a much below average rating on quality measures. Records show that 71.7 percent of its long-stay, low-risk residents lose control of their bowels or bladder, well above the national average of 47 percent. Additionally, 14.5 percent of Linley Park’s long-stay residents have pressure ulcers, also known as bed sores, compared to a national average of 5.7 percent.

Since last year’s name changes, three of Orianna’s Upstate nursing homes — Fleetwood Rehabilitation and Healthcare Center in Easley, Manna Rehabilitation and Healthcare Center in Pickens and Patewood Rehabilitation and Healthcare Center in Greenville — have seen their overall ratings improve.

The overall ratings have dropped for Capstone Rehabilitation and Healthcare Center near Easley and Linley Park Rehabilitation and Healthcare Center in Anderson.

The ratings at Brushy Creek Rehabilitation and Healthcare Center also declined after an inspection in late November that was the first conducted since Orianna took over the facility from Greenville Health System on Oct. 1. The nursing’s home overall rating, staffing rating and quality measures rating went from much above average to above average. Its health rating was lowered from above average to average.

Six deficiencies were documented during the inspection, twice the number found in the last inspection that took place when Brushy Creek was still owned by Greenville Health System.

The deficiencies in the most recent inspection involved a lack of steps to address the safety of a resident who fell seven times, and a medication problem. The nursing home also failed to provide hospice services for a resident, follow dietary instructions for another resident and assure foods were kept at appropriate temperatures prior to serving.

Greenville Health System spokeswoman Karen Potter emailed a statement regarding the inspection:

“The challenges Orianna faces are the same challenges other skilled nursing facilities around the country face. We have a vested interest in Orianna’s success as they provide post-acute care to a significant number of our patients, and we will continue to work together to ensure patients received high-quality care.”

Meer also addressed the inspection at Brushy Creek in her email.

“The six deficiencies noted were of a low scope and severity with no harm resulting to any residents,” she wrote.

Meer described Brushy Creek as a “high performing 4 Star facility” and she said Orianna “has every expectation that it will return to a 5 Star rating in the near future as the survey cycle allows.”

Orianna Health Systems/Covenant Dove Upstate nursing homes

Lessons learned: One family’s nursing home odyssey

Zora Mims and her family have gained valuable insights while spending countless hours with relatives at two Anderson nursing homes during the past several years.

The most important lesson they have learned is nursing home employees tend to provide better care to residents who have frequent visitors.

“The staff knows who comes. If you come with any frequency, you see them scramble,” said Mims, a retired AnMed Health medical technologist who lives near Pendleton.

“Many residents don’t get any visitors,” she said, and they “are ignored for the most part.”

One of her four siblings, Michael Stone, voiced similar sentiments.

“If they don’t think anyone else cares, they don’t either,” he said. “You need to go there and see what is really going on.”

An expert on aging agreed.

“If you want your loved one to receive the best care, you’d better be there,” said Joyce Varner, a nursing professor at the University of South Alabama. She also is on the editorial board of International Journal of Older People Nursing.

Varner, whose grandmother spent eight years at a nursing home after developing dementia, said relatives and friends should make a point of visiting nursing home residents at random times.

“Never let the staff know when you are going to be there,” she said.

She said her research shows about 60 percent of nursing home residents don’t have regular visitors.

Painful journey

Mims’ mother, Mae Waldrep Stone moved to Ellenburg Nursing Center in Anderson from an assisted living facility after her dementia worsened over the course of a decade.

Stone, who worked for 30 years at JCPenney, could walk when she went to the nursing home, Mims said.

“She was put in a wheelchair and stuffed in her room,” Mims said.

Being in a wheelchair didn’t keep Stone from falling 15 times in less than four years, resulting in numerous trips to the emergency room, Mims said.

“It makes you wonder how a frail female, 125 pounds, could even turn over a wheelchair,” she said.

Mims said she was not satisfied with the nursing home’s explanation for the falls.

She said her mother’s dementia continued to progress, eventually preventing her from speaking.

“It is just a downhill process,” she said. “They can’t tell you if they’re in pain or if they’re hungry or they’re thirsty.”

“For over two years, she didn’t know she was in this world.”

Mims said her mother’s 85th birthday celebration was postponed because of a quarantine at the nursing home related to a norovirus outbreak in February 2014. Her mother got the virus and was sent to the hospital about 10 days later with a 105-degree fever. Stone died the next afternoon, Mims said.

Coping with unexpected events

As preparations were made for Mae Stone’s funeral, Mims’ sister-in-law, Abby Stone, was forced to deal with another death.

Abby Stone said her oldest sister died after choking on a peach at a nursing home in Easley.

A month later, the family struggled to cope with another unexpected health crisis. Kenneth Stone, who is Abby’s husband and Mims’ brother, collapsed on Easter night in 2014. He was 51 at the time.

Kenneth Stone “actually stopped breathing two or three times on the way to the emergency room,” Mims said.

Today Kenneth Stone is blind and partially paralyzed. He lives in a double room at the end of oldest wing of the Linley Park Rehabilitation and Healthcare Center in Anderson.

“He is experiencing sort of the opposite of my mom,” Mims said. “Her body was in good shape physically but her mind went.”

Mims said her brother is alert and aware but “for the most part helpless.”

Kenneth Stone, who is bedridden, said the quality of the staff at the nursing home varies from shift to shift. He said a caregiver cursed at him a few months ago when he asked what she was feeding him.

Carla Heritage, the administrator of Linley Park Rehabilitation and Healthcare Center, did not respond to emails and phone messages from the Independent Mail.

Mims visits Kenneth Stone frequently. His wife, Abby Stone, and brother, Michael Stone, try see him each day. They have some minor differences in their opinions about his care.

Mims said a lack of staff attention at the nursing home has contributed to her brother’s frequent bed sores and urinary-tract infections.

“You can sit in his room for hours and no one comes there,” she said.

Mims and Michael Stone both expressed disappointment that their brother no longer receives physical therapy and that the staff never takes him outside. But Michael Stone said he has noticed some changes since the nursing home’s ownership and name changed last year.

“The people here seem to be more friendly,” he said.

Abby Stone also wishes her husband could go outside. But she said the staff has been generally responsive to her concerns.

“Whenever I have an issue with someone, they take care of it,” she said. “I think they are trying to get better. I applaud them.”

Mims said she wishes every nursing home resident had the same level of family support her mother and brother have received.

“It is very important for family members to not give up on their loved ones,” she said. “They need you more than ever.”

“Nursing homes are sad places. It smells sometimes,” Mims said. “It is just something that you want not to face. But unfortunately for a lot of folks there, this is their life before they pass.”

Looming challenges: Availability, cost of Upstate nursing home beds

An existing shortage of nursing home beds in the Upstate is expected to worsen as baby boomers continue to age. At the same time, the already high cost of nursing home care could soar. These are among the challenges families face as the explore long-term care options for elderly or infirm relatives.

Today there is a need for almost 2,200 additional nursing home beds in Anderson, Greenville, Oconee and Pickens counties. That equates to a 37 percent increase from the 3,666 nursing home beds now in the four counties.

The lack of nursing home beds “is a huge problem,” said Karen Nichols, executive director of the Foothills Retirement Community in Easley.

This problem is not confined to the Upstate.

South Carolina has about 20,000 nursing home beds, but experts say another 13,000 are needed.

Nationally, the number of nursing homes gradually dropped during the past decade, though the decline has essentially halted in recent years, according to the Centers for Medicare & Medicaid Services. According to the latest federal figures, 1.4 million Americans live in the nation’s 15,600 nursing homes.

The number of seniors in the Upstate will increase by 65 percent in the next decade, Nichols said. Throughout the state, the number of residents older than 85 – the age group most likely to need nursing home care – is projected to almost double during the next 15 years. Across the United States, 10,000 Americans reach retirement age every day.

Rising costs

Shelley Stone is AnMed Health’s discharge planning manager. Her job often involves finding nursing homes for elderly patients who are ready to leave the hospital after surgery or other medical care.

“We are kind of at the mercy of what the bed availability is,” Stone said.

Patients who receive Medicaid, a joint federal-state program that assists families and individuals with limited incomes, are the most difficult to place in nursing homes, she said.

“There is very limited amount of long-term Medicaid beds,” Stone said.

As a result, she said, patients from Anderson might be sent to nursing homes in Greenville, making it more difficult for them to keep in touch with their families and friends.

Greg Shore, CEO of Medshore Ambulance Service, said there have been instances when his employees have taken patients to nursing homes in South Georgia because that is where the closest Medicaid bed was available.

On a recent Thursday in late March, 121 beds for private-pay residents or those covered by Medicare were available at nursing homes throughout the Upstate.  In contrast, only 15 Medicaid beds were available, according to the South Carolina Long Term Care Bed Locator.

State officials have failed to provide enough funding for more Medicaid beds, said J. Randall Lee, president of the South Carolina Health Care Association. His group represents most of the nursing homes in the state.

The demand for Medicaid beds at nursing homes has exceeded the supply since the late 1990s, according to data in the South Carolina’s 2015 State Health Plan. Since 2000, the state’s number of Medicaid nursing home beds has fallen from 11,995 to 10,455.

The proposed state budget calls for the South Carolina Department of Health and Human Services to spend $587 million on Medicaid payments to nursing homes next year, a decrease of $14 million from the current budget.

“Medicaid pays for the care of approximately 70 percent of the South Carolinians who are in nursing homes,” said Colleen Mullis, the department’s deputy communications manager. “So this is an important service and appreciable fraction of our budget, but it is not currently an area of significant growth or concern.”

Mullis said the existing budget for Medicaid payments to nursing homes included some one-time expenses. She said the money in next year’s proposed spending plan is in line with the amount her department requested.

The state health department pays nursing homes an average of about $62,000 annually for each resident receiving Medicaid.

According to a 2016 survey by an insurance company called Genworth Financial, nursing homes in South Carolina seek to bill each resident about $72,000 a year. The national yearly average cost is about $82,000. In neighboring Georgia, the yearly average cost is just under $70,000, compared to nearly $79,000 in North Carolina.

The same survey found the annual cost for nursing homes in the area that includes Anderson and Greenville is a little more than $80,000 per resident in a semi-private room, well above the state average and barely less than the typical national charge.

Genworth also offered a sobering look at how much nursing home care may cost in the future. In the next 20 years, according to the company’s estimates, the cost of staying in a semi-private room at an Upstate nursing home could rise to about $145,000 annually.

Faced with a shortage of beds and rising costs at nursing homes, more seniors are opting for home-based care.

Under the proposed state budget, the South Carolina Department of Health and Human Services would receive $229 million for community long-term care expenses, an increase of $62 million from this year.

“As more baby boomers continue to choose to receive services in their own home, use of home and community-based care services will continue to increase and provide alternatives to institutional care,” Mullis said.