A nursing home can be a supportive environment for elderly residents to live out their last years with companionship and medical care. It can alternatively be a place where vulnerable people with severe physical and mental health needs are warehoused and neglected.
A report released Wednesday by the Disability Law Center examining a neurobehavioral unit at Bear Mountain nursing home in Worcester illuminates in stark terms what allegedly happens when people with schizophrenia, dementia, and other ailments are left alone, with few programs and inadequate staffing. The Disability Law Center writes, speaking broadly about nursing home patients, “They become vulnerable to abuse and neglect because of inadequate staffing and clinical expertise, excessive use of medication, substandard conditions, and prolonged isolation.”
The report, while difficult to read, cries out for a response — from Bear Mountain and the state. Lawmakers and state administrators have responded to nursing homes’ financial needs by increasing reimbursement rates. But as the report points out, rates need to be paired with oversight to ensure the money is going to provide at least a minimal standard of care.
Advocates with the Disability Law Center, which has legal authority to monitor Massachusetts organizations serving people with disabilities, said they began scrutinizing Bear Mountain because of complaints about staffing. But the issues identified are emblematic of larger problems. “You have a for-profit long-term health care system taking people who are complicated and for whom nursing homes aren’t primarily prepared to be caring for,” said Nina Loewenstein, senior attorney for the Disability Law Center.
Arlene Germain, cofounder of Dignity Alliance Massachusetts, which advocates for nursing home reforms, said it is problematic that as more nursing homes establish behavioral health or other specialty units, regulations haven’t kept pace. While there are statewide standards and staffing rules for nursing homes in general, there are no state standards establishing the level of staffing and training required to run specific specialty units, like those focused on behavioral health.
Bear Mountain at Worcester, one in a chain of nursing homes, has about 140 residents, most with Medicaid insurance and complex behavioral needs. It has consistently been given the federal government’s lowest one-star ranking. The 82-page report, covering the period between October 2021 and October 2023, examines a neurobehavioral unit housing about 70 residents with cognitive disabilities, psychiatric disorders, and brain injuries. It found a litany of problems, mostly involving understaffing, neglect, and overuse of psychotropic medications.
The report found that the facility consistently had staffing ratios below federal recommendations and occasionally below Massachusetts’ minimum standards for nursing homes. Between 35 percent and 54 percent of nursing staff left each year. Residents’ family members said there were weekends when one certified nursing assistant was responsible for an entire 35-person floor and residents who needed help getting up were left in bed. The report said staff lacked sufficient training in behavioral health care.
A 2022 Department of Public Health inspection cited in the DLC report found residents who were dehydrated, had long nails and unbrushed teeth, and were not fully clothed. State inspectors discovered medication errors and staff who failed to properly handle feeding tubes and treat wounds. During the audit period, several residents were hospitalized for infections. Visitors from the Disability Law Center found undressed and ungroomed residents, dirty floors, and smells of urine. Resident activities were minimal, and outdoor space was scant.
The home had high rates of residents receiving psychotropic medication and a lack of robust medical oversight to manage medications, the report found. In several case files reviewed by the DLC, residents appeared to be overmedicated while denied therapy or programs.
Bear Mountain attorney Allison Lennon, in a written response to the Disability Law Center, said the nursing home vehemently denies the allegations, which it said “are not grounded in fact and, in many respects, are based on overgeneralizations and inferences gleaned from outdated data and reports unrelated to the Facility.” Lennon said Bear Mountain acquired the struggling nursing home just before the COVID-19 pandemic hit and improved its performance despite staffing challenges. She said the home provides specialized and trained staff; has medical oversight of medications; adequately cares for patients’ health needs; and started offering more programming.
While the burden is on Bear Mountain to improve care, the Department of Public Health must provide robust oversight. The report found that one DPH inspection of Bear Mountain was delayed six months due to staffing constraints at DPH and inspectors lacked clinical expertise. When issues were identified, they were not always addressed.
In a written response, Health and Human Services Secretary Kate Walsh said the agency is “engaged in a multi-year initiative across multiple agencies to improve quality of care in nursing facilities,” including improving screening when residents enter a home, ensuring residents have access to necessary services, and offering resources to help residents leave nursing homes. The agency is reworking MassHealth rates and conducting audits related to antipsychotic medication, Walsh wrote.
The DLC report advocates for statewide licensing requirements for behavioral health units to ensure units have enough trained staff to meet residents’ needs. It suggests conditioning higher Medicaid rates for complex patients on facilities demonstrating they have adequate treatment resources. (MassHealth officials reject this approach, arguing that giving extra money to any facility with complex patients preserves consumer choice and geographic access.)
The Massachusetts House in November passed a comprehensive bill aimed at improving nursing home quality. As the Senate deliberates, the Disability Law Center report provides a blueprint for additional changes that could be incorporated.
Bear Mountain is not the only one-star nursing home in Massachusetts. Residents deserve better.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.