Group faults Mass. nursing home dementia care

Says many homes in the state mislead public about extent of services

Nearly 60 percent of Massachusetts nursing homes that advertise dementia care appear to be skirting state rules designed to ensure they are not making false claims about their services and can appropriately treat their most vulnerable patients, according to a review by the Alzheimer’s Association of Massachusetts and New Hampshire.

The association’s findings are similar to a Globe review conducted in February and come as state regulators face increasing criticism for their oversight of the state’s nursing homes, which care for roughly 40,000 residents.

“People’s lives are at risk,” said James Wessler, president of the Alzheimer’s Association, which championed a 2012 dementia care law intended in part to prevent deceptive practices. “This is misinformation to the general public, and it’s one of the things we wanted to stop — having nursing homes claiming they have special care and not be in compliance with minimal standards of dementia care.”

Senator Patricia Jehlen, a Somerville Democrat who is chairwoman of the Legislature’s Joint Committee on Elder Affairs, said she was troubled by the findings and worried that the state Department of Public Health, which oversees nursing homes, may not have enough inspectors to monitor facilities.

“This is wrong,” said Jehlen, who was a cosponsor of the dementia care legislation. “Families need to know this was the intent of the law, that you could not do false claims and there would be some quality standard. People [in the Legislature] are very concerned.”

Officials at the state Department of Public Health said Tuesday that they have not seen the association’s review. They have previously said inspectors include a review of dementia services and advertising during their annual inspection of nursing homes but are not separately ensuring compliance.

The trade association for the state’s nursing homes said facilities are trying to do the right thing, with help from health officials, and believe they have not run afoul of the law.

The Alzheimer’s Association spent years lobbying for the law, which was designed to close a loophole that had allowed nursing homes to advertise dementia care services without specific training for their workers, specialized activities for residents, or safety measures to prevent residents from wandering.

It took the Department of Public Health nearly two more years to implement the law, which required all of the state’s 414 nursing homes to complete staff training in dementia care by last November. Training was required even at facilities that do not offer specialized dementia care, because more than half of nursing home residents are believed to have dementia.

Nursing homes that advertise dementia services face additional mandates that include the hiring of an activities director dedicated to the dementia unit to ensure meaningful activities for residents, an expanded common space room, and a fenced-in outdoor area.

Eighty-three nursing homes have provided documentation to the state that they completed requirements for offering dementia services.

The Alzheimer’s Association then reviewed advertising from about 320 other nursing homes and found that 114 advertised or suggested they provide care to people with dementia, Alzheimer’s, or other cognitive impairments but had not shown that they have complied with the dementia regulations.

A spokeswoman for the state’s nursing home trade association said regulators assured them that facilities were allowed to advertise dementia care — without completing the extra requirements — as long as they don’t say they offer special dementia care units.

“Facilities are trying to do the right thing and I think most have done the right thing, to our knowledge,” said Helen Magliozzi, director of regulatory affairs at the Massachusetts Senior Care Association.

Genesis HealthCare, the nation’s largest nursing home company, owns 34 Massachusetts facilities and appears to be side-stepping the law with 18 of them, according to the Alzheimer’s Association review. Websites for those 18 list dementia care services but then note they do not have a dementia specialty care unit as defined by state law.

Genesis said in a statement that it worked closely with the state health department to “ensure that our language was clear and met all state regulations” and that it added the disclaimer at regulators’ suggestion, with exact language provided by the department.

The company said it operates 10 specialized Alzheimer’s care programs in Massachusetts nursing homes and it added the disclaimer for “all others that have the capability to care for those with dementia.”

The health department disagreed with Genesis’ assessment.

“A nursing home that advertises itself as providing dementia care would be in violation of the nursing home licensure regulations if it has not met the dementia special care unit requirements, including the filing of a disclosure statement with the department, even with a disclaimer statement that it does not have a specialized dementia care unit,” the department said in a statement.

The department is facing an increasing number of complaints from elder advocates who say it is stalling on several fronts and failing to ensure the safety of frail elders. Recent Globe stories highlighted complaints about the state’s oversight of Synergy Health Centers, a rapidly expanding company that bought 11 nursing homes since December 2012.

A law passed last summer requires the department to establish a public hearing process before nursing homes are sold or closed, yet officials have not put that into effect. The department is still working on rules to implement the law.

Synergy acquired four of its Massachusetts nursing homes since that law was passed.

“In each of these instances, we are running into major roadblocks at [the department] and it’s unacceptable,” Wessler said. “We’re willing to be partners, but we have to have someone to be partners with.”