One of Anchorage’s largest nursing home and rehabilitation facilities was fined over $300,000 this year for what federal investigators described as serious deficiencies including extended isolation and numerous residents with chronic bed sores.
The approximately 90-bed Providence Extended Care facility is located off Boniface Parkway about 4 miles from Providence Alaska Medical Center, the state’s largest hospital. Providence describes the center as providing a home environment for patients who need long-term nursing or rehab services.
The Centers for Medicare and Medicaid Services levied the $310,369 fine earlier this year after investigators discovered problems at levels higher than were reported at other similar facilities in Alaska last year.
Providence officials say the federal findings, which have since been rectified, occurred in the wake of the state’s worst COVID-19 wave, which overwhelmed Alaska’s health care system and prompted staff shortages as well as sometimes extreme measures to protect these at-risk patients from the virus.
In a report from December 2021, surveyors with the Centers for Medicare and Medicaid noted instances of patients who did not leave their rooms for months or even, in the case of one patient, two years.
They also found advanced bed sores involving wounds that had festered long enough to develop dead tissue, a situation generally considered an immediate health risk, among nearly a quarter of all residents at the time — well above the national average for similar facilities.
One of the many violations, involving residents quarantined to their rooms when federal COVID-19 guidelines didn’t require such a drastic step, was serious enough that it “placed the residents residing in the facility at risk for loss of independence, self-esteem, and quality of life,” the surveyors wrote.
Providence Extended Care has since paid the fine, passed a reinspection that occurred a few months later, and is now in good standing with the Centers for Medicare and Medicaid, an agency spokesperson said recently.
The pandemic’s role
Providence hospital officials say the investigation, which took place in December after the height of Alaska’s COVID-19 delta wave, illuminated the consequences of a severe staff shortage brought on by the pandemic and the burden that nursing homes like Providence’s were forced to undertake when hospitals needed a place for patients to go to free up beds for coronavirus patients.
At the time of the site visit, Providence Extended Care and other skilled nursing homes in the state were serving as overflow for the main hospitals, an unusual role that added new patient loads to the already-understaffed facility.
In a statement to the Daily News, facility leadership described the actions that had been taken in response to the survey, which included closing one of the cottages and discharging residents to other skilled nursing facilities in order to free up staff, forming a work group to respond to the bed sores and reeducating staff on quality assurance measures.
“We take all citations very seriously and quickly corrected deficiencies,” according to an emailed statement from Providence leadership.
[Federal inspectors fault assaults, escapes, improper isolation at North Star youth psychiatric hospital]
All facilities that receive Medicare and Medicaid funding are required to pass regular inspections from federal and state surveyors who arrive periodically and without warning to check on quality of care.
Jared Kosin, president of the Alaska Hospital and Healthcare Association, said in an interview that it is normal for those inspections to unearth dozens of minor and sometimes insignificant problems that need to be addressed.
According to a database managed by ProPublica, in 2021, five nursing homes in Alaska out of 20 that qualify for that funding were faulted for one or two serious deficiencies. Providence Extended Care was cited for five.
‘Nothing to get up for’
The report described multiple instances of patients confined to their rooms for long periods of time.
Providence says that at the time, it was following federal rules and regulations meant to prevent highly vulnerable residents from contracting COVID-19.
But the surveyors appeared to find instances where those precautions may have been taken too far.
One resident, in a late December interview with investigators, said they no longer got out of bed and hadn’t left their bed in two years. Another resident told investigators the last time they’d been out of bed was to be taken to the hospital — nearly two months earlier.
A third resident told investigators that “there was nothing to do, nothing to get up for,” according to the report.
Others described being unable to visit friends in other parts of the facility, exercise, or sit in the dining room and look out the window. They complained about limited activities and few opportunities for socializing or mental stimulation.
“We are doing Zoom bingo at the moment, that is the only group activity,” one resident told investigators.
Spending so much time in bed also contributed to one the more serious findings in the report concerning “pressure ulcers,” also known as bed sores.
Bed sores are skin injuries caused by persistent pressure, and typically show up on people confined to bed or who sit in a chair or wheelchair for long periods of time.
At the time of the report, roughly a quarter of all residents at Providence Extended Care had advanced or “unstageable” pressure ulcers, a serious condition in which the base of the wound is covered by dead tissue.
Surveyors noted the facility “failed to ensure that residents received the necessary care and services to prevent the development of new pressure ulcers” in one in seven surveyed residents.
The center’s failure to stop the progress of sores resulted in “physical harm to residents who developed deep tissue injuries” with two developing medical complications, the report said.
Providence said the increase in ulcers was an “unintended consequence of adhering to the CDC’s COVID-19 guidelines directing residents to remain in their rooms as much as possible to limit possible COVID-19 exposure and spread,” according to the statement from leadership.
“In the absence of group activities and being able to move freely through the facility, residents spent more time in bed than usual and experienced this negative outcome,” the statement said.
‘There are trade-offs’
Currently, Providence Extended Care is caring for 94 residents, 10 of whom are being treated for pressure ulcers, according to Mikal Canfield, a spokesman for Providence.
That level is well below what it was in late 2021, and close to the national average in nursing homes, which was around 11%, according to a 2009 federal Centers for Disease Control and Prevention report.
Asked what the extended care facility could have done differently, Providence Alaska’s chief medical officer, Dr. Michael Bernstein, said facility administrators could have considered offering increased incentive wages to hire more staff as travel nurse demand skyrocketed and health care job resignations hit all-time highs.
[Alaska’s hospitals are relying on Lower 48 nurses to fill empty positions. It’s a costly strategy.]
Ultimately, though, Bernstein said most of the precautions taken to protect residents from getting COVID-19 were necessary, despite some of the negative outcomes identified in the report.
“I don’t think we, even in retrospect, would have done that differently, because although some people may have dealt with pressure injuries, that’s better than dying from COVID,” he said. “There are trade-offs in those decisions.”