When It Comes to Nursing Home Safety, Governor Fix-It Has Been Down in the Basement

A series of articles by Kay Lazar in the Globe has brought us the unsavory story of Synergy Health Centers, a New Jersey company that arrived in Massachusetts three years ago and now operates 11 nursing homes here. The Globe details the dangerously substandard care  that Synergy is providing to the residents of these nursing homes (medication errors, insufficient training, short staffing, a scabies outbreak, the death of a patient who was dropped while being transferred by mechanical lift to a wheelchair). Meanwhile, Synergy’s officers are making seven-figure salaries.

The Synergy stories also reveal the laxity of our nursing home licensing process. The health department’s investigation of Synergy failed to uncover, to take just one example, the arrest of one of Synergy’s owners for 1400 code violations and unpaid fines in a New Jersey apartment complex he once owned.

Nursing home safety in general and Synergy’s track record in particular came to the Legislature’s attention a while back, and it responded by directing the health department to establish regulations to ensure that a hearing with opportunity for public comment be conducted before any nursing home could be closed or sold.

And thereby hangs a tale of wrangling between the Legislature and the Baker administration, BFF’s on most issues, over the latter’s reluctance to exercise its regulatory power.

To be fair to Governor Baker, the Legislature’s directive to the health department to provide for public hearings happened in mid-2014, and the Patrick administration failed to act on it during its last six months.  But after Governor Baker took office in 2015, the foot-dragging continued. One of the Governor’s first initiatives was a “regulatory pause” — a  prohibition on any new agency regulations in order to start relieving the Commonwealth’s “job creators” (his term) from excessively burdensome oversight. The regulatory pause soon lengthened into a regulatory moratorium by way of an Executive Order requiring agencies to take a year to review every regulation and to discard those that “unduly and adversely affect Massachusetts citizens and customers of the Commonwealth.” Government regulations, the Governor often says (during his most Pioneer-and Cato-Institute moments), are like the junk that accumulates in your basement and which, in the interests of good housekeeping, you need to clean out every so often.

By May 2015, five months into Baker’s term, there were still no nursing home licensing regulations and no timetable for their arrival. To be sure, the press of other business — like the opioid crisis — was keeping the health department busy. And the ranks of health department staff were about to be thinned through the early retirement incentive program that the Governor and Legislature had agreed on as a cost-savings move. Yet even taking those problems into account, it was difficult to avoid the conclusion that protecting Synergy Health Centers from meddlesome governmental regulators was more important to the Baker administration than protecting elderly and disabled nursing home residents from Synergy Health Centers. Governor Fix-It may have been attending to a lot of problems, but on the issue of nursing home safety, it might be said, he was downstairs cleaning out the basement.

Therefore, frustrated by the lack of progress on nursing home licensing and concerned that the Governor’s blinkered view of regulations extended beyond just the issue of nursing home licensing, the Legislature decided to require agencies to maintain a log of the statutes passed in the previous 24 months for which regulations were required and for which regulations had not yet been adopted. Also, agencies were directed to make this information available on their websites.

The Governor’s response to this mandate?  Veto — on the ground that the requirement would unnecessarily burden state agencies. Yet at the same time, as the Globe noted, the Governor’s health department was unable to find any reason to deny Synergy another nursing home license, its 11th, even after many more reports of reports had become public that a Synergy-owned nursing home mistakenly put ear drops into a patient’s eye and then did not call a doctor until the patient had suffered for five hours.

And the Legislature’s response to the Governor’s veto?  Override — along strict party lines.

So where are we now?

There are no signs yet that agencies are complying with the requirement to post the regulations they’ve been directed to adopt, even though that’s been the law for several months now.

In January the health department finally produced the long-sought nursing home licensing regulations, 18 months after the Legislature requested them. The department also acknowledges having received more than 11,000 complaints related to nursing homes during the past year alone. It’s planning to launch a program of surprise inspections to curb abuses at problem facilities. The Governor has proposed hiring two more nursing home inspectors for this effort.  (There are 414 nursing homes in Massachusetts.)

The regulatory review and basement-purging that the Governor ordered a year ago is due at the end of March. For the sake of nursing home residents, one hopes that agency staff will then be free to attend to other matters and that the moratorium on new regulations will be lifted when it’s appropriate to do so.

 

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