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Bethany Nursing and Rehabilitation Center, in Lakewood, is one of 88 nursing homes nationwide designated by federal regulators as a "special focus facility," meaning it receives extra inspections. Photographed on June 26, 2019. (John Ingold, The Colorado Sun)

In Longmont, a nursing home staffer was arrested and criminally charged with assaulting a resident. In Aurora, a nursing home didn’t tell state regulators about two instances where its workers were convicted of sex crimes.

In Rocky Ford, federal workplace-safety inspectors fined a nursing home for not protecting staff from violence at the facility. And in Pueblo, a jury delivered a $5.5 million verdict against a nursing home after a resident at the home died following abuse and neglect.

“We had a jury that really didn’t like this company putting profits ahead of patient care,” the lawyer who won the verdict said shortly afterward.

All of these are examples from recent years of when Colorado nursing homes failed in their most basic duty: protecting the vulnerable people for whom they are entrusted to care. But, when the federal government this month released a list of the state’s most troubled nursing homes, none of these facilities were on it. The list, from a federal initiative called the Special Focus Facility program, is designed only to sort out which nursing homes need more attention from regulators.

While it added new details about how the federal government scrutinizes nursing homes, it also raised more questions about an already complex system of overlapping federal and state regulations  — one that can leave families bewildered when searching for the best place for their loved one.

So what can a family do?

“The best thing anyone can do is go visit, meet people, do your own due diligence,” said Anne Meier, the state’s long-term-care ombudsman, who acts as an advocate for nursing home residents and their families.

Here is an explanation of the list, the regulations and the resources available to families when choosing a nursing home.

The list

The Special Focus Facility, or SFF, program designates 88 nursing homes across the country that are labeled as “participants” in the SFF program and are considered most in need of improvement. SFF participants get inspected more frequently.

The names of the SFF participants have long been made public. In Colorado, there is one nursing home designated as a “participant” in the SFF program: Bethany Nursing and Rehabilitation Center in Lakewood.

When state inspectors went to Bethany Nursing and Rehabilitation Center in 2017, they documented an instance of staffers failing to protect two residents from sexual harassment and failing to thoroughly investigate allegations of abuse. Bethany has been an SFF participant for nearly a year, and this month federal regulators included it in a group of facilities they said had not improved while in the program.

The federal government also designates around 400 candidates for the SFF program — sort of an on-deck circle to the main program. Candidates are selected based on an analysis of the nursing home’s three prior inspections.

While on the candidate list, nursing homes aren’t inspected any more frequently than other homes or required to adhere to any additional regulations. But when a nursing home moves off the SFF participant list, the federal government can bump up one of the candidates, after consulting with state authorities.

Colorado has four nursing homes on the candidate list: Monaco Parkway Health and Rehabilitation Center in Denver; Alpine Living Center in Thornton; Aspen Living Center in Colorado Springs; and Pearl Street Health and Rehabilitation Center in Englewood. All are owned by the same company: SavaSeniorCare.

The list of SFF candidates had never been made public until this month, when the two U.S. senators from Pennsylvania released it in a report on poor care in the country’s nursing homes. The list has received a lot of attention, nationally and locally, as a quick way to identify the most-troubled nursing homes — with some merit.

But, in other ways, the SFF lists don’t capture the full scope of problems at nursing homes or necessarily identify the worst offenders in Colorado.

For instance, there are 27 nursing homes in Colorado with one-star quality ratings from Medicare, the lowest rating. None is on the SFF list. All of the nursing homes in Colorado on the SFF candidates list have two-star Medicare ratings.

Alpine Living Center is the most-fined nursing home in Colorado, according to Medicare data compiled by the investigative-journalism organization ProPublica. But none of the next four nursing homes with the most fines is on the SFF list. 

Monaco Parkway Health and Rehabilitation Center has been hit with more serious violations than any other in the state, but rankings of nursing homes with the most total violations and the most serious violations also show that facilities in the SFF program don’t always stand out from the crowd.

The SFF list also doesn’t capture ways that the nursing homes on the list may have improved since being added. Shannon Gimbel, the ombudsman program manager for the Denver Regional Council of Governments, said SavaSeniorCare has worked to make its facilities better in recent months.

“This list is a tool, the five-star rating on the (Medicare) site is a tool,” she said. “But it’s not the only thing you should look at.”

State and federal regulation

The state and federal governments play a role in regulating nursing homes — sometimes in overlapping ways. In Colorado, for instance, state inspectors conduct the investigations that federal authorities use to determine discipline. And Colorado officials can also impose their own discipline.

The worst-case scenario for a nursing home is that state or federal regulators could revoke its license. But that rarely happens.

Peter Myers, a manager in the section of the state Health Department that oversees health facilities, said he’s not aware of any nursing home that has had its license revoked in Colorado for at least the past six years. The state can also take less severe — but still strict — action, such as issuing only a conditional license or mandating that a nursing home bring in a consultant or follow a specific plan for improvement.

In addition to imposing fines, federal officials can deny Medicare payments to facilities for new admissions.

Resources for families

Information about disciplinary actions against a nursing home is posted online, but finding it can be tricky.

There are three main places to look:

  • To find information about discipline from the state government, look up the nursing home by name at www.healthfacilities.info. Once on the nursing home’s page, click on all the various inspection reports to read more about what state inspectors found — and what the nursing home did about it. The state doesn’t tally up its findings in any central place, so this can be time-consuming, but it also provides more information about what is going on inside a nursing home than anywhere else.
  • Information on federal discipline can be found on Medicare’s Nursing Home Compare site, where users can search by location and name. The site is simple to navigate but doesn’t provide the same level of detail as the state site.
  • For a quick overview, head to ProPublica’s Nursing Home Inspect site, where it is easy to see how nursing homes rank for number of federal violations and fines. Click on Colorado in the maps at the top of the page to narrow the results to just Colorado nursing homes.

Colorado also has an extensive ombudsman program to help families find the right nursing home and to advocate for residents once they are there.

“We are sort of like your next best friend,” Meier said. “If I do my job well, we are sort of like your brother, sister or friend who helps you with your concerns.”

Last fiscal year, ombudsmen across the state conducted more than 3,700 complaint investigations and gave out advice in more than 10,000 individual or family consultations. The most common complaint is when residents feel they are being discharged from the nursing home too soon.

“A lot of what we do is just trying to keep people where they’re at,” Gimbel said.

In those situations — as with other complaints about quality of care — the ombudsmen will act as advocates for residents. They also are required to make regular visits to nursing homes and assisted-living facilities to be available for residents to share concerns.

Otherwise, connecting with a local ombudsman requires contacting your local Area Agency on Aging, where the ombudsmen are based.

Gimbel said that’s a call that can come even as families are deciding which nursing home or assisted-living facility is right for their loved one. Ombudsmen will help families make sense of all the disciplinary documents and answer questions about different facilities as best they can.

“If we can get you to the right place beforehand, that’s the goal,” Gimbel said. “And hopefully you won’t have to call us when you’re there.”

John Ingold

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage. Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior...